How to Help the Healthcare System Help You (Part 2 of 3)

In last month’s column I discussed the beginning steps for making informed decisions about your health and how to work with your physician and other providers in order to develop an effective plan of care. This column is part two.  After building productive and positive relationships with your providers, as well as gaining knowledge about your health condition or goals for good health, you want to think about making your health care safer.

Making our Health Care Safer with Better Collaboration & Communication
 
Collaboration and Communication
Collaboration and Communication with clinicians is critical because in our current healthcare environment we often find ourselves with multiple caregivers and numerous physician specialists caring for us. Although having specialists involved has it benefits, information can also fall between the cracks. So what can we do to help?
 
1. First ask the obvious: Be specific about asking what your condition or diagnosis is. Some doctors avoid the terminology. Many times my patients with “congestive heart failure” never heard the term because they never asked for the diagnosis, and the doctor may have assumed that it sounded scary. The patients were treated and advised, but they failed to learn what their diagnosis was.
 
2. Do not be shy and do not assume that your doctors have communicated with each other. Ask questions and ask if the other providers talked to your physician or sent reports.
 
3. When you choose to obtain a second or third opinion, let these providers draw their own conclusions. Therefore, repeat your story and get a fresh perspective when you go for another opinion.
 
4. As noted in my last column, have a one-page medical history to present at your office visit, so you have time to get to the “heart of the visit.” If there is significant family history, include it (diabetes, autoimmune diseases, etc.).
 
5. Include a third eye and ear on the office visit. It always helps to have someone with you to listen, advocate and think of questions for you. It is hard to pay attention in these circumstances, especially if you are anxious.
 
6. Do not assume “no news is good news” (AARP Bulletin, September 2016). Test results can be lost or overlooked.
 
Making our Health Care Safer by Addressing Misdiagnosis
 
Top on the list for attaining safe care is getting the right diagnosis. We might think that misdiagnosis occurs mostly with rare or atypical conditions, but this is not the case. According to the National Academy of Sciences’ 2015 report “Improving Diagnosis in Health Care,” the following has been researched:

• In the US, at least 5% of all adults seeking care will experience a misdiagnosis
• Approximately 10% of patient deaths are due to misdiagnosis
• In complications that occur in hospitals, 6-17% are a result of misdiagnoses

(http://www.nationalacademies.org/hmd/Reports/2015/Improving-Diagnosis-in-Healthcare.aspx). This last statistic doesn’t even address errors made outside the hospital setting; it is difficult to track this information. It is not uncommon for a doctor to never find out when he/she made a wrong diagnosis.
 
The consequences of being misdiagnosed can be devastating (http://www.nationalacademies.org/hmd/Reports/2015/Improving-Diagnosis-in-Healthcare.aspx).  It is important to intervene. In addition to communication issues as discussed above, here are some things to think about to help prevent misdiagnoses:
 
1. Transparency and disclosure of mistakes

• Initially if you feel that something doesn’t make sense or that your physician is heading down the wrong path because the diagnosis does not match your symptoms or what you are experiencing, encourage your physicians early on to reconsider and to please explore other options or conditions.

 

• As mentioned in my first column, you want to become informed about your condition. If you are not getting better or not responding to the treatments, this needs investigating. It might mean a second opinion, repeat tests, or ordering new tests.

 

• If your doctor dismisses your opinion, it is time to change doctors or get that second opinion.

 

• Look for physician practices, facilities, and health organizations that value the team approach and encourage family members and patients to be part of the process. Unfortunately, resistance to change is cultural and we continue to witness small thinking.  But we can look for signs of innovative thinking and values that better match our own. For example, it is a good sign when a pediatrician emphasizes that he/she values the parents’ input about the health of their child and considers it number one in importance.

 

• In the world of medicine the reluctance to apologize is a complex issue. Without getting into liability issues, it is a good sign when a healthcare provider can apologize and then take corrective action. There is actually a “Sorry Works Coalition” in this country that helps to address adverse medical events, often including misdiagnoses. Voicing the simple phrase – “I am sorry”– is actually very powerful, and apologies for medical errors can get us to a better place.

 
2. Stereotyping, Gender Biases, and Narrow Focus on Symptoms
We are all human, including professionals; and at times we mistakenly draw conclusions that are subjective, biased, or incomplete. When it comes to diagnosing a health condition, it is essential that you sense your physician as being objective, thorough, and careful to differentiate.

• Stereotyping: For example, in working with a few of my older adult clients with complaints of muscle weakness, they experienced the stereotyping that this was age-related weakness and their complaints were dismissed. Actually, they were experiencing the side effects of a statin prescribed for their elevated cholesterol.

 

• Gender-bias: I knew a woman, who in the early stages of cancer, experienced gender-bias when the doctor – without doing any testing – concluded she was presenting with symptoms of menopause. 

 

• Narrow Focus on Symptoms: Finally, sometimes doctors (in haste especially) do not obtain a complete history and come to the wrong conclusion because of the narrow focus of symptoms. A doctor might conclude after seeing six patients with the flu that the seventh patient must have it too (AARP Bulletin, September 2016), because the physician failed to get a complete history about the patient’s recent travels and exposures, resulting in another type of infectious disease.

 
I call this the “Pooh-Pooh Syndrome.” If you feel your doctor is “pooh-poohing” your symptoms or dismissing what you have to say, move on to another doctor. Physicians who fall into this trap are either stereotyping, acting in haste, or their egos are getting too big to listen and treat their patients.
 
Making our Health Care Safer by Maintaining Your Personal Health Record
 
In order to safeguard your health, I always recommend that my clients maintain their own health record. Sign medical releases to obtain your files from your caretakers and your hospital (if you were hospitalized). If you have complex health conditions or a cumbersome file, you may want to hire someone to compile your record for you and help to interpret it. In general, include the following:

1. Current list of your prescribed medications, supplements, & over-the-counter drugs
2. Health summary on one page (previously described in Part 1): List current issues & conditions, medical history, allergies, emergency contact and insurance information
3. Baseline electrocardiogram
4. List of immunizations
5. Recent laboratory results
6. Reports of test results (X-rays, MRIs, ultrasounds)
7. Hearing & vision tests
8. Advance Care Directives
9. Any significant consults, progress notes, or summaries

 
Know what HIPAA means (Patient Privacy and Protection): Most of us have heard all too often the term, HIPAA, which stands for Health Insurance Portability and Accountability Act. The basics of this 1996 act provide the consumer with a national standard for handling our medical information, access to our own records, notification of privacy practices, disclosure policies about our health information, and processes for filing complaints and penalties.  The HIPAA laws pertain to providers, health insurance companies and healthcare “clearing houses.” Oddly enough, some examples of organizations not covered under HIPAA (which means they DO have access to your medical information) are life insurance companies, agencies that deliver Social Security and welfare, auto insurance plans, law enforcement agencies, Workers Compensation, and more. It is important for us to understand medical release of information and HIPAA in order to better safeguard our health.
 
In summary, October’s column (Part 1) addressed the steps to take to become an effective consumer, who can contribute to your own healthcare. This month’s column (Part 2) addresses ways that you can become a helpful watchdog in order to make your healthcare safer. Next month (Part 3), we will look at ways to find your inner voice to speak up and prevent harmful practices. Once again, the outcome is a worthwhile investment.