One of the more valuable books I have read in some time about healthcare is The Patient's Playbook by Leslie D. Michelson. It's not really about health reform or innovation or the future; instead it is a practical guide for patients and families on how to survive encounters with the healthcare system and prepare to stay as healthy as possible for as long as possible.
There's no magic to his prescription. The author, an executive of a firm that advises patients on choosing treatment options, suggests all of us should prepare for illness while we are still healthy. One of the first things he suggests is getting hold of our medical records, to which we have a legal right. A next step is determining what hospital we would want to go to in an emergency. Some of us live in areas where we already know which hospitals have better reputations than others, but you should really research which hospitals have the best quality scores, mortality rates and shorter ER wait times.
Michelson writes that we should all choose a primary care physician with whom we can have a dialogue and build a trusting relationship. A good family doc will orchestrate a patient's care when illness arises. But the author cautions us on this point. "The challenge," he says, "is that the typical primary care physician sees 20 to 40 patients a day. How can such doctors think clearly and carefully about each one?" For those who can afford one, Michelson strongly advises choosing a primary-care physician in a concierge practice. He says that if you want someone "who can give you an abundance of quality time at the drop of a hat," paying the annual or monthly retainer for a concierge physician is likely the best choice. "But even if you cannot afford the concierge option, it is worth investing time in the selection process. Develop a list of qualities you feel are important in a doctor, solicit recommendations, interview candidates," he writes.
When a serious condition arises, he advises that patients seek out "super specialists" — "doctors who spend their time thinking about the disease you have. These experts tend to be found in academic medical centers and are often deemed 'in-network' by insurers, representing a rare healthcare bargain."
Michelson implores patients to be intensely involved in their own care. Many people, when speaking with a doctor about a health problem, behave as if they were powerless or their fear renders their communications less clear. He urges patients to "bring their A-game" to the doctor's office. Use a trusted resource like the National Institutes of Health or a reputable medical website to educate yourself about your condition. "Then, during your appointment, take notes and ask questions," he states.
Michelson cautions us that if you end up in the hospital you must be vigilant. Why? He claims that 10 percent of patients suffer a hospital-associated complication such as a fall, infection or adverse drug reaction. A 2015 Johns Hopkins study revealed that medical errors are the third most common cause of death in the Unites States.
No patient should accept a new medicine or submit to a procedure in a hospital without understanding why it was ordered, Michelson writes. Patients should also insist that any new symptoms — swelling, fever, pain — be promptly evaluated. If a biopsy is performed, make sure the most expert pathologist available evaluates the sample. Although doctors may have entered medicine "to develop a strong emotional bond with people and help them through health challenges," providers now find themselves drowning in patients, process and data. As a result, patients need to closely monitor their own care.
The author also makes it clear he believes in smart care, not more care. He devotes a chapter on the harms of unnecessary testing and gratuitous procedures, reminding readers that "overtreatment can be as dangerous as under-treatment." Short of an emergency, it is important for patients and doctors to think things through. Michelson recounts the story of a man whose shortness of breath led him to a new doctor, a reflexively scheduled angiogram and the insertion of stents in his heart arteries well before a careful diagnosis had been made. The man's problem, it turned out, wasn't the heart but the lungs. The stent procedure wasn't necessary.
In essence, Michelson is giving us a guide to survive in this time of medical change and disruption. If we truly want good health, we have to involve ourselves in making sure the care we receive from the medical profession is delivered to us in an efficient, effective way. I urge you to read his book for your own survival and that of those you care about.