Navigating the healthcare system in the U.S. is often confusing and disheartening, but it doesn’t have to be. In his new book, The Patient’s Playbook, Leslie D. Michelson, the CEO of Private Health Management, offers tips for how get the most out of medical care and how to make the system better work for you from the ground up.
Develop a strong bond with your primary care physician. How is your current relationship with your internist? Do you trust and respect her and feel comfortable telling her secrets that affect your health? Is he someone who, if you were experiencing a variety of symptoms, would stay engaged until the two of you could wrap a diagnosis around the problem and determine the best treatment plan? When you develop this relationship, you’re forging a bond with someone who will be invested in your wellbeing for the long haul—and who will be dogged about getting you in for the preventative exams that are right for you. If you don’t have a primary care physician, you are driving without a seatbelt.
Take emergency inventory. Make lists for yourself and your family members with the following: 1. Diagnoses and any major surgeries ; 2. Allergies; 3. All drugs and supplements you’re taking; 4. A roster of your physicians ; 5. An emergency contact person. Keep this information in your wallet or purse—which is the first place an emergency response team will look in the case of an unconscious patient.
Measure twice, cut once. This is a basic rule of carpentry, where the only thing at stake is a piece of wood. Shouldn’t it apply to your care? Diagnostic error contributes to the death or disability of 80,000 to 160,000 Americans each year, according to a 2013 Johns Hopkins study. Before agreeing to surgery and other treatments, have your pathology, labs or scans re-read by independent pathologists or radiologists to be sure you have a correct diagnosis. Then consult with an expert in your condition—for example, not a general neurologist, but a multiple sclerosis specialist—to at least hear a different take on your disease and treatment options. Expertscape.com is an excellent online tool for finding doctors devoted to your problem. The major philanthropic disease organizations can also provide guidance and resources.
Recruit a healthcare quarterback. Medicine is the only team-performed function in which there is no leader. You could have a brilliant internist, an accomplished oncologist, and other top-flight physicians—but nobody is ensuring that your caregivers are moving in a coordinated way toward the same goal. If you woke up tomorrow to learn you had a potentially fatal disease, who’s the person you most trust to be at your side during doctor visits, taking notes and asking questions you might not be thinking of? Who could help you find the right specialists and do research on the latest drugs and clinical trials that could be helpful to you? Think about the people you could reliably turn to for help, and ask one or more of them to be your healthcare quarterback. People always say, “How can I ask anyone to do that? I’m uncomfortable with the idea of dragging my cousin to my appointments.” But you probably have asked a friend or family member to serve as the guardian of your children should that become necessary. Letting someone help you to navigate the healthcare system is a similar bestowing of trust.
For significant problems, go to significant medical institutions. Community hospitals are terrific institutions that can do great things, but for complex issues and procedures—pancreatic, esophageal, neurosurgery, lung surgery, big cancer operations, endocrine surgery or cardiac operations, for example—you want to be cared for at a major institution that does high volumes of similar cases. And here’s a little-known quirk of our system: In medicine, it frequently doesn’t cost any extra to get better quality care. Most Americans live within 100 miles of a major metropolitan city. Almost every large city has an academic medical center or distinguished hospital that is in-network, with specialists and surgeons who take Medicare and most kinds of insurance. We know that unfortunately there is wide variation in pricing for the same procedures at different health venues, but there is no connection between that variation and the quality of care that you are receiving. Unlike clothing, airlines or hotels, a higher cost doesn’t necessarily mean a higher quality in medicine. Many people may find it difficult to travel for care. But if you’re facing a serious disease or need technically demanding procedures, consider going to the closest large hospital, which is more likely to have the experience and expertise necessary to get you the best outcome.
