Defend Your Health: Be an Empowered Patient

by denisesalceda

“After generations of our treating health-care providers and doctors like gods, never questioning them and feeling complacent, Cohen’s book is a wonderful shot in the arm. It’s for all of us who want to approach medicine like consumers, to ask questions, and to know our rights. The Empowered Patient gives patients the valuable tools to advocate for themselves and their loved ones.” -Lee Woodruff, author of Perfectly Imperfect

I came across The Empowered Patient, written by Elizabeth Cohen, CNN senior medical correspondent, on one of the nearly bare bookshelves at my local Borders during their store closing sale and figured I’d give it a try. Well, it turned out to be the best $2 I have ever spent.

Once I picked the book up to start reading it, I couldn’t put it down.

I know, a book about the health-care industry? Doesn’t sound too intriguing, right? This one proved me wrong.

I can’t believe I ever stepped foot in a hospital without having read The Empowered Patient. It really opened my eyes as to how important it is for us to advocate for our own health, and even our own lives.

Although I think you should definitely read the whole thing because it’s super interesting and chock-full of unbelievable real-life cases, I’ll give you a quick run-through of the main facts, tips, and advice that Cohen provides in her book.

(the following information based on various studies, statistics, and interviews has been adapted from The Empowered Patient by Elizabeth Cohen)

What Doctors Won’t Tell You

  • 99,000 Americans die yearly from infections they get at the hospital.
  • 98,000 more die each year from medical mistakes made in the hospital.
  • Hospital dangers kill more people per year than breast cancer, prostate cancer, car accidents, AIDS, and diabetes put together.
  • When you go to the doctor with a health problem, his diagnosis will be wrong as many as one out of four times.
  • More than 7 percent of the time, doctors fail to inform patients when they’ve had an abnormal test result.

Be a “Bad Patient”

Real-life case:When Stephanie turned 13, she started losing weight dramatically and began getting cramps and bloody diarrhea every time she ate. Her mom, Barbara, took her to a gastroenterologist who diagnosed Stephanie with irritable bowel syndrome (IBS). For the next eight years, Stephanie tried drug after drug to cope with the pain and embarrassment of her illness. When she reached age 23, Stephanie began taking yet another drug prescribed by her gastroenterologist, but instantly got a high fever and experienced 26 bloody bowel movements in six hours. Although she reacted badly to the drug, Stephanie’s doctor insisted that she stay on it, but Barbara refused to keep her daughter on a medication that was obviously wreaking havoc on her body. When Barbara told the doctor they would be getting a second opinion from a different specialist, he shook with anger, stormed out of the hospital room, and slammed the door behind him. A surgeon at the University of Chicago quickly informed Stephanie that she had never had IBS, diagnosed her with ulcerative colitis (an inflammation of the lining of the large intestine and the rectum) and surgically removed her colon. Stephanie recovered and reached a healthy weight. However, if Barbara had been a “bad patient,” her daughter could have been treated at 13 instead of 23–without the unnecessary years of pain and suffering.

  • Ask a lot of questions: make sure you understand everything the doctor tells you. If you don’t, ask for clarification. Don’t simply accept everything they tell you because you may think they know what’s best. Keep in mind that patients who understand their discharge instructions are 30 percent less likely to be readmitted to the hospital or visit the emergency room.
  • Don’t worry about whether your doctor likes you: your health is more important than that.
  • Remember, it’s a business transaction: you’re paying the doctor for a service. It’s okay to be respectful, but at the same time, demand the care you deserve.

Dr. Wrong Can Sabotage Your Health

Real-life case: When Dr. Nancy Snyderman was a medical student doing a rotation in the emergency room, a middle-aged woman walked in with chest pain. The senior doctor asked Dr. Snyderman and her fellow students what the diagnosis could be, and they offered various possible answers. He disagreed with all of them. The senior doctor explained that she could be hysterical, so he gave the woman some antacids and sent her home. She walked out of the emergency room and dropped dead in the parking lot.

