Managing the Medical Muddle

After recently escaping mayhem in an emergency room encounter, I began a search for a health care survival manual. Luckily I found one, The Patient's Playbook by Leslie D. Michelson. Here is a summary of Michelson's wisdom:

• Prepare for illness when you are healthy by getting a copy of your medical records. (Electronic medical records don't work outside of your hospital system because the software of separate hospitals and clinics don't match with other hospitals.)
• Find a hospital you want to go to in an emergency.
• Develop a relationship with an informed, empathetic primary care physician who will take the time to talk with you about you medical challenges. A specialist may take care of your left arm but know nothing about your right. Having several specialist take care of you puts you at risk for over treatment. We all need a guide, a referee to explain what the advice from specialists indicates. Tragedies occur when there is no oversight.
• Develop a list of qualities you feel are important in a doctor. Solicit recommendations from friends, acquaintances, your dentist, your attorney. Check out credentials. Where did the physician go to school? Where did the physician get their residency training? Finally, check out the physician with a visit when you are healthy. 
• Sadly when primary care physicians see 30-40 patients daily they have no time to think and communicate about your case so you may want to consider paying extra money to find a primary care physician in a concierge practice who will give you quality time. 
• For serious medical problems seek a super specialist at top academic medical centers.Be intensely involved in your own care. Use reliable Internet resources such as the National Institutes of Health website or the UpToDate medical website.
• Remember that over treatment can be just as dangerous as under treatment. You want smart care not more care. Quiz your physician. Is he a critical thinker? Can he back his decision by reciting the literature.
• Understand that electronic medical records are your biggest enemy. Because hospital administrators are more interested in having forms and check lists completed than your personal medical care and because clerks (inspectors) with no medical knowledge put pressure on the staff to duplicate useless information, you get ignored. In the past medical progress notes were invaluable in communicating what the physician was thinking about your case to other physicians and staff. Now electronic medical records become useless cut and paste items insuring that the hospital administration gets paid and you get poor care. Showing empathy for the harassed medical staff will get you better care. Telling them that you understand the burden of electronic medical records will get you the best care.  
• If your attempt at developing a good doctor-patient relationship fails, insist that the doctor and nurses look at you and not the computer. 
• Because 10% of patients or more (depending on the hospital) suffer hospital associated complications such as infections, falls or drug reactions be a vigilant inpatient. Don't assume doctors or nurses know what they are doing. 
• If at all possible avoid emergency rooms and hospitals. 
• Post a summary of your medical history near your hospital bed.
• Develop a friendship with your health care providers. You want to become a person to the staff instead of a gastric ulcer in bed 101B.
• Don't take new medicines until you know exactly what they are for.
• Don't submit to procedures unless you are given a logical reason for why they were ordered.
• Insist that new symptoms---a fever, swelling, dizziness---be promptly evaluated and explained.
• If the doctor or nurse fail to explain procedures and medicines to you ask for another doctor or nurse. 

I empathize with doctors and health care staff in our current age of oversight medicine. Most physicians and health care professionals entered medicine to develop strong emotional bonds with people and help them through health care challenges. Now they find themselves bound to government rules and regulations that separate them from patients. Government red tape erodes time that could be spent in keeping up with medical advances. The ticking clock keeps them moving toward the door instead of explaining medial approaches and procedures. They are harassed and helpless, dominated by needless rules and regulations.

You can help them out by being friendly and kind while taking charge of your own health care.