Taking Charge of Your Healthcare

In the old days, you might visit the same doctor your whole life. Most likely, you had complete trust in his or her judgment, from diagnosing your symptoms to recommending medicines or treatments. You'd get friendly phone calls to follow-up on your progress or schedule routine checkups. And you'd know your local pharmacists by name.

These days, it's a whole new world. We move around more, jobs are less stable, and our health insurance may change year to year, along with our providers. At times, the health-care system may seem confusing, intimidating, even frustrating. But if you learn more about the system and play an active role, you can make it work better for you.

Be your own advocate

You may still get that friendly phone call from your doctor scheduling your annual tests and vaccinations, but even if you do, it's best to know what you need. One of the best things you can do is to find what tests and immunizations, if any, that you need each year. Ask your doctor for advice, and find out what's covered by your health plan. For example, many preventive services are completely covered under the Affordable Care Act, which is still in effect as of April 2017. Read your insurance provider's handbook carefully and schedule those appointments.

In addition, it's good to remember that immunizations you had as a child may not continue to protect you as an adult. Fortunately, you can find out which vaccines you need on a government Web site, the Centers for Disease Control and Prevention.

Keep current with your dental visits and tooth cleanings, too -- fixing a crack in a filling or a small cavity may save you from a dental abscess, root canal, or expensive crown or implant later on. If you don't have dental insurance or funds set aside for dental visits, ask your dentist about a payment plan or credit card payments. You can also visit a dental school for free or low-cost services. Brushing at least twice a day and flossing daily will also help keep your teeth in good shape.

It's also good to call and confirm your appointment, especially if there's been any change in plans. Patients arriving for chemotherapy after rescheduling, for example, have sometimes reported that the right medicine isn't available -- something that forces them to return the next day for treatment. Calling ahead helps to avoid those problems.

Find a plan that works for you

If you're lucky enough to have a choice of health insurance companies, it's critical to do some homework before picking one. Ask the plan's customer service office whether it has a "report card" that shows how well it takes care of patients. Some report cards are based on patient ratings, and some are based on how well the plan follows basic guidelines for health care. Important issues to pay attention to include what your plan will cover in case of an unforeseen life-threatening event, and what preventive services are covered. In some cases, health plans require your primary care provider to authorize an emergency care visit -- something another family member will need to do if you're unconscious. In addition, some plans are much better than others at covering basic preventive care.

When you've decided on a company, always check if your current doctors are in your particular plan's network. Not all health plans offered by the same company will have the same networks. In general, PPO plans tend to be the least restrictive about seeing specialists without a referral, but they usually cost more.

To find free "report cards" on any health care plans reviewed by the National Committee for Quality Assurance, go to http://www.ncqa.org. Many states have their own reports available as well; check your official state Web site to find out more.

Now find a good doctor

If you don't already have a doctor you like -- or in your plan's network -- then you have some legwork to do. You can't look up "good doctor" in the phone book, but you can ask family and friends about their experiences. If someone says a particular doctor is a good listener who takes concerns seriously, your search may have just become much easier. You can also look up profiles of physicians and hospitals at the HealthGrades Web site at http://www.healthgrades.com and http://www.bestdoctors.com. Some plans will let you work with them to add doctors to their network.

Once you've found a doctor who seems like a good fit, schedule a new patient visit and use it as an audition. All doctors know a lot about medicine, but they don't all know how to communicate with all patients. Let your doctor know you want to work as a team to improve your health, and ask some questions about your health, medicines, or treatments. If your doctor doesn't seem happy to answer your questions, or doesn't explain things to you clearly and thoroughly, it's probably time to audition someone else. If you need a specialist, follow the same steps. Also, ask your doctor who he or she would see or entrust with the care of his spouse or children.

No question is too embarrassing

Questions are the key to good communication. Don't ever be embarrassed or intimidated. Remember that your doctor is working for you, and has probably seen your problem before, no matter how strange it may seem to you.

Before every appointment, or before a new test or procedure, write down your questions. Keep in mind, the length of each visit may be limited. You can ask questions more effectively if you do a little homework ahead of time. That way, you can begin with your most important questions.

If your doctor suggests a particular medicine, write down the name and ask how it works. Ask why he or she recommends that particular drug, as well as the potential side effects and what you can do to minimize those problems. (Also, ask what side effects you should report right away.) Find out what would happen if you don't take the medicine at all. Also, ask what diet and lifestyle changes you could make to improve your health -- your doctor will probably be glad to write you an "exercise prescription."

If your appointment is almost over and you still have questions, ask your doctor for a follow-up appointment or a referral to another helpful care provider.For example, doctors often refer people with diabetes to diabetes educators or group classes. He or she may also have handouts that you can take home with you.

You can also do some follow-up research on your own on the Internet or at libraries. Just be aware that not all sources are reliable. Large nonprofit agencies such as the American Heart Association or American Cancer Society have excellent information. You can usually trust information from government agencies such as the National Institutes of Health (NIH) or the Centers for Disease Control and Prevention (CDC). Your doctor can give you other sources to help you make informed decisions.