  • Unfortunately, not all patients are treated equally–doctors play favorites.
  • Doctors consider up to 30% of their patients to be “difficult.”
  • Women are less likely than men to receive gold-standard treatments for diseases.
  • Women are twice as likely as men to die within the first few weeks after suffering a heart attack from not receiving the right treatment.
  • White patients are more likely than black patients to walk out with prescriptions for heavy-duty drugs such as OxyContin, Percocet, or Vicodin.
  • More than 40 percent of doctors say they have a “negative reaction” to obese patients.
  • Out of dozens of different categories, physicians ranked obesity #4 on the negativity scale, behind drug addiction, alcoholism, and mental illness.

Find Dr. Right

  • Find a doctor who takes you and your health care concerns seriously.
  • Start the search when you are healthy–when you’re already sick, you’re desperate.
  • Take the doctor/staff for a test drive by doing a “meet and greet,” or by scheduling an appointment for a small problem to see how they handle it.
  • Ask how your doctor handles illnesses that occur on weekends or after their office has closed. Are they or one of their partners on call?
  • Do you like this doctor? Do they make you comfortable? Do you trust them? Listen to your gut instinct.

Be Prepared for Your Appointment

  • The average doctor’s appointment lasts 18 minutes–not enough time to solve a serious health issue.
  • On average, a patient talks 23 seconds before a doctor interrupts with a redirecting question/comment that makes the patient lose their train of thought.
  • Stop being passive and start practicing “planned patienthood.”
  • Think through what you want to get out of the appointment before you get to the doctor’s office.
  • Always carry your insurance card with you.
  • Walk into the examining room with a list of questions and a list of medications you’re currently taking.
  • If your medical history is complicated, have a piece of paper with relevant treatments, surgeries, and procedures jotted down on it and hand this to the doctor.
  • Bring in test results from other doctors’ offices.
  • Remember what issues are important even when the doctor interrupts you.
  • When you walk out, have a clear idea of what you need to do in order to get better.

  • You can get an appointment on short notice by speaking with a nurse or an office manager, or emailing the doctor directly.
  • To avoid long waits in the waiting room, book the first appointment in the morning, or the first appointment after lunch.
  • Ask your doctor for his e-mail address for getting an appointment on short notice or getting clarification after an appointment.
  • Patients do better when they have a family member or a friend at an appointment to help ask questions and listen to doctor’s instructions.

Avoid a Misdiagnosis

  • In a study, pathologists (doctors who look at tissue samples under a microscope) were presented with tissue samples and asked to say if they were normal, cancerous, or precancerous. They made the wrong call close to 12 percent of the time. 
  • According to infectious-disease experts, the flu test (including swine-flu) typically given in ERs and doctor’s offices across the country is wrong about half the time.
  • When researchers at the University of Chicago surveyed eight family medicine practices, they found that in an 8-month period, there were 966 test-processing errors.
  • Know your medical history; tell it well and be specific and concise about what is bothering you at your doctor’s appointment. 
  • If you get a test done, get the results yourself–don’t expect your doctor’s to talk to each other.
  • The first diagnosis isn’t always the right one. Diagnosing a health issue is a complicated process with many opportunities for mistakes.
  • Research your diagnosis on the internet and make sure your symptoms match the disease you supposedly have.
  • If you suspect a misdiagnosis, ask your physician, “Doctor, what else could this be?”
  • Ask if there are any tests that could help determine the right diagnosis. If you haven’t had them, ask why.
  • If you still feel that you’ve been misdiagnosed and your doctor isn’t answering your questions, seek a second opinion.

The Internet is Your Friend. Do Your Research.

  • Find the good health sites: you can usually trust websites that end in “.gov” or “.edu” and sites for well-established groups such as the American Heart Association. Be careful of sites that try to sell you something.
  • Email physicians who are leaders in their field: many respond to emails from patients you don’t know.
  • Learn how to find doctor’s email addresses: if they work at a university, go to the school’s website and do a search for their name. If you can’t find it, look up the doctor’s name on Google Scholar or PubMed because their email is almost always published in the study.
  • Don’t take a stack of internet printouts to your appointment:  bullet point the most crucial information and discuss it with your doctor. Say something like, “Doctor, what is your opinion on _____? I have heard about it, and I’m wondering if it’s what I might have.”

