How to Be a Smarter Patient
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How to Be a Smarter Patient

We asked doctors on the front lines to tell us the real secrets for getting better medical care.

Finding Dr. Right

I've survived breast cancer -- twice. And I'm a health journalist. My life and my living depend on asking doctors the right questions, so you'd think I would be a smart patient, right?

The truth is, I've done some dumb things. I've gone to appointments unprepared, left without knowing what I really needed to know, and had tests and procedures I probably could have skipped. I even put off one surgical decision till the very last minute, still debating options while the nurse was starting my IV. While my errors haven't caused any catastrophes, they could have. Medical mishaps occur every day -- but we don't want them to happen to you. That's why we asked members of the LHJ Medical Advisory Board to share their best insider advice to help you work the system like a pro and get the best care possible.

Finding Dr. Right

Most people spend more time researching a household appliance than shopping for a physician, but your health is worth the effort.

Tap Your Social Network

You can find a great doctor by asking an acquaintance with your exact same problem or someone who works with doctors every day. "With Facebook, everyone can have a doctor friend one step away. Use your connections to come up with names," suggests David Kriegel, MD, director of the Manhattan Center for Dermatology in New York City. Looking for a surgeon? Ask your friends if they know a local anesthesiologist, scrub nurse, or surgical resident, because they see what goes on in the OR every day and know who the most skilled specialists are. If you need an orthopedic doctor, talk to a physical therapist. And no one knows obstetricians like a labor and delivery nurse.

Erin Turner, 29, of Arlington, Virginia, found the perfect doctor thanks to Twitter when she learned that a specialist at the Mayo Clinic, Richard Berger, MD, was hosting an online chat about wrist pain. Turner described the pain she had lived with for five years and the treatments she'd had, and Dr. Berger recommended she get a second opinion. Turner researched his credentials and experience and decided she should see him. "Less than 24 hours after my initial appointment with Dr. Berger, I not only had a new diagnosis but had surgery to correct a torn ligament," she says.

Don't Be Afraid to Consider a New Doctor

It's important to build a relationship with a physician you see regularly, but don't fall into the trap of being too loyal. What kind of woman cheats on her favorite doc? A smart one. Even a specialist can't be an expert on everything within her specialty. "For example, it's hard for women to acknowledge that the obstetrician they love and trust may not be the best person for every gynecological problem," says Lauren Streicher, MD, assistant professor of obstetrics and gynecology at the Feinberg School of Medicine at Northwestern University. "One gynecologist might be an expert in PMS while another concentrates on menopause or hysterectomies. If a physician is interested in a specific problem, she'll read about it, see more patients with it, and get better at treating it."

If you have questions your doctor isn't able to answer or a problem that's not getting resolved, or you're at a certain life stage, such as trying to have a baby or going through perimenopause, go with the expert more specialized in your type of case. You can always switch to your former physician -- or not.

Dig a Little Deeper

To find a doctor who focuses on your specific problem, take your research to the next level. Check with a teaching hospital referral service. They usually list detailed information about each doctor's particular interests. Don't assume that the department head is your best bet; he may be at the top because of his administrative abilities, not his medical skills, says Robynne K. Chutkan, MD, the founder and medical director of the Digestive Center for Women in Washington, D.C.

While searching for a specialist, get suggestions from the local chapter of an advocacy group, like the National MS Society or the American Diabetes Society, or a professional organization such as the American Association of Gynecologic Laparoscopists. For serious or complicated problems, use Google Scholar or PubMed.gov to find doctors who publish papers on your condition. And patient-support groups often have great advice about local providers, treatments, common side effects, and how to cope.

Find a Surgical Specialist

Experience counts when treating any tricky condition but especially when it comes to surgery. One of the best questions you can ask a potential surgeon is, How many times have you done this particular procedure? "That doesn't mean that an orthopedic surgeon who does knees and shoulders and broken arms can't do a knee as well as someone who only works on knees," says Daniel Rousso, MD, past president of the American Academy of Facial Plastic and Reconstructive Surgery. "He may be an exceptional surgeon who can do it all. But the people who do mainly one procedure get the kinks worked out."

Keep It in Perspective

Of course, you don't always need -- or even want -- the most specialized expert you can find. There will be times when you need a physician with a broad, experienced view to balance the narrow focus of some specialists. For example, if you go to a breast surgeon after an abnormal mammogram, you may end up with a breast biopsy -- even though watchful waiting might be the best course of action, says Dr. Chutkan. Sometimes the best physician for the job is someone with a wider focus who can help you decide where to go for the next step and how to sort through conflicting advice.

