By Dr. Mike Roizen and Dr. Oz, with Joint Commission Resources
March 02, 2009
Most patients don't do a great job of communicating with their doctors, because patients often give too little pertinent information to go on. Remember, just like a detective, doctors are looking for the facts. At the same time, they may also give us too many distracting or off-topic details.
The first sign of a smart patient is that telltale document they produce during their first visit or their 50th—it's their health profile. This is the sign of a patient who means business, one who will challenge us to be at our absolute best and who won't waste time and money on redundant and unnecessary efforts.
Bring Your Health Advocate Bring your health advocate to your doctor's appointment when you're giving your health history. There are a lot of questions that only he or she can answer.
How Healthy Is Your Health Insurance? Many of us have few options in picking health insurance, because we're tied to the plan from our jobs. But when you are lucky enough to have choices, here are some important questions to ask:
How does the insurer rate with the National Committee on Quality Assurance? Find out at NCQA.org. Also, the National Association of Insurance Commissioners lets you check out individual companies at NAIC.org.
Which hospitals and doctors are in the plan's network? Are the hospitals Joint Commission–accredited? If your doctor isn't in the network, ask your company's HR department to twist the insurer's arm to add him or her.
What will happen if I get cancer, get pregnant or become disabled? These are the biggies that really test insurance.
What's the maximum lifetime benefit? It should be at least $5 million.
At what age will my children be cut off from the plan?
How to find Dr. Right Find Dr. Right
One of the most important decisions you will ever make—and one you'll likely make more than once —is choosing your doctor. Choose wisely and you could rest easy for many years to come.
To Find a Great Doctor, Ask an ER Nurse Grill the ER nurse-manager at the best local hospital. A nurse in the intensive-care unit is also a good choice. These registered nurses get a battlefield view of doctors at their best and worst.
Go Board-Certified The American Board of Medical Specialties recognizes 24 areas of medical specialty, including anesthesiology, cardiology, internal medicine and pediatrics. Search for board-certified physicians at ABMS.org.
Get to know your hospital...before there's an emergencyKnow Your Hospital
To find the best hospital for you—whether it's a small community hospital, a hospital in your rural area or a large teaching hospital—go for an accredited hospital listed on the Joint Commission's Quality Check website at JCAHO.org. Joint Commission accreditation is the Gold Seal of Approval for a hospital—and that's what you want. The Joint Commission also evaluates ambulatory clinics, home health agencies, home medical equipment companies, nursing homes, laboratories, behavioral healthcare facilities and more.
Know Your Hospital's Numbers Practice makes perfect. Research has shown that for several common operations, hospitals that perform a specific number or more of that operation every year have better success rates. Your surgeon should be able to give you this info, as should the hospital's information line.
Have the Surgeon Draw a Picture Surgery performed on the wrong limb? Or wrong person? Absurd! Unbelievable! Except it really does happen. You know that. You see it in the news more frequently than anyone would like. The Joint Commission requires the surgeon to literally mark the site of your surgery (for example, left elbow, right side of abdomen, wherever appropriate) before the operation. And the docs and nurses will triple-check your identity to make sure that you're the right patient before they even lift a scalpel.
Get Thee to a Hospital How are you feeling? Fine? Never better? You need to find a hospital. The perfect time to scout for the best hospital is when you don't need one. Most people don't give it a thought until a paramedic is looking them in the eye and asking, "Do you have a preference of which hospital you want to go to?"
Insist on Being Scanned In the hospital, have staff check your hospital ID bracelet before they give you any medication, take blood or wheel you off for a test. If your hospital uses bar code scanners on ID bracelets, insist they scan you every time.
Is your ER on the level?Re: Going to the ER Racing Hearts Do you know how fast your local emergency room treats heart cases? What is their average time for getting heart attack patients into surgery? Hospitals are required to document their times. This info is also available on the Joint Commission's website at QualityCheck.org.
Is Your ER on the Level? We bet you didn't know all ERs have a level number. Level 1 ERs are tops; they have specialists and high technology at the ready and are equipped to handle anything, most notably, trauma. You'll be lucky if you live near (or have your accident near) one. ERs that rate a level 2 or 3 have a narrower repertoire and fewer specialists.
Make friends with your pharmacistPharmacy Friends
Your pharmacist is the least expensive and most accessible health resource you have. Why do so few people take advantage of this golden resource? It baffles us. Smart patients develop a personal relationship with a pharmacist, which makes it easier to ask questions.