Don’t Let Your Insurance Get You Down

  • Research the nations best plans: Consumer Reports Best Insurance
  • Look up consumer complaints: NAIC Consumer Information Service
  • Check out a national satisfaction survey: J.D. Power and Associates national satisfaction survey
  • Find out financial ratings: Go to ehealthinsurance.com and look up your policy
  • Read about a heartbreaking experience with short-term insurance: “The Health-Care Crisis Hits Home”
  • Stay away from health-care discount cards: don’t waste your money–they are either scams, or don’t offer much of a discount.
  • Beware of short-term insurance policies: each time a policy ends, the company can discriminate against you because of preexisting conditions. Opt for a long-term policy and stop paying the monthly premiums when you don’t need it anymore.
  • Choose between an HMO or a PPO: Health-maintenance organizations generally cost less, but offer less flexibility in terms of choosing a doctor. Preferred-provider organizations cost more but give more options.
  • If your claim is denied, appeal! And then appeal again, and again: if your insurance company refuses to pay your bill it really should cover, you may need to appeal multiple times before you win.
  • Ask for help: when your insurance company refuses to pay a legitimate claim, ask your company’s benefits office for assistance. Doctors or advocacy groups can help too.

Get Cheaper Medications!

Real-life case: Bernadine was an unemployed 60-year-old who was paying nearly $500 a month for her prescription drugs to treat herpes (Valtrex: $197/month), high blood pressure (Azor: $138/month), and acid reflux (Zegerid: $154/month). She was struggling with the cost of her brand-name medications and desperately asked Cohen for help. By talking to doctors and pharmacists and visiting the Consumer Reports Best Buy Drugs website, Cohen was able to reduce Bernadine’s monthly pharmacy bill from $489/month to $32 a month. Bernadine’s new medication list? Over-the-counter Prilosec for acid reflux ($24/month), generic acyclovir for herpes ($4/month), and generic benazepril for high blood pressure ($4 a month).  Wow.

  • Plan ahead: if you know what kind of drug your doctor is likely to prescribe at an appointment, like birth control pills, see if your pharmacy has a $4 generic option or call your prescription-drug insurance company to find out the name of the cheapest pill that’s available. Ask your doctor if that specific pill can work for you. 
  • Your pharmacist can help: ask them to call your doctor’s office to see if you can take a less expensive alternative to a brand-name drug.
  • Just say “no” to samples: they’re usually the most expensive drug out there, so once you run out, you’re screwed. In the long run, it’s better to pay for a less expensive drug from the beginning.
  • Look into a Prescription Assistance Plan: Consumer Reports gives good advice on how to choose an assistance plan that helps you pay for expensive drugs.
  • Cut your cost in half: get a prescription for a dosage that’s twice as high and split the pill in half (as long as your doctor says it’s okay).

Beware of Greed and Other Drugs

“We’re trained to get doctors to use the newest, most expensive drugs we have.” -Gene Carbona, former drug representative

“I left the industry for a lot of reasons, but one was that something I said, or didn’t say, to a physician was going to hurt someone. I couldn’t sleep at night. Our jobs had nothing to do with truly educating doctors. It was all about how to get a doctor to write a prescription.” -Kathleen Slattery-Moschkau, former drug representative

  • Your doctors don’t always prescribe the very best medicine on the market for you.
  • Pharmaceutical salespeople cloud a physician’s judgment by taking them out to steak dinners, bringing them lunch in the office, and even directly giving them money–in exchange for the doctor prescribing the pharmaceutical rep’s drugs to their patients. 
  • Drug companies employ 90,000 salespeople, which is one person for every 5 office-based physicians.
  • In a 2007 study, researchers at Harvard found that 92 percent of doctors acknowledged having some type of relationship with pharmaceutical companies.
  • Another study found that the average doctor sees drug reps four times a month, and many see drug reps in their offices every day
  • Yale University reported that for every dollar the drug industry invested in marketing top-selling drugs, the company made $10.60 in sales.
  • Pharmaceutical reps are given training in sales school similar to training in spy agencies like the CIA–so that they can look around a doctor’s office, spot objects like photos, magazines, sports memorabilia, etc, and establish a personal connection with the physician.

