A New Year’s Resolution for Smart Patients
Resolve to Be a Smarter Patient
With the first deadline for complying with Obamacare’s insurance requirements looming large, it may be hard for many Americans – especially patients in our broken healthcare system – to think about anything else. But the start of this new year may be a better opportunity than most to refocus on not just the usual weight loss and fitness resolutions, but on your broader healthcare needs as well.
Losing excess weight, especially fat, and improving your fitness are worthy goals in their own right. But their real payback is in avoiding disease and the medical interventions they require. If you’re obese or even moderately overweight – or your weight is “normal” but you’re physically unfit - your risk for one or more chronic diseases is substantially greater than average.
Chronic diseases are life-long burdens that can substantially shorten your life, increase your pain, and lighten your wallet unless you reassess your priorities as a patient and devote more time and effort to measures designed to keep you out of hospitals as much as possible.
That’s because hospitals can be dangerous places – hotbeds of infection and errors that can harm as much as heal (see Our Healthcare Sucks for more on this). Reducing this risk of medical injury – variously estimated as causing up to 440,000 avoidable deaths every year in the U.S. alone – should be a prime new year’s resolution for anyone with a chronic disease patient in their family.
Focus on Communication
Many of these medical errors are attributable to the poor communication between many medical specialists caring for the same patient.
Merely closing this communication gap by fully understanding your treatment plan and communicating openly with each medical specialist can significantly reduce errors and improve treatment results. It can also avoid duplication of services that end up costing you more and exposing you to greater risk of injury.
Your primary focus as a patient should be on the poor transitions in our fragmented healthcare system. These are ripe for miscommunication about your medical condition, your treatment plan, and a host of other details important to your medical treatment and outcome – as well as your medical bills.
There are a handful of crucial transition phases in your treatment that are notorious sources of medical errors:
Referral to another physician – Does the new physician have your medical record, lab or imaging results, etc.?
Hospital admission – Inaccurate patient information on admission can cause errors in treatment. Communication between your hospital doctors and your office-based doctor is often non-existent. Even hospital-based doctors seldom communicate with one another because they don’t get paid to and they’re stressed and distracted as it is;
Changes in shifts while hospitalized – Shift changes are common sources of medical error as caregivers often fail to fully communicate each patient’s medical condition, needs, etc. This is compounded by understaffing on nights and weekends that limits the ability of these caregivers to proactively seek missing patient information;
Hospital discharge – This is another area where poor communication and lack of clear instructions to patients often cause avoidable hospital readmissions. Insist on a written discharge plan and confirm whether scheduling a follow-up appointment with your primary care physician is urgent and whether he or she has received a copy of your discharge plan; and
Start of new academic year in July – This is when new residents and interns start at academic medical centers, with higher rates of medical error probable during their first few months of training (July – September).
It’s best to postpone elective hospitalizations during this period, if possible, or to find a community hospital without residents and interns.
If this is unavoidable, make sure your patient advocate – a trusted friend or family member – is alert for errors and pays close attention to communication and coordination of care missteps.
Don’t Need a Medical Degree
These are all areas where patients’ personal involvement in their care can benefit them dramatically without needing to learn the medical science of their condition.
It’s about improving communication between your doctors and other caregivers, which is often just a matter of asking your new caregiver if they know what they should about your condition and your needs.
As an example, never repeat a scan or procedure without understanding why and be certain it’s not just because your current doctor doesn’t have the prior results.
In that situation, ask if it can wait until they’re able to find your prior scan or test results rather than undergo it a second time.
This isn’t just a cost consideration – cancer risk increases with cumulative exposures to ionizing radiation from CT scans and other radiation-based medical technologies. More is definitely not better when it comes to CT scans and other ionizing radiation associated with multiple cancers and cardiac disease.
Decision Support Tools
All of this can seem a bit overwhelming if you haven’t assumed an active patient role in your medical care until now. However, there are tools to help guide you through the learning process.
Researchers at the Ottawa Hospital Research Institute have developed an online tool called the “Ottawa Personal Decision Guide” that nicely lays out the thought process of balancing the risks and benefits of your medical decisions.
This includes a simple 1-5 star mechanism for weighing each of the pros and cons. It also helps you determine the role you wish to play, what support you can count on, additional needs to reach a final decision, and a plan for the next steps to reach your final, informed decision and to track your progress.
Several variations on this tool are available here, including PDF versions you can print out and complete by hand, an interactive online version, and even a Facebook application called “iShould” you can use to include family and friends in your decision-making process. Specific health issues are addressed here.
Dartmouth-Hitchcock Medical Center also sponsors an online “Center for Shared Decision Making” with videos of different treatment options available for free here.
Click “Decision Aid Library” in the left-hand column for videos and online materials on a broad range of medical conditions. These include cancer screenings, breast cancer treatment options, heart disease, back pain, stroke, and women’s health, among others.
This is an excellent way to assess your treatment options with objective advice independent of your own physician’s recommendations.
You can’t take effective control of your own treatment plan without first understanding what is shown to work best for your condition(s) by the best scientific evidence available.
And you can avoid some of the most misused treatment options by checking the Choosing Wisely website – where medical specialists from over 30 specialties have listed the medical interventions you should avoid for certain diagnoses in their specialty areas.
You might think you can rely on your doctors for this, but all the evidence shows it’s our doctors who are guilty of resorting to these often ill-advised interventions. The reasons for this vary from not remaining current with medical advances to personal financial gain from performing these procedures.
Whatever the reasons, it’s clear that smart patients should take advantage of the easy access to this information at choosingwisely.org.
Knowledge IS Power
Gaining such knowledge – and knowing it’s based on solid science and not someone’s income objectives – can be enormously empowering for patients.
Knowledge can also be a powerful motivator for action…it’s harder to continue self-destructive lifestyle behaviors when you understand exactly how they worsen your medical prognosis.
It’s unlikely you’ll get very far, however, without the right attitude toward both any medical conditions you may currently have and to the constructive role you can personally play in preserving and/or restoring your health.
It’s important, of course, not to become obsessed with your health or lack of it – though it may be difficult not to when it dominates your day and your budget – because it’s also important to live and enjoy your life.
The idea is to reduce disease-promoting stress, not add to it by becoming overly worried or preoccupied with your medical needs.
Living with a chronic disease is challenging, to say the least. But the right attitude can make a huge difference in your quality of life and likely longevity as well.
Adopting a balanced attitude can help you avoid overreacting to a potential diagnosis before fully exploring all your treatment options.
With that, please accept my best wishes for a happy, healthy, and very MedSmart New Year.