Inquire About Technology Ask if your pharmacy uses the latest safety cross-checking software and medication-monitoring technology.
Go Digital Some pharmacies allow doctors to write prescriptions electronically. Your doctor can punch in your prescription, and it will be waiting for you at the pharmacy. This eliminates errors from misreading handwritten prescriptions, and renewals are a snap. Ask your pharmacist if she has this capability, then ask your doctor to use it.
What's the Buzz About Grapefruit Juice? "Don't mix this drug with grapefruit juice!" This strange warning has been circulating in recent years. It's due to a nerdy biochemical thing. To digest grapefruit, you use the same enzymes in your lower intestines that you use to metabolize many drugs. This means more of the drug will reach your bloodstream, which can increase its effect and chances of being toxic.
Declare germ warfareDeclare Germ Warfare
The biggest enemy you have in the hospital isn't your phone-addicted roommate. It's much smaller. And there are billions of them. They have names like B. staphylococcus or staph, Klebsiella and enterobacter. One may have even visited you before. His name is E. coli, and he's responsible for half of the all hospital infections.
Mom Was Right—Wash Your Hands! When you're in the hospital, absolutely insist that everyone who comes in contact with you washes their hands first, and make sure you wash your own hands several times a day. You might even post a sign that reads "Thank You for Washing Your Hands" as a gentle reminder.
You Don't Bring Me Flowers To reduce the odds of getting a hospital infection, your first gift should be an industrial-size jug of alcohol hand-sanitizing gel. Keep it by your bed and ask all visitors who might conceivably touch you to squirt some on.
Insist on a Clean Stethoscope Stethoscopes are filthy from being used on several patients an hour. Most doctors now wash their stethoscopes with alcohol between patients, but we'd always ask.
Don't Touch That Remote! Or wear rubber gloves if you want to click through the daytime soaps. A study found that remote controls are some of the most germ-infested things in a hospital room.
Stick up for your rightsNavigate the Bureaucracy Never Think Twice About Getting a Second Opinion No smart detective would hang his whole investigation on a single witness' story without making sure it checked out. And no smart patient would hang her whole life on a single expert's judgment. Research has found that getting a second opinion results in a new diagnosis in as many as 30 percent of all cases, but shockingly, only 20 percent of patients get a second opinion.
When you consult a doctor for a second opinion, simply hand over the test results, give the facts of your case and let the doctors ask the questions. Do not say, "My doctor said I have this, but I have my doubts." That could bias the specialist.
Just What Gives You the Right? When you're admitted to the hospital, you're given an armload of forms explaining your rights, but are you in the right state of mind to read them? That's just one of the reasons you need a health advocate—a trusted family member or friend—who will help you navigate the healthcare system and ask smart patient questions. Ask your healthcare advocate to dig through all the forms on your behalf.
What, Exactly, Is a Do-Not-Resuscitate Order? Simply, this means that if your heart stops or you stop breathing, the medical staff won't try to revive you. You have to specifically ask for a DNR and put it in writing. Find a sample form online at JCInc.com and RealAge.com.
Know all your alternative optionsKnow Your Alternatives
Although a large number of alternative medicine professionals have their patients' best interests in mind, shams abound. Some are dangerous. You can't bumble your way through the world of alternative medicine and expect to stay out of harm's way. Make sure that your practitioner is open to conventional medicine and will work with your doctor's therapy and doesn't insist on being the alternative to your doctor's therapy.
The ABCs on Vitamins and Minerals You might be surprised to know that, except for a few basic vitamins and a few minerals, we have limited scientific information about most supplements on the market. The bottom line? If a supplement works for you, then it works.
Look for the "USP" Nutritional supplements are classified as food products, so the FDA does not regulate them. Manufacturers can sell them in any quantity or combination they want, with little quality control. The pills might not even contain the substance claimed. Always look for a small "USP" on the label. This means that the United States Pharmacopeia, a reliable nonprofit science organization, has tested and verified the supplement. Check out the U.S. Pharmacopeia's website at USP.org to get more details.
What's the Real Deal on Echinacea? Come cold and flu season, we see hordes of patients taking the herbal powder echinacea to ward off a budding bug. Unfortunately, the very few studies on echinacea in Germany and the United States have produced mixed results. And a few even hinted at negative affects. You might be better off putting your money toward a piping hot bowl of chicken soup, which has been proved beneficial by scientific research and grandmas everywhere.