Excerpt from Chapter Four
The Rights and Responsibilities of Patients
The Proactive Patient Bill of Responsibilities
- Take your health seriously. If you don’t take your health seriously, neither will your doctor. Your doctor cannot help you unless you are putting forth the effort to maintain overall wellness. If you are not living a healthy lifestyle, your body cannot heal. Your diabetes medication is only a Band-Aid approach if you are not following a healthy diet. If you have a heart condition, your doctor cannot help you if you maintain a high-fat diet and use tobacco products. Your desire for good health must outweigh your need for unhealthy habits.
- Be vigilant about getting regular screening tests. You are responsible for knowing which screenings you need and when, based on age, family history, and risk factors. To find a list of recommended screenings by age, check out Web MD: women.webmd.com/tc/early-disease-detection-overview. Although these recommendations appear in the women’s section of the site, the listing includes men’s screenings, such as prostate and testicular cancer, so, guys, you’re not off the hook!
- Find the best primary care physician possible. In most cases, your primary care physician will be a family practitioner or an internist. Your PCP will be a generalist and the focal point of all your medical care, referring to you appropriate specialists as needed and intervening on your behalf for emergency medical care. In addition to checking the credentials and any past or pending disciplinary action of your PCP, you also need to ensure that she has hospital privileges. If you need to visit the emergency department or stay in the hospital, you will need a PCP with privileges at that hospital to coordinate treatment with the emergency department or to oversee your treatment in the hospital.
- Coordinate your care from several different medical practitioners. To ensure that you are not receiving treatments that conflict with one another, make sure your PCP knows about medical care you are receiving from any specialists you have found on your own or from alternative practitioners. You may find that one doctor needs to share your records and, in some cases, X-ray films with other doctors. It is your responsibility to follow up to make sure this happens, even if it means hand delivering reports and films yourself. You must also be the focal point when you have several medical practitioners working together on your case. You cannot assume that all of your doctors are communicating effectively with one another.
- Disclose fully all health-related information with all your medical practitioners, even if it means disclosing something unflattering or embarrassing that you would rather not reveal. If you have a poor diet or a history of mental illness, substance abuse, or unprotected sex or you just can’t seem to break that nicotine or caffeine addiction, your doctor needs to know. You must also apprise him of all family medical history. A number of serious diseases are hereditary, and your doctor cannot be alert to your risk without full knowledge of your family history. He must have all the pieces in order to solve the puzzle, and this includes your emotional and spiritual well-being. You may find that he is interested in knowing about nonmedical aspects of your life such as family, work, and hobbies. In recent years, the medical community has gotten more involved in treating the whole person rather than just the physical symptoms. If your doctor seems nosy, be grateful—you are receiving holistic care.
- Keep in mind that respect is a two-way street. I reviewed the responses to the Physician Survey question regarding patient etiquette and found many of the responses appalling. Physicians reported inappropriate patient behavior ranging from texting and talking on cell phones during office visits to physical assaults in the emergency department. The more respect you show for your medical providers and the time that you spend together, the more you are likely to get in return. You are responsible for keeping appointments and, when you are unable to do so, to make every effort to cancel at least twenty-four hours in advance. Eliminate distractions to the best of your ability during your consultations. Remember, you will probably have no more than ten minutes to present your case and get the help you need. And yes, this means turning off your cell phone!
- Help your doctor help you. Ask thought-provoking questions to help your doctor expand the possibilities. If you are having trouble finding the right diagnosis, ask questions such as, “What else could it be?” or, “Which parts of the body are near the source of my symptoms?” Clarify any confusion or misunderstanding you have about anything your doctor has said during the consultation, even if it means calling his office later. You should also provide feedback to let your doctor know whether or not a possible treatment is helping your symptoms. This not only helps him narrow down your case, but your feedback may help with future patients. Doctors and nurses want and need to know when they have helped a patient. They entered this helping profession for a reason.
- Recognize the human fallibility of health care professionals. Although medical practitioners and facilities are cognizant of their own fallibility and employ a number of safeguards, errors may still occur. This is where you come in. Speak up and question anything that looks or sounds suspicious. Make sure you have a trusted advocate with you when you are hospitalized or need emergency care. Request copies of all diagnostic and screening tests and double-check the results. Research possible diagnoses and treatments on your own and present the information to your doctor. Be aware that your PCP knows a little bit about a lot of different medical issues and has to look at what is going on throughout your entire body. If you suspect a problem in a particular area of the body, don’t be shy about asking to see a specialist. Keep in mind that although your PCP should be on the lookout for various cancers, she may not make the connection between symptoms and a possible cancer threat. If you have any reason to suspect cancer, don’t wait for your doctor to broach the subject. Be proactive and insist on the appropriate diagnostic tests.
