Table of Contents
Chapter 1: Health Plans: The Choice is Yours
Chapter 2: The Family Doctor: Your Partner in Good Health
Chapter 3: Alternative and Complementary Medicine: Remedy or Ruse?
Chapter 4: The American Hospital: A Brief History
Chapter 5: Hospitals: Check ’em Out Before Checking In
Chapter 6: The Emergency Room: Real Life Drama
Chapter 7: Social Services: The Hospital’s Hidden Treasure
Chapter 8: The Maternity Unit: Where Babies Come From
Chapter 9: The Oncology Unit: Battling the Big “C”
Chapter 10: The Cardiology Unit: Have a Heart
Chapter 11: The Pulmonary Unit: Breathing Lessons
Chapter 12: The Neurology Unit: Brain Central
Chapter 13: The Intensive Care Unit: A Hospital’s SWAT Team
Chapter 14: Rehabilitation: On the Road Again . . .
Appendix A: The Patient’s Bill of Rights
Appendix B: Patient Rights, Part II
Appendix C: Patient Responsibilities
Appendix D: Top 100 Hospitals in the U.S.
Appendix E: State Insurance Regulators
Glossary of Terms
Mark Cromer’s Biography
Mark Cromer is a journalist living in his native Southern California. He has written for an array of newspapers and magazines including Los Angeles Times, L.A. Weekly, The Tribune, London Daily Sport, Details, New Mobility, Rehab Management and others. He also works as a media consultant for Casa Colina Centers for Rehabilitation, one of the top medical rehabilitation facilities in the nation.
Mr. Cromer was inspired to write Health Care Handbook—A Consumer’s Guide to the American Health Care System after witnessing hundreds of patients endure lengthy and costly hospital stays which could have been avoided had the patients been more knowledgeable and proactive in their own health care. As Mr. Cromer states in his introduction to the book, “My tenure at Casa Colina has raised my consciousness about health care several levels, completely reinforcing the idea that as consumers we not only have rights but, perhaps more importantly, we have responsibilities. And that the more we fulfill our responsibilities as patients, the more likely we will be able to understand and enjoy our rights as health care consumers.
“Indeed, there are few places where the old adage of ‘Knowledge is Power’ is more true than in the world of health care. It is my hope that Health Care Handbook will give you the knowledge and the power to obtain the best health care the American system has to offer.”
Excerpt–Talking with Your Doctor
As health care has become increasingly consumer-driven, significant strides have been made throughout the profession to better communicate with consumers. Yet much remains to be done. As an example of the communication hurdles that still exist between patients and their physicians, social workers at major hospitals will often tag along with a doctor when the diagnosis of a chronic or terminal condition is being discussed with the patient–not just to soften the blow but to literally interpret for the patient what the doctor is saying.
Association’s Patient Bill of Rights states that a patient “. . . has the right and is encouraged to obtain from physicians and other direct caregivers relevant, current and understandable information concerning diagnosis, treatment and prognosis.”
Many doctors and health care workers will take the time to make sure that a patient understands what they are being told about their condition. They will ask a patient if they have any questions, or will pose a question out loud and then answer it, letting the patient know it’s okay to ask.
Then again, not all doctors will go the extra mile in communicating with a patient, which is why it’s critical for patients to be prepared and initiate conversation with their physician.
Doctors Want You to Talk with Them
Let’s face it, the doctor is one of the ultimate authority figures in our society. Few people command as much respect as a doctor, save perhaps a priest. And like a priest, the doctor has long been seen as a father-figure, beyond question and above reproach. This perception has evolved over hundreds of years, and its presence is still widespread today. Even a heady consumer-driven market isn’t enough to overcome our fears of daring to open our mouths in the examination room . . . unless the doctor is holding a tongue depressor and asking us to “Say ahhhhh.”
But the good news, believe it or not, is that doctors want you to talk with them. A patient who is prepared to ask questions and share information is a good patient. When done properly, this doesn’t offend a good doctor, but actually helps him.
Remember, one of the few things doctors don’t learn in med school is mind reading. They are doctors, not psychics. Though doctors can run battery after battery of tests on you, as useful as that information is, it’s no substitute for letting them know exactly what’s bothering you: where it hurts, how much it hurts and how often it hurts. At the same time, a doctor’s diagnosis that is laden with complex medical terminology does little to ease your fears about what’s wrong and what’s happening with your body.
So when you are waiting for your doctor in the examination room, use those few extra quiet moments to collect your thoughts (instead of browsing through the office copy of Field & Stream or Cosmo), and make a mental list of things you’d like to know. Focus on what you are concerned about, and visualize yourself asking the doctor these questions.
Chances are that you’ve known your doctor for awhile and may already have a more casual, conversational relationship with him. But if not, there’s no time like the present to start one.
