Related Resources • Part 1: Why the Health Care System Behaves Like That • Part 2: Managing Your Doctor • Part 3: Managing Your Health Plan

By DrRich

DrRich doesn't want to slip into an "every man for himself" frame of mind, but it's still true that no one cares about your health more than you do. To become a truly effective patient, you've got to be deeply invested in promoting your own health.

By "promoting your own health," we mean doing four things: become as knowledgeable as possible about your own health conditions; take good care of yourself; make the most of your encounters with your doctor; and keep careful records.

Become as knowledgeable as possible

Learning as much as possible about your heart condition is a simple matter of self-preservation. Even under an ideal health care system (which, most assuredly, we don't have,) doctors won't always have the time or the inclination to discuss every important aspect of all your medical conditions. The more you teach yourself about those conditions, the better off you'll be. You'll be better able to interpret what your doctor is saying, and you'll even be able to steer your discussions into the areas that are most pertinent to you. You'll have a better understanding of what your doctor thinks should be accomplished, and a better grasp of what you can do to help accomplish it. Knowledge allows you to become an active participant, rather that a passive one, in managing your health care.

As an added bonus, by becoming highly educated about your health - and perhaps more importantly, by seeming to be highly educated - you will automatically make yourself ineligible for rationing by omission. Nobody would dare try to withhold information from you if they thought you were probably already aware of all the options. Educating yourself is the best defense you can use in our increasingly hostile health care system.

There are many ways to become more knowledgeable about your health care. Start with this web site, which has hundreds of pages of information on heart conditions, as well as serving as a gateway to other Internet resources.  Then check your public library. Your librarian can point you to helpful books and articles about cardiovascular disorders.

Take good care of yourself

It goes without saying that you will enjoy better health if you do all those things you know you should be doing, things like giving up tobacco, maintaining an ideal body weight, cutting down on saturated fats, and getting plenty of exercise. If your doctor has you on a particular medical regimen (such as taking prescription drugs), make sure you follow that regimen religiously. 

You gain direct health benefits from doing these things, as you well know. What you may not have realized, however, is the secondary gain you receive. By taking a genuine interest in trying to keep yourself healthy, you also endear yourself to your physician. You enlist him to your cause. Doctors should be engaged in the care of each of their patients, of course. That's what it is supposed to mean to be a doctor. But, you know by now, they can't. They're under steady, unrelenting and overwhelming pressure to make the interests of their patients secondary to the interests of the HMO, of the government, and ultimately, of society at large. They simply cannot go to bat for all their patients. Some (the ones HMOs like the best, and the ones you have tried to avoid) won't go to bat for any of their patients.

The many doctors who still maintain a strong sense of professional pride (the recalcitrants, the ones you have tried to choose for yourself) will still try to advocate for their patients, at least as circumstances allow. These, however, need to marshal their energies carefully. When they do go out on a limb for their patients, they are much more likely to do so for patients who are assiduously trying to help themselves. If the patient won't accept responsibility for his own health, it's not realistic to expect the doctor to jeopardize her career for the patient's health.

Make the most of your encounters with your doctor

Your doctor has so little time for you these days that, in order to become an effective patient, you've got to get the maximum possible benefit out of the time you do spend with him.
You should plan a visit with your doctor the same way you'd plan an important business meeting.

Set goals. Before each doctor's appointment, set down in writing the specific goals you'd like to accomplish during that visit. Some goals will be fairly specific and straightforward ("Find out what my cholesterol level is."); others will be more open ended ("Any ideas why I'm tired all the time?"). But anything you want to accomplish during this visit should be listed as a goal.

Write down your questions and comments.  Under each goal, write down the questions you would like to have answered, or comments you want to make, regarding that goal.
Consider communicating with your doctor before the visit.  If your doctor knows in advance what you hope to accomplish during your visit, he can take pains to be sure those goals are met. This "heads up" to your doctor should be made by letter, fax, or e-mail.  Be aware, by the way, that the phenomenon of patients bringing lists of questions to ask their doctor has been stigmatized in some medical texts as being a sign of a mental disorder in itself - it is called the maladie du petite papier (the pathology of the little paper) and is said to indicate an anxiety disorder.  To the extent that trusting your life to the current health care system ought to provoke some anxiety, perhaps this is correct.  But use this knowledge to your advantage - if your doc begins rolling her eyes when you produce your list, then treating you as if you should be an inmate in Cuckoo's Nest, that's a good sign you've got the wrong doctor.

Have pertinent data with you.  Don't assume your doctor has all the information he needs. Always bring a list of all the medication you're taking, and who prescribed it. If another doctor has performed an examination, test, or procedure since your previous visit, bring a record of that encounter with you (see below under "keeping records.")

Take notes.  During the visit itself, check off each of your questions as they are answered, each comment as you make it, and each goal as it is accomplished. Take notes on the pertinent points your doctor makes with you. Some recommend tape recording doctors' visits. If you choose to do so, remember to ask the doctor's permission first, as it is illegal to surreptitiously record conversations in many states. Also keep in mind the following: if you ask to tape the visit, your doctor will immediately have visions of hearing that recording played back to her three years later in a court of law. If you tape record, expect your doctor to be more circumspect, and possibly less forthcoming, in her comments to you.

Repeat what you heard your doctor say. When your doctor makes an important point, repeat it back to her in your own words. That gives her the opportunity to confirm what you just heard her say, or alternatively, to restate her comment in case the message you got was not the message she tried to convey. Along the same lines, if your doctor gives you specific instructions, write them down, and let the doctor see what you've written.

Don't stray from the point.  Your doctor has limited time to spend with you - very limited, with most health plans. Don't waste this time by talking about your sister's wedding. Stick to the script, or you will not meet your goals.

Take a support person with you.  Taking a spouse, sibling, or good friend with you can be helpful. . By listening to your conversation with your doctor, your support person can later confirm (or call into question) what you think you heard from your doctor. If what she heard is different than what you heard, you can then clarify the discrepancy. During the visit itself, your support person can also remind you to bring up an issue you wanted to discuss, if you are forgetting to do so. 

After the visit, go over your list.  Were your goals met? Were your questions answered? Did you understand the answers? If not, you ought to consider faxing or e-mailing your doctor within a day or so (while you're still fresh in his mind), and ask for clarification of the outstanding issues.

Keep careful records

Letting the American health care system be responsible for keeping your medical records is a major mistake. Especially nowadays, when patients change doctors and health plans as often as they change shoes, assuming that your medical past is able to keep up with you is a very bad assumption.

You should keep your own records. At the very least, you should have a copy of your most recent medical history and physical examination, of all hospital discharge summaries, and of the results of any major tests or procedures you have had (such as CAT scans, treadmill tests, or heart catheterizations.) Even better, you should have copies of all consultants' reports, and possibly records of all office visits. 

You'd be surprised how often this kind of information gets lost or misplaced. During his 20 years of practice, DrRich was continually astounded by the difficulty he had in getting reports from other hospitals or doctors on such major events as brain surgery or episodes of heart failure. If patients maintained that information themselves, all future encounters with the health care system would not only be simpler, they would be far safer.

The effective patient doesn't allow the health care system to jeopardize his health by losing his records. Instead, he gets copies of those records himself, and keeps his files up to date.
Doctors and hospitals often don't want to release medical records to patients themselves (fearing litigation), but the information stored in those records belongs to the patient, and the patient has every right to them. Your doctor, of all people, should understand this, and if you've chosen your doctor wisely, he will help you obtain the records you need. If you haven't chosen your doctor wisely, we refer you one more time to Rule # 1.