You, the individual, can do more for your health and
The quality and the cost of medical care depend more on you than on your
doctor.
To become a wise medical consumer, start with three basic principles:
Good partnerships are based on a common goal, shared effort, and good
communication. If you and your doctor can make these things happen, you
will both gain from the partnership. You will get better care and your doctor
will practice good medicine.
Both you and your doctor would prefer that you don't get sick in the
first place. And if problems arise, you both want a return to good health
as soon as possible.
Your record of symptoms will help both you and your doctor make an
accurate diagnosis. And, the better job you do recording early symptoms,
the better you and your doctor can later manage the problem.
As the front-line partner, you can manage a lot of minor health problems
on your own. Use this book, your own experience, and help from others to
create a self-care plan.
Medical appointments are often scheduled for only 10 to 15 minutes per
visit. The better organized you are, the more value you can get from the
visit.
Is it okay to call your doctor?
Of course it is. Often a phone call to the doctor or advice nurse is all you
need to manage the problem at home or determine if a visit is needed. Here's
how to get the most from every call:
If you don't have a family doctor (primary care physician), now is the time
to get one. Everyone needs a regular doctor. A host of specialists working on
separate health problems may not see the whole picture. In choosing a doctor
there are lots of questions to ask, but these two matter the most:
Training and Experience
For most people, a good choice for a family doctor is a board-certified family
practice doctor or internist. These doctors have broad knowledge about medical
problems. See page 20 for a brief description of medical specialists. Does this
doctor work with nurse practitioners or physician assistants? These primary
care providers have special training for managing minor and routine medical
problems. For many health problems, these professionals can often see you
sooner, spend more time with you, and help you just as well as a doctor.
During your first visit, tell your doctor that you would like to share in
making treatment decisions.
Pay attention to how you feel during the visit.
Not everyone wants to be a partner with their doctor. Perhaps you don't like to
ask your doctor questions.
Perhaps you don't want to share in any decisions. Perhaps you would rather just
let your doctor tell you what is best for you. If that's what you prefer, tell
your doctor. Most doc- tors have a lot of patients who don't want to be a
partner. The doctor just needs to know what you expect.
If you are unhappy with how your doctor treats you, it may be time for a
change. Before you start looking for a new doctor, tell your current doctor how
you would like to be treated. Your doctor would probably be pleased to work
with you as a partner - if only you would tell him that's what you want.
Otherwise, he may think that you, like many of his patients, want him to do all
the work.
Advice Nurses are registered nurses who have special training to help you
manage short-term illnesses, help you decide an appropriate response to
symptoms, and to answer questions about your problem or concern. The Advice
Nurses are easily reached by phone (the number is in your member directory).
In many cases, a call to the Advice Nurse may save you the inconvenience of a
trip to the clinic. In addition to being a resource for health information, the
Advice Nurse works with your health care provider to monitor, support, and
adjust treatment for illnesses you manage at home.
The Telephone Advice Nurse Service, pioneered by Kaiser Permanente, is
available for Adult Medicine, Pediatrics, Obstetrics/ Gynecology, and for many
specialty areas.
Except in an emergency, you cannot be given a treatment or test without your
"informed consent." You must be informed of the risks and agree to the
treatment. In a partnership, however, informed consent may not be enough. The
real goal is shared decision making, where you actively participate in every
medical decision.
Why should you help make decisions with your doctor? Aren't you paying him to
know what to do? Well, the choices aren't always black and white. With many
health problems, there is more than one option. Consider these examples:
You have moderately high blood pressure (160/95). Your doctor says that
although exercise and diet might bring it down, most people don't succeed that
way. He recommends that you start on medication to control it. You would rather
try exercise and lose weight than take pills for the rest of your life. The
best decision depends on your values.
Your three-year-old has a headache and a fever. The doctor says it's probably
nothing to worry about. Then you tell her your hunch that it might be
meningitis. Some testing may be appropriate.
You have been suffering from carpal tunnel syndrome for several months. Your
doctor is now recommending a wrist splint and a steroid injection. You would
prefer trying just the splint with aspirin first. If that doesn't work, you
will consider other medica- tions. Your doctor agrees that is a good plan.
In each case, the treatment you choose will have an effect on your life.
Therefore, the best medicine for you combines your doctor's medical expertise
with your personal values.
Tell your doctor that you want to help make decisions about what to do
for your health problems.
Sometimes you need to learn things on your own before you can fully
understand what your doctor is saying. Call or visit your Kaiser
Permanente facility's Health Education Center for help in getting the
information you need. See "Health Education Resources" on page 23.
Always ask "why?" before agreeing to any medical test, medication, or
treatment. By asking why, you will often discover another option that
better meets your needs.
Learn enough to understand the options your doctor thinks are feasible.