Get a second opinion

If your doctor diagnoses a serious illness or recommends major surgery, you'll want to ask for something else: a second opinion. You may also want a second opinion if you feel that something is wrong and your doctor isn't taking your concerns or symptoms seriously.

Don't worry that asking for a second opinion will hurt your doctor's feelings or signal distrust or disrespect. You need to get all of the information you can before starting a potentially life-changing course of treatment. Most doctors actively seek out advice from other doctors whenever they have a complicated case.

Your insurance company can also help you locate a specialist for a second opinion, and in some cases may not even pay for certain treatments unless you've had your diagnosis confirmed by a second doctor. You can also ask a local hospital or medical society for recommendations.

It's not enough to talk to this specialist over the phone or by email. The doctor needs to see you in person. Ask your doctor to send all of your x-rays and medical records to the second doctor. You may need a sign a waiver for the office to release that information, and you may also need to carry the x-rays by hand.

Often, the second (or third) opinion will look much like the first, but the second doctor may have a different approach to your illness. If you've been diagnosed with cancer, for instance, one doctor may recommend surgery while the other may suggest "watchful waiting." As a patient, it can be hard to know which advice to take, especially if both of the doctors are highly qualified. You'll have to ask about the benefits and risks of each approach. Ask, too, about how each approach would affect your quality of life. Ultimately, the decision is up to you. After all, you know yourself the best, and you know what changes and treatments you can tolerate.

Of course, in some cases you may have a serious condition and not a lot of time to make important decisions, like choosing among different types of chemotherapy, for example. So if time is short, seek out these opinions aggressively. Some doctors report that they have seen urgent health needs go untreated as patients spend too much time exploring all the options.

Some second opinions contain surprising news. You may even discover that pathologists can disagree about a diagnosis, and sometimes a repeat biopsy or a third opinion may be necessary. Experts at Johns Hopkins University recently took a second look at 684 biopsies (tissue samples) to check for prostate cancer. According to their second opinion, 4 percent of patients who had been told they had cancer were actually free of the disease. On the other hand, the experts diagnosed cancer in more than 14 percent of patients who were told they didn't have the disease.

Coordinate your care

If you have a complex illness, you'll need more than just one doctor. You'll need a whole team. If you have diabetes, for example, you may need to see a diabetes educator and a nutritionist along with regular visits to your primary care doctor. You'll also need a yearly foot exam by a podiatrist and an eye exam. If you have breast cancer, you may have a surgeon, a radiation oncologist (cancer specialist), and a medical oncologist, in addition to a primary care doctor.

As your team grows larger, so does the need for communication. Your team members must work together to avoid mistakes like ordering the same tests twice or prescribing medicines that clash with something you already take. Make sure your primary care doctor knows about every other doctor you see, and remind him or her to share your medical records with everyone on your team. One tip from a family doctor: Get in the habit of collecting your doctors' business cards and distributing them to every member of your health-care team so they all know how to reach each other. Also, ask them to "cc" all team members on every consultation report.

You can help keep everyone on the same page by bringing an up-to-date list of your medicines -- including over-the-counter drugs and supplements -- to every appointment. You should also be able to give every doctor a short-but-clear summary of your condition and your treatments. It will be easier to keep things straight if you write down the information before your appointment. If you suspect that communication is breaking down -- perhaps because a doctor orders a test that you just had last week -- be sure to speak up.

Keep a health record

Keeping track of your health care is an important but challenging task. To understand what's really going on, you'll want to get personal copies of your medical records. Your doctor may be able to put together a summary of your records, if you prefer. (Ask in advance if there's a charge.) Besides keeping the original file, put all the important information in a computer or a notebook and update it every time you get a new prescription, have a test, or receive a new prescription. When you go in for a test, ask for a personal copy of the results and share the information with all of your doctors.

It's also a good idea to keep an updated copy of a Personal Medication Inventory so that you and your team members know the details of all the drugs you are taking. A wallet-sized version can be very helpful in case of an emergency.

All this responsibility might make you long for the good old days when you never changed doctors.On the other hand, health outcomes are -- in many cases -- a lot better than they were in the "good old days," and doctors usually respond very positively to patients who are interested in sharing responsibility and creating good communication. Like it or not, we live in a complex world, and as things get more complex, it's easier to make an error. If you're on your toes and well-informed, and act as a hub for communications, you're more likely to get better medical care and prevent costly mistakes. And that is definitely worth it.

References

Agency for Healthcare Quality and Research. Guide to health care quality: How to know it when you see it.

National Institutes of Health. Talking with your primary care doctor: A guide for persons with OI.

American Academy of Family Physicians. Tips for talking with your doctor.

Chan TY and JI Epstein. Patient and urologist driven second opinion of prostate needle biopsies. Journal of Urology 174: 1390-1394.

Yale New Haven Hospital. Getting a good second opinion.

Department of Health and Human Services. Tools to help you build a healthier life: How to get a second opinion.

Insure Kids Now, Centers for Medicare and Medicaid Services

Your Personal Health Information: A Guided Tour, Why should I keep a Personal Health Record? American Health Information Management Association.

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