  • Stick with the older, more reliable drugs: don’t let your doctor talk you into using a new, expensive drug just because. If the older, cheaper stuff works for you, keep using it. 
  • Figure out if drug reps have been influencing your doctor: see any young, attractive, well-dressed people with rolling suitcases in the waiting room? Those are drug reps. Do some research by going on the internet and looking up medical journal articles and conference presentations to see if your doctor has received money from the company that makes the drug or surgical device in suspicion.You can also directly ask, “Doctor, sorry to ask, but I actually ask all my physicians this question. Do you have a financial relationship with any drug companies?” or “Doctor, do you have any affiliation with the company that makes this drug you’re prescribing?”
  • Take caution if your doctor is unusually enthusiastic about a particular drug or surgical approach: if they push just one drug or surgical approach, ask if there are any other options. If your doctor says no, do your own research to make sure that’s true. However, if there are other options, have your doctor explain why the drug or surgical approach they are pushing is really the best one for you.

Don’t Let a Hospital Kill You

Check out actor Dennis Quaid’s story about a preventable hospital mistake that nearly cost him and his wife the lives of their newborn twins. Click here to read what happened and watch the 60 Minutes interview.

  • 98,000 people are killed each year by medical mistakes in hospital, while another 99,00 Americans die yearly from infections acquired in the hospital.
  • About 1 out of every 22 patients that check into a U.S. hospital acquires a bacterial infection, which adds more than $28 billion to health-care costs (2009 CDC report).
  • According to the Centers for Disease Control and Prevention, only 40 percent of health-care workers follow recommended hand-washing procedures to prevent the spread of infection.
  • In 2008, the average total emergency wait room time was four hours and three minutes.

  • Choose the right hospital: some hospitals are better equipped to take care of premature babies, stroke victims, or cancer patients. To find the hospital that is right for your needs, check out U.S. News and World Report’s top 50 hospitals, and visit healthgrades.com or leapfroggroup.org
  • Inform yourself about your medications: every morning, ask for a daily medication list along with dosages, administering time, and if they’re not intravenous, what they look like. Every time you get a medication, check to make sure it’s the right one at the right dosage. And don’t forget to check to make sure if the name on the label is yours–not another patient’s.
  • Call your family doctor on your way to the emergency room: your doctor can call ahead so the ER staff knows you’re on your way and why you’re coming in. Don’t use an ambulance unless it’s absolutely necessary–it’s expensive and you won’t get helped any faster.
  • Make some noise in the ER: if you’re not helped in a timely manner, don’t keep quiet. Ask to talk to the person in charge, but remain calm and mention if the person you brought in is getting worse. No response? Look for a house phone, dial zero, and ask for the hospital administrator on call.
  • Prep for your surgery: the week before your surgery, ask your surgeon if you should wash your skin daily with a disinfectant like chlorhexidine to prevent infections. Also ask if you should have a nasal or skin swab for the hospital infection superbug, MRSA.
  • Once in the hospital, take steps to prevent infections: before surgery, ask to be clippered, not shaved with a razor, which causes nicks and cuts where bacteria can thrive.
  • Be a germaphobe: ask the people who touch you to wash their hands. It doesn’t matter if someone walks into your room with gloves on; ask them to wash their hands and put on a new pair of gloves. To keep it simple, you want to actually see them wash their hands in front of you.

Helpful Websites

  • Is your doctor on the naughty list? Go to the Federation of State Medical Boards at www.fsmb.org to find out. 
  • Find a specialized, board certified doctor on the American Board of Medical Specialties website at www.abms.org.
  • Look up a doctor to see if they’ve been convicted of fraud or patient abuse on the Office of the Inspector General at www.oig.hhs.gov.
  • Get tips on how to negotiate your medical bills by reading the book My Healthcare Is Killing Me online.

I most highly recommend that you buy the book, The Empowered Patient, for yourself and read it from cover to cover–it may be one of the most important books you’ll ever read!

Check out elizabethcohen.com to learn more about the book and to buy a copy for yourself.

Thanks for reading! I hope you learned a lot! I sure did.

-Denise

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