Ask your doctor if it would be risky or costly to wait a while (day,
week, month) before treatment.
Tell your doctor if you prefer one option over another based on your
personal desires and values.
Tell your doctor what you are expecting from the treatment and ask if
that is realistic. If appropriate, discuss side effects, pain, recovery
time, long-term limitations, etc.
When you share decisions with your doctor, both of you must accept the
responsibility for the outcomes.
Shared Decisions About Medical Tests
Medical tests are important tools, but they have limits. Some people think that
the more tests they have, the better off they'll be. Wise consumers know
medical tests have costs and risks as well as benefits. To help your doctor
make good choices about tests for you, you need to:
Learn the basics.
Once you agree to a test, ask what you can do to reduce the chance of errors.
Ask about food, exercise, alcohol, or medications to avoid before the test.
After the test, ask to review the results. Take notes for your home records.
If the results are unexpected and the error rate of the test is high, consider
redoing the test before basing further treatment on the results.
Shared decision making requires two-way communication, like playing a game of
ping-pony.
Ping: You describe your symptoms, main concern, and hunches.
Pong: Your doctor makes a diagnosis and describes treatment options.
Ping: You tell your doctor your personal preferences or ask about other
options.
Pong: Your doctor restates the options and how they relate to your
preferences.
Ping: You accept one of the recommended options or learn more about what
you should do.
With good two-way discussion, the chances are better that you will end up with
the treatment plan that is best for you.
The first rule of medications is to know why you need each drug before you put
it in your mouth, rub it on your skin, or whatever. The same as with medical
tests, there are a few things you always need to know about medications.
Learn the basics.
Every surgery has risks. Only you can decide if the benefits are worth the
risks. Are you willing to live with your problem or do you want to have the
operation? The choice is yours.
Learn the basics.
If you have ever thought that the cost of your medical care doesn't matter
because your company or health plan pays the bills, think again. You do pay.
Most people have to pay co-payments and deductibles. Employers pay for health
care coverage by restricting wage increases. Governments pay for health care by
increasing taxes or reducing other benefits.
As medical costs go up, there is less money available for housing, education,
wage increases, etc. These costs do affect you. If you can help reduce health
care costs, you help yourself - and everyone else.
Once you become a partner with your doctor, you can do a lot to reduce your
health care costs. The goal is to get just the care you need, nothing more, and
certainly, nothing less.
Dermatologist (MD): skin
Endocrinologist (MD): diabetes
and hormonal problems
Family Practitioner (MD):
primary care
Gastroenterologist (MD):
digestive system
Geriatrician (MD): older adults
Gynecologist (MD): female
reproductive system
Head and Neck Surgeon (MD):
ears, nose, and throat
Internist (MD): primary care for
adults
Neurologist (MD): brain and
nervous system disorders
Oncologist (MD): cancer
Ophthalmologist (MD): eyes
Optometrist (OD): eyes when
disease is not involved
Orthopedist (MD): surgery on
bones, joints, muscles
Pediatrician (MD): primary care
for children and teens
Podiatrist (DPM): foot care
Psychiatrist (MD): mental and
emotional problems
Psychologist (PhD): mental and
emotional problems
Pulmonologist (MD): lungs
Rheumatologist (MD): arthritis
and rheumatism
Urologist (MD): urinary and male
reproductive systems
Healthy lifestyles and regular preventive services are the best ways to
keep costs down. See Chapter 3. Also see Chapters 17, 18, and 19 of this
book for ideas on how to stay healthy your whole life long.
Every time you successfully manage a health problem at home, you reduce
the cost of health care for you and for others.
Family physicians, internists, pediatricians, nurse practitioners, and
other primary care providers are the best place to start for most health
problems. See page 13 for more information.
Don't agree to expensive medical tests until you understand how they
will help you. Unneeded tests are often done because "it is standard
practice" or to protect doctors from possible malpractice suits. The
only good reason to do a test is because the benefits to you outweigh
the risks and the costs. No test can be done without your consent. See
page 15 for more information.
Ask your doctor about every prescribed medication. Ask what would happen
if you chose not to take a medication. Don't expect to get a
prescription for every illness; sometimes self-care or non-drug remedies
are all you need. See page 16 for more information.
Specialists are doctors with in-depth training and experience in a
particular area of medicine. For example, a cardiologist has years of
special training to deal with heart problems. Specialists generally
charge more for visits than primary care doctors, and they routinely
prescribe more expensive tests and treatments. Of course, they often
provide the information you need to decide what to do about a major
health problem.
When your primary doctor refers you to a specialist, a little
preparation and good communication can help you get your money's worth.