- Follow your doctor’s instructions cooperatively. Forty percent of the time, a disease’s worsening is caused by the patient’s noncompliance with medical advice. You are responsible for taking medication as directed; following instructions for lab work, X-rays, and invasive testing procedures carefully; and complying with any treatment recommended by your physician, such as physical therapy. Speak up if the doctor suggests something you don’t think you can pursue or maintain. Be sure you understand all aspects of your protocol, contacting your doctor’s office as often as necessary.
- Participate actively in your diagnosis and treatment. Don’t sit back and let your doctor make all the decisions for your care. Take ownership. You are responsible for your decisions, so you must be as well informed as possible. Ask your doctor for detailed information about recommended tests and treatments. Be proactive, and keep up with all tests results, treatments, and referrals. Be the squeaky wheel that gets the grease if you are experiencing any delays in diagnosis or treatment. Your doctor’s office may not call to inform you of test results, so be prepared to call and get that information.
- Arm yourself with as much information as possible. Your primary care physician cannot possibly know everything about every medical condition. If you are referred to a specialist, you will learn more about a specific condition, but you may need to find additional information on your own. You can find an infinite amount of medical information online, but your challenge is determining which sites are reliable and which are not. Chapter Two offers strategies for finding reputable sites, and for additional guidelines you can visit www.nlm.nih.gov/medlineplus/healthywebsurfing.html. The Joint Commission, the accrediting body that helps health care organizations help patients through the provision of health care accreditation and related services that support performance improvement, offers a plethora of patient empowerment tools at www.jointcommission.org. The Agency for Healthcare Research and Quality provides information on topics such as wellness and prevention, health plans, and surgical and medication safety at www.ahrq.gov/consumer. The American College of Surgeons also offers a number of patient resources at www.facs.org/patienteducation. Additional reputable sites include www.webmd.com, health.discovery.com, www.mayoclinic.com, and www.pubmed.com. The Resources at a Glance section in the back of the book includes a complete listing of recommended sites.
- Manage your medications. Use just one pharmacy to avoid dangerous drug interactions. You must have one central source for your medications; there is too much room for error with more than one. Most pharmacies have sophisticated computer systems that flag dangerous interactions. But as an added precaution, you should check medications before you take them to make sure you received the correct prescription. Learn as much about medications’ side effects and interactions as possible. Talk to your pharmacist, look at the package inserts, check the Web sites of the drug manufacturers, and check online for postings from patients who have experienced troubling side effects. Call in refills on your medications several days before you run out in case the pharmacy has to order more. If you use a national pharmacy chain, you may be able to get your medication at another of the chain’s stores in town if your regular store does not have it in stock. If you call your doctor’s office for more refills, be sure to do it well before you run out of your medication, and have your pharmacy’s phone number ready to give your doctor’s office staff.
- Know your medical insurance plan. It is your responsibility to know how your medical group or HMO works, which health care professionals are covered, and what to do after office hours. You need to know which precertification rules apply to various medical procedures. If you do not have this information, make sure you get it by calling your provider, checking its Web site, or contacting your company’s benefits administrator. If you have Medicare or Medicaid, you do not have to stay within a network, but some physicians and facilities do not accept Medicare or Medicaid patients. It is your responsibility to find out where you can receive care. To find out which physicians and facilities accept Medicare or Medicaid patients, you can call the local medical society or association.
- Manage your medical records even if all is well. If nothing else, you get to find out what your doctors think of you. I learned that not only was I suffering from conflict about my role as a Southern woman, I was also depressed, anxious, obsessive-compulsive, suffering from an organic mood disorder, overweight, and not very smart. Unflattering labels aside, you need to know which tests and evaluations are normal so that you can have a baseline. You can obtain copies of most of your records from your primary care physician. Your file will probably contain reports for office visits with your PCP and with specialists recommended by your PCP, as well as lab work, X-rays, diagnostic procedures, surgical procedures, and hospital summary reports. If your PCP does not have any of these reports, you need to contact the specialist, lab, imaging center, or hospital directly. You may have to pay for copies of your records, but the expense is well worth it. The more familiar you are with your history, the more efficiently you can work with your medical practitioners. You cannot count on your PCP to keep up with your history, which tests you’ve had, which medications you are taking, etc. Remember, he is seeing twenty-five to fifty patients per day, and your specialists are even less familiar with your medical history.
- Comply with all health care facility rules and regulations affecting patient care and conduct. Rules and regulations are necessary for the safety, comfort, and quality care of all patients, particularly during hospital stays. You may not like or even understand some of the regulations, but they exist for a reason.
- Fulfill your financial obligations as promptly as possible. Medical expenses can escalate quickly, and you may not be able to pay your out-of-pocket expenses. Most medical facilities will work with you to create a fair and reasonable payment plan. If you find yourself in this situation, you need at least one ally in the accounting or finance department.
- Prepare thoroughly for all consultations. Keep in mind that the average internist must see twenty-five patients per day to make ends meet. The average family practice sees about fifty patients per day. Your time with your doctor is extremely limited, so you must take advantage of every second.