When reports are published demonstrating just how dangerous it can be to utilize our healthcare system, I, like most physicians want to imitate an ostrich and stick my head in the sand. But the sad truth is errors are made and the implications can be decidedly bad. So bad, in fact, that medical errors (acts of omission and commission) are one of the leading causes of death in the United States. So what can you do to prevent becoming an unpleasant statistic?
1. How would you select a mechanic to work on your aircraft? Check their credentials? Talk to them and see if there is a common language about what you want to achieve? Ask fellow pilots for their experiences? Of course you would! But most people choose their doctor by looking for a name in their insurance provider’s guides or maybe going to the extraordinary lengths of asking a friend. And yes, I am being sarcastic. When selecting a primary care physician—and that can be a gynecologist for a woman, pediatrician for a child, or general practicioner for anyone—ask for an initial consultation. How busy is the waiting room? Are people seen on time? Is the support staff polite and pleasant? When the doctor sees you, is there a firm handshake, is eye contact made, and do you get the impression the physician is engaged in your issues. Someone who leans forward, takes notes, has an open face and responds to questions with kindness and respect is more likely to be caring and diligent. Sir William Osler described a good doctor as one who is able, available, and affable. You deserve all three.
When choosing a specialist, ascertain their training and experience level. You will not insult surgeons by asking them how many of a given procedure they have performed—in fact, if they do object, you have your answer; get the heck out of there! Sometimes it is worth asking if you can talk to prior patients if about to undergo a major procedure. One sure fire way to know you have a classy doc is to surreptitiously ascertain who the hospital staff would choose to do their operation!
Recent changes in our society have had some strange consequences in medicine. The debate about conflicts of interest in medicine has become rabid and for any doctor to have corporate relationships with a pharmaceutical or medical technology company is deemed anathema. Yes, there have been abuses, but after many years in medicine, I have to state that I have seen the finest and most ethical behavior from my colleagues. It is inconceivable to me that any doctor would prescribe one drug over another, or use one particular surgical instrument because he or she received payment to give lectures or run a clinical trial for a company. In fact, if you think about it, for a surgeon to state to a patient “you have colon cancer and I need to operate on you” is, by definition, a conflict of interest because the surgeon will be paid. But any right-thinking person knows this to be an odious assertion. Things have become so crazy that any interaction a doctor has with an industry where money changes hands will become a matter of public record under the “Sunshine” act. I am laying this out to make a point; when seeking care for myself or loved ones, I would be delighted to find the most conflicted physician with multiple corporate relationships. Why? Because that doctor is clearly at the top of his or her game, and his or her opinion is sought by folks in the business. That is who I want looking after me!
2. Similarly, when selecting an institution to have your care delivered, use all available resources to evaluate their quality and competence. As Americans, we have “faith in bricks”—the hospital must be good because it has a big name. But remember, there are multiple specialties within any given hospital or clinic and it is the ones germane to your care that you need to know about. Look for comments from people you know who have been treated there, see how the institution ranks among groups like US News and World Reports. Check out the various patient grading websites, but do so with a keen eye; some doctors do not appear because they ask their patients not to advertise them—some truly like a quieter life. The issue of data transparency has some real benefits by inspiring people to do better. For instance, check out the Pennsylvania Health Care Cost Containment Council’s website. They grade in-state hospital and physician performance and write excellent reports. See how your hospital stacks up and ask if they make their data known to the public. They should.
3. Understand what is going to be done to you. This is your health, and just as the doctors and nurses have an obligation to look after you, it is your obligation to do your bit. Outcomes are definitely improved by having realistic expectations and that can only happen if you have done your research, ascertained what the questions are, and obtained the answers. Prior to a procedure you have to sign an informed consent form. You need to be informed before you do. Take control of what is going to happen—for instance, if you are going to have surgery on a right groin hernia, take an indelible marker and write on the correct side: "THIS SIDE" with an arrow. As a surgeon I always appreciated that!
4. Among the most common medical errors or unintended sequelae of therapy are hospital acquired infections (HAI) and the rise of nasty bugs like MRSA (Methicillin Resistant Staphylococcus Aureus). Check out the work of prior Lieutenant Governor of New York Betsy McCaughey. Consider asking each healthcare worker if they have washed their hands before touching you, and if you need a central venous line, ensure the Center for Disease Control protocols are followed. Once again, it comes down to taking charge.
5. Be involved in all aspects of your care, and that includes dealing with the insurance companies. If they resist a specific treatment, it may be because there is truly something better or that they are trying to save money. Ask for facts and demand that everyone who is involved treats you well. This is health care after all! It is not about being a pain; it is resetting standards, which have slipped for sure and must not be allowed to slide further.
Be well, fly well!