Do a Background Check

Once you have a list of physicians, check their credentials. Go to the Federation of State Medical Boards (fsmb.org) to access information about licensing and complaint history. Resist the temptation to look at doctor-rating sites. Dr. Streicher and Dr. Chutkan both caution that some sites encourage doctors to become paid members, which then boosts their rankings, and others simply don't have enough consumer reviews to be reliable or objective. Finally, go to the American Board of Medical Specialties (abms.org) to be sure your top candidates are board-certified. Then make an appointment.

Prep Tips

Our medical advisory board is unanimous on this point: Preparation is the key to maximizing your health care, yet few patients seem to do it. "I tell people to prepare for an appointment as if they were going to a job interview," says Jennifer H. Mieres, MD, a cardiologist at the North Shore-LIJ Health System in Lake Success, New York.

Create a Medical Profile

When you're filling out the doctor's paperwork in the waiting room, having your own health summary at your fingertips will make it faster, easier, and more accurate, suggests Carol E. Ash, DO, a pulmonary, critical care, and sleep medicine specialist at Meridian Health, New Jersey. Keep it up-to-date so you can grab it quickly for appointments and emergencies. You should include contact information for all your doctors and your pharmacy, insurance details, the dates of previous ailments or surgeries, chronic conditions, a list of allergies, medications, herbs or supplements you take (including frequency and dosage), age at your first period, any pregnancy-related problems you've had, and a detailed family health history. Download and fill out our exclusive personal medical profile form at LHJ.com/medicalprofile.

Keep a Health Log

This can be an informal diary you write in a notebook or online. It should include notes about symptoms and triggers, the results of any medications or treatments you try, and other health issues. Jot things down as they happen and include dates. Also keep track of numbers such as your blood pressure and cholesterol results, says Dr. Mieres. You may notice trends over the years that could otherwise be missed, especially if you switch doctors.

Elizabeth Pflaum, 45, a parenting coach in Scarsdale, New York, was being treated for ulcerative colitis, but discussing diary details with her doctor helped the two of them figure out that she didn't have that at all. "In fact, my symptoms were caused by lactose intolerance and an infection caused by another condition. So I was able to stop taking steroids and getting colonoscopies every six months," she says.

Do Selective Research

It can be helpful to read up on a condition at a reliable health site, such as NIH.gov or MayoClinic.com. But think twice about diagnosing yourself online no matter how tidily your symptoms seem to fit. "If you come in thinking you have X when you really have Y, you may not be listening to your doctor," says Tina Alster, MD, founding director of the Washington Institute of Dermatologic Laser Surgery in Washington, D.C. "We spend a lot of time reeducating patients because there's so much misinformation out there."

Adriane Fugh-Berman, MD, associate professor of pharmacology at Georgetown University Medical Center, warns that you should watch out for fake consumer sites if you're researching a particular condition. "It's not always easy to tell if a drug company is behind a site or how it's funded, but it's smart to check," she says.

Prioritize Your Questions

Think about what you most need to learn from your visit, and write your questions down, especially if you're shy about discussing certain topics or symptoms. Plan to focus on your top three concerns early in the appointment so you get to the important stuff before your time is up. If you have a lot of questions to remember, Dr. Kriegel suggests listing them on your smartphone and working them into the conversation since doctors sometimes get unnerved when they see a lengthy list. And you thought only patients got anxious!

A Good Appointment

Surprise: The amount of time primary care docs spend with their patients is actually growing. Between 1997 and 2005, the average length of a visit increased from 18 to 21 minutes. Many doctors say they wish they could talk with patients more, but you can do a number of things to maximize the limited time you get.

Bring a Friend or Family Member with You

While you'd probably think to do this if you were getting the results of a biopsy or a diagnosis, our experts recommend bringing someone along for any major informational visit, whether it's a pregnancy checkup or to discuss how to get your diabetes under control. Not only will your companion come up with questions you might not think to ask, he'll also keep you honest and may be able to help you nail down specifics with greater accuracy. "I'll ask a patient how long she's had a certain spot on her skin, and she'll say, 'Oh, probably a month,' and the husband will say, 'It's more like a year,'" says Dr. Kriegel. That could make a difference in whether the doctor decides to do a biopsy or just watch it for a few months.

Retain the Information

Even if you have a backup with you, one of you should be taking notes or even recording the conversation (be sure to ask first). "Studies suggest that 85 percent of what patients hear is forgotten by the time they get to the reception desk," says William N. Levine, MD, director of sports medicine at Columbia University Medical Center. Before you leave, find out the preferred way to have your follow-up questions answered. A call to the nurse or physician assistant might be your best bet, but some offices let patients use e-mail for simple questions.