Before you go see a specialist:
In life-threatening situations, modern emergency services are worth
their weight in gold. However, they often charge far more for routine
services. Emergency rooms charge two to three times more for routine
services than a doctor's office. Also, your records are not available,
so emergency room doctors have no information on your medical history.
Hospital emergency rooms are set up to handle trauma and
life-threatening cases. They are not set up to care for routine
illnesses, and they do not work on a first-come, first-served basis.
During busy times, people with minor illnesses may wait for hours.
Use good judgment in deciding when to use emergency medical services. If
you feel you can safely wait to see your regular doctor, do so. Apply
home treatment in the meantime. However, if you feel that it is an
emergency situation, by all means go to the emergency department.
Prepare for the emergency room:
Over half of all health care costs are for hospitalizations. A stay in a
modern hospital costs far more than a vacation at most luxury resorts.
(And hospitals are a lot less fun.)
If you do need in-patient care, get in and out of the hospital as
quickly as possible. This will reduce costs and your risk of
hospital-induced infections.
Don't check in just for tests. Hospitalization is no longer needed for
most medical tests. Ask if the tests can be done on an out-patient
basis. If you agree to control your diet and activities, the doctor will
usually support your request.
Additional days in the hospital can sometimes be avoided by bringing in
extra help at home. With help available, many patients can shorten a
hospital stay.
Hospitals are not the only choice for people with a terminal illness.
Many people choose to spend their remain- ing time at home with people
they know and love. Special arrangements for the needed care can be made
through Kaiser Permanente's hospice care programs. Ask your doctor for a
referral or call your facility's hospice office to learn more.
When you need to be in the hospital, good consumer skills can help
improve the quality of care you receive. However, don't overdo
consumerism. If you are very sick, ask your spouse or a friend to help
watch out for your best interests.
Learn as much as you can about your medical problem. Your research may
turn up new options.
If you need help understanding a complicated problem, or want to learn
more about your options:
There is severe bleeding or blood loss. See page 219.
The person is unconscious or is having significant difficulty breathing.
The person is having a seizure last- ing longer than seven minutes.
You suspect a spinal or neck injury.
It is not an emergency. Ambulance services are expensive and, if not needed,
may not be covered by insurance.
Millions of people are taken in each year by medical fraud and worthless health
products.
Bogus "cures" are often advertised for chronic problems. These promotions
target people with ar~ritis, cancer, bald- ness, impotence, or other problems
who are ready to try anything. Unfortunately, these cures rarely help and often
(one out of ten) cause harmful side effects.
Be suspicious of products that:
Medicine is not as magical as we once thought. If someone takes the time to
explain a problem or a treatment to us, we can usually make a pretty good
decision about what is best for us.
Use your common sense to become a working partner with your doctors. The best
medical tests, diagnosticians, and medical specialists are not enough. Good
medical care also requires your own common sense. It will help you find the
care that is right for you and avoid services (and costs) that you don't need.
If you trust your common sense, you are on your way to becoming a wise medical
consumer.
There are 28 Kaiser Permanente Health Education Centers where you can watch
videos, read med- ical information, get information to take home, and learn
about addi- tional resources. Health Education Centers offer many health educa-
tion programs, including classes, counseling, and special programs for
children, teens, older adults, couples, families, and others. In addition, a
professional health edu- cator is available at every Health Education Center.
You are always invited to call or stop by the Health Education Center at your
local Kaiser facility to learn more about maintaining or improving your health,
or about a medical condition or treatment.
You may also receive counseling and educational materials from your doctor or
other Kaiser health care provider as part of your off~ce visits.
As a Kaiser Permanente member, you will also receive an award- winning
quarterly magazine called Partners in Health. This magazine will keep you up to
date on health issues, new health education pro- grams, and changes that take
place at the medical centers.
well-being than any doctor; any hospital, any drug,
and any exotic medical device.
Joseph Califano
By following these three principles, you will gain more control over the
quality and cost of your health care than you have ever had before.
Work in Partnership
With Your Doctor/Nurse Practitioner
Calling Your Doctor
Leave a clear message.
Follow through.
Finding the Right Doctor
But I Want a Take-Charge Doctor
Consider the risks and benefits.
Ask about costs.
Let your doctor know:
If a test seems costly, risky, and not likely to change the recommended
treatment, ask your doctor if you can avoid it. Try to agree on the best
approach. No test can be done without your permission.
Consider the risks and benefits.
Ask about costs.
Let your doctor know: Your concerns about the drug.
Shared Decisions About Surgery
Consider the risks and benefits.
Ask about costs.
Let your doctor know:
Once you understand the costs, risks, and benefits of surgery, the decision
is yours.
Hospital Consumer Skills
Be suspicious of any doctor who:
The best way to protect yourself is to ask questions and be observant. If you
don't like what you see, find another doctor.
Trust Your Common Sense