Think Like a Boy Scout: Be Prepared
Surprisingly, many people find themselves in an examination room answering their doctor’s questions with a lot of vague replies like “I’m not sure,” “Every so often,” “A little bit,” “Sort of” and more. Can you imagine if your doctor responded to your questions in the same manner?
“Hey doc, is it serious?”
“Well, sort of.”
“Will I be able to go back to work?”
“I’m not sure.”
“How long will I have to endure this pain?”
Get the picture? It’s important that you are reasonably prepared by the time you sit down in that examination room. Don’t hesitate to take notes at home and bring them with you to the doctor’s office. The doctor won’t mind-again, specific information is going to assist him in helping you. A doctor’s office can be slightly intimidating, plus you’re obviously not feeling well when you are there, so having it down on paper right in front of you will help ensure that you won’t forget to tell him everything you want to say.
Specifically, you’ll want to write down as much information as possible about your symptoms. What’s bothering you? How is it bothering you? Sharp pains, dull aches, burning sensations? What time do they strike? How often? Where? Are you taking medication now? What type of medication? What are you taking it for? Are you taking it as prescribed? If not, why not?
These may seem like common sense questions that should be easy to answer off the top of your head, but the fact remains that many of us end up in the doctor’s office answering questions far less accurately than we could have had we been a little more prepared.
If you are seeing a doctor who you haven’t worked with before and you are on medication, it’s important that you inform him of the medication that you are presently taking. He’ll probably ask, but you should be prepared to raise the issue in the event that he doesn’t. Add a list of your medications to your notebook along with the questions and other information that you have for him. Better yet, bring the medication with you, which will allow him to look at what you are taking. The bottle will tell him more than you can, particularly when it comes to dosages.
Work as Your Doctor’s Partner
Your doctor is going to appear a lot less intimidating to you (and visits to his office will be a lot less stressful) if you start to look at him more as your partner than as your manager. Consider him more of a trainer than a coach, someone you consult and work with to get yourself into the best shape as possible, all the while knowing that you are calling the shots (based on his advice). Remember, too, that you are ultimately the one responsible for your own health.
Of course, few of us ever start off with this sort of “partner” relationship with our doctors; it is not something that happens overnight. You don’t walk into your doctor’s office one afternoon, stick out your hand and exclaim “Hey partner!” It is best to develop this relationship gradually. Every time you are going to the doctor, be prepared. Have this goal of partnership in mind. Think of at least three to five questions you’d like to ask him, jot them down in your notebook and don’t talk yourself out of asking them! This is dialog building and it’s important. Sure, your doctor may be surprised that you’re not sitting there like a “Silent Sam,” but he’s apt to be pleased. If you feel like it, even let him know that you are determined to take a more proactive role in your health care and that you are looking forward to working with him as a more responsible patient. Encourage him to share more information with you whenever possible. Let him know that you want to know. As this pattern continues over the weeks, days, months and years, your doctor will grow used to your active participation. The partnership will grow, becoming stronger and more effective.
If your doctor has a tendency to use a lot of medical terminology that you don’t understand, let him know that you have a tough time understanding him when he uses that jargon. Ask him to explain things without such terminology.
Also, remember that while talking with your doctor is a lot easier than you might think, it still requires common conversational etiquette. When you ask your doctor a question, give him time to answer and let him finish a thought or sentence before you ask another. If you are asking him why he wants a series of tests done, or why he has recommended a certain treatment plan for you, or how much the tests or treatments will cost (all very good questions), make sure you do so in a non-confrontational manner. Sometimes we can pose a question in an accusatory or skeptical tone without meaning to, so it’s important to be aware of how a question may come out. Try framing it like this: “I’m eager to know if this particular treatment will affect me differently than other treatments. What can I expect?”
Questions to Ask
Try to ask relevant questions, and don’t worry about sounding dumb. As the old saying goes, “The only stupid questions are the ones you don’t ask.” This is especially important if you have concerns about a treatment or test your doctor has prescribed. Consider asking your doctor these questions:
- Why do I need this test or this treatment?
- How does the test/treatment work?
- What will the test tell us?
- How soon will the treatment start working?
- What will the treatment do for me, specifically?
- What happens if I decline to undergo the treatment or test?
- What are the specific alternatives? Why weren’t those chosen first?
If you don’t like or don’t feel entirely comfortable about the answers you hear, let your doctor know that you’d like more information. Asking for a second opinion is not heresy! You may think that your doctor is going to feel as if you are going “behind his back” in asking for a second opinion, when in fact your doctor is quite unlikely to feel threatened by your request. It will probably reaffirm his perception of you as an engaged patient and self-advocate. However, if you can’t bring yourself to tell your doctor that you’d like a second opinion, then don’t. There’s no law that says you have to, it just makes good sense to do so if you are trying to cultivate an active partnership with him.
© 1997 Mark Cromer