Get Reassurance

Doctors assume, logically, that you go to see them to find out what you have and how to fix it. But sometimes what you really want to know is what you don't have. You want reassurance that persistent bloating isn't ovarian cancer or that an endless cold hasn't turned into a sinus infection. Once you know that, you may be comfortable with waiting it out. If that's your situation, speak up. "Doctors may order tests or prescribe drugs when they think the patient expects them to do something," says Dr. Chutkan. "Watchful waiting is not in vogue, but it's a useful tool." Every time your doctor suggests a drug or test, be sure to ask: What will happen if I don't do this? Are there any alternatives? What are the risks?

Talk About Side Effects

Sometimes your doctor will prescribe a newly approved drug or offer free samples of it. "But we may not have much information about the long-term effects," says Dr. Fugh-Berman. If you have the option, especially if it's for a long-term, chronic condition, it's generally better to use an older drug. "And generic medicines are not only cheaper, they've usually been on the market at least seven years, so we know a lot more about them." While doctors should always tell you about any potential adverse effects, they may not know as much about the medication as you'd like. It's worth talking to your pharmacist or looking up the drug yourself (try FDA.gov or Drugs.com).

Get a Second Opinion

Yes, you've heard it before, but our advisory board says most people still skip this step, perhaps because they assume they already have the right diagnosis and treatment plan. That's not a safe assumption. "In a series of studies, the diagnosis or the treatment changed 30 percent of the time with a second opinion. And they weren't minor changes," says Michael Roizen, MD, chief wellness officer at the Cleveland Clinic and coauthor of You: The Smart Patient. A great doctor not only expects you to double-check his work with a colleague but hopes you will because it adds a second viewpoint to the problem being evaluated. After all, your physician has the same goal you do: to keep you alive and well.

Many doctors say you should get a second opinion any time you're contemplating nonemergency surgery, coping with a life-threatening or chronic condition, or taking long-term medication, such as antidepressants or statins (to be sure you need it and that it's the best drug for you). You should also seek a second opinion if you can't get a diagnosis, if you're not getting better, or if you don't believe your doctor is taking your symptoms seriously.

Denise Cohen was glad she did it. The 50-year-old was initially diagnosed with stage III breast cancer in Colorado Springs, where doctors recommended that she start chemotherapy immediately, followed by a mastectomy and radiation. She decided to get a second opinion at Memorial Sloan-Kettering Cancer Center in New York City, where doctors urged her to have the surgery first. "It turned out that I was actually high stage I or low stage II. So instead of the heavy chemotherapy regimen my first doctors recommended I was able to participate in a clinical trial with a much smaller dose of chemo and I didn't need radiation at all," says Cohen.

Don't let cost stop you. Insurance typically covers fees and some plans require you to get a second opinion. Options to help with travel expenses exist. Cohen was able to stay for free at the American Cancer Society's Hope Lodge in New York (she learned about it through social networking) and also got several free flights through the Corporate Angel Network.

Can't Get an Appointment?

"The receptionist should become your new best friend," says Dr. Streicher. "I can't tell you how many times my receptionist has said to me, 'You don't have any openings, but I've been talking to this very nice woman and she really needs to see you. Is there anything you can do to make time for her?'" If you can't charm your way in, ask another doctor, such as your internist or gynecologist, to call the office on your behalf. "Unless the doctor's going to Zimbabwe for three months, there's almost always a way to get in if you really need to," Dr. Streicher says.

Also consider seeing a nurse-practitioner or physician assistant. With more education than a typical nurse but less than an MD, these professionals can be a great resource for general care or straightforward problems.

When You're in the Hospital

Appoint a friend or family member to be your advocate. "Your job is to heal, so it's important to enlist someone else to take the job of asking questions," says Shmuel Shoham, MD, infectious disease specialist at Johns Hopkins University School of Medicine. "It's always good to get a general idea of the plan for the day and then keep asking questions: What is this fluid? What is this pill? What are the most common side effects of that?" Also: Do you have a checklist for this procedure? More and more hospitals are using step-by-step checklists for everything from inserting IVs to delivering babies and this simple innovation has been shown to reduce medical errors and complications.

Dangerous antibiotic-resistant infections are on the rise in many hospitals. So your advocate should also politely request that your health care providers wash up if they didn't do it when they entered your room. While hands are the most obvious germ carriers, studies have also shown that doctors' neckties, white coats, pens, and stethoscopes can all harbor infectious bacteria. So it might also be worth asking your doc if he will tuck in his tie and clean his stethoscope with an antiseptic wipe.

On a more personal note, Dr. Shoham suggests that you bring a framed photo of yourself to the hospital. He says, "I've seen patients do that, and it's a reminder that you're a person, not just a patient. It's a wake-up call that pushes me to be a better doctor."

Originally published in Ladies' Home Journal, August 2011.

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