NEW YORK CITY, May 1—Patients these days often find the healthcare system to be a confusing, intimidating, and frustrating entity that is more interested in cost containment than in their well being. But they can take charge of their experience and get more satisfying results by finding the right physician, asking plenty of questions, and doing their homework prior to visiting the doctor’s office. That was among the practical advice offered by two healthcare system experts at an April 27 workshop at The New York Academy of Medicine entitled "How to Find Your Way through the Healthcare Maze," sponsored by the Academy’s Social Work Leadership Institute.

The first and most important healthcare step a person can take is to select a doctor who is the proper fit, said Myra Glajchen, DSW, MSW, one of the speakers and Director of the Institute for Education and Research in Pain and Palliative Care at Beth Israel Medical Center. The doctor should be located close to where you work or live, offer evening and weekend hours if that best fits your schedule, and be housed within a major medical center so that any needed lab tests can be done onsite, Glajchen said. Doctors should not keep you waiting more than an hour—if they do, find another doctor, since there are plenty to choose from. Doctors should also communicate with patients, something they often fail to do. “Patients say, ‘I want to be spoken to as an equal, I want my doctor to listen, and I want them to explain things simply,’” Glajchen told the 30-person audience, comprised mostly of women. “You should watch for doctors who do more talking than listening.”

Upon selecting a doctor who you feel comfortable with and who suits your needs, it is of the utmost importance to educate yourself and avoid being a passive patient. If diagnosed with an illness, learn about it and then ask your doctor any lingering questions. If a doctor advises you to receive a certain treatment, inquire about alternatives and the risks/benefits of each. “These days, we have a lot of choice,” Glajchen said. Finally, be sure your doctor is aware of all the medications you’re taking “even if it means putting all of your bottles in a paper bag and bringing them in,” and make it your business to learn about any new medication your doctor prescribes. “I wouldn’t dream of going on something if I didn’t read up on it,” Glajchen said. The new medication could cause possible side effects that you are unwilling to risk.

The doctor-patient relationship has become quite strained in recent decades for a variety of reasons. Among them is that the economics of healthcare effects patients in ways it previously did not, with more decisions based on meeting the insurers’ bottom line. In the 1990s, HMOs began restricting doctors to an average seven-minute interaction with each patient so they could see more people and thus make more money. And doctors have found their role has shifted to one of containing costs, gate keeping, and negotiating with these third-party payers – all of which steal time from patient interaction.

Marianne J. Legato, MD, FACP, who also spoke at the event, told the audience that she does not accept insurance for that very reason. Though this approach eliminates many potential patients from her primary care practice, Legato said it enables her to give patients who can afford it the care and time that they deserve. She offers an initial office visit that lasts for 1 ½ hours, and contacts each patient personally with test results. She also makes home visits, which allow her to learn more about patients. “Most physicians in this city don’t operate that way,” said Legato, who is a Professor in Clinical Medicine at the Columbia University College of Physicians and Surgeons, and an expert on women’s health. She has authored several books on the subject, and is Founder and Director of the Partnership for Gender-Specific Medicine at Columbia. This kind of personal care is rare, but worth paying for, she said. The ideal healthcare system would “charge what the traffic will bear, and give away care for free to all those who can’t afford it.”

Legato mentioned that she worked at Bellevue Hospital as a medical student in the 1960s, and they did not turn anyone away for care. “Now these people fall desperately between the cracks” because of the third-party payer system, in which insurers rather than patients cover most medical costs, she said. “The whole issue of care of the indigent is one of the greatest heartaches in this country,” said Legato, who has appeared on Good Morning America, The Today Show, and the Oprah Winfrey Show. “We never debate the moral and ethical question of how to pay for those resources, how to distribute them fairly.”

Legato described doctors’ daily challenges and workload and advised audience members as to how they can help doctors help them. If you call your doctor and want questions answered, leave the specific question with the receptionist or on the answering machine, and provide a time that you can be reached. Doctors become frustrated when they take the time to return a call, only to get the patient’s answering machine and begin a game of telephone tag. Doctors are pressed for time and receive many calls from patients each day: Legato said she has 1,400 patient charts in her office and receives 200 calls daily.

When it’s time for the actual office visit, Legato said, you must be brutally honest with yourself and your doctor about any aspects of your life that are impacting your health. Hiding the details about your eating habits, alcohol consumption, exercise routine (or lack thereof), or stressors in your life will prevent the doctor from accurately assessing your health. Raise these issues, even if the doctor doesn’t ask. “As you’re preparing for the doctor, if you have three or four things that bother you, make a list. Write it down,” Legato said. We are at our most vulnerable in the examination room upon shedding our clothes (which act as our defenses), donning a paper gown, and waiting “for the great one to arrive,” Legato pointed out, so it is important to be armed with a tool like a list to help get through the experience successfully. “When you come into a doctor’s office, you’re not your mature, well-put-together self,” said Legato, who is also senior attending physician at St. Luke's-Roosevelt Hospital, and attending physician at the Presbyterian Hospital.

Both Legato and Glajchen stressed that consumers should never forget that they are the most important players and have the right, and the responsibility, to demand the best possible care and the type of treatment they desire. This is true both when we are healthy, and if we should become incapcitated. Glajchen advises all patients to prepare an advance directive, which includes a living will that documents your wishes concerning medical treatments at the end of life, and a medical power of attorney (or healthcare proxy) that allows you to appoint a person you trust as someone authorized to make medical decisions on your behalf should you become incapacitated. “It’s better to discuss these things before a crisis hits,” Glajchen said. If you do adopt a living will, be sure to give copies to your doctor, attorney, and a friend or family member. “What often happens is although those things exist, they don’t get into the medical system” and your desires aren’t honored, she said.

Founded in 1847, The New York Academy of Medicine is an independent, non-partisan, non-profit institution whose mission is to enhance the health of the public. Today it is a leading center for urban health policy and action working to enhance the health of people living in cities worldwide through research, education, advocacy, and prevention. Visit us online at www.nyam.org.

Resources for Patients:
Consumer health questions: Visit www.nyam.org/library. The New York Academy of Medicine Library is the only medical library open to the public in the New York City area. Research librarians are available to help consumers with health care and medical questions. Located at 1216 Fifth Ave. (at 103rd St.), third floor. Call (212) 822-7315 or email library@nyam.org. The Academy also administers a consumer health website with easy-to-understand information at http://www.noah-health.org.

End-of-life care: Visit www.caringinfo.org for information regarding options about end-of-life services, care, and advance directives. Visit www.stoppain.org for information on palliative care and treatment options for chronic pain.

Medicare maze: Visit medicarerights.org, medicareinteractive.org; medicare.gov for information about Medicare, the federal health insurance program for people age 65 and older and for individuals with disabilities. These websites offer information on how to get Medicare prescription drug coverage, and more.

Posted on 05/01/2006

Contact:
Malini Doddamani
Director of Communications
mdoddamani@nyam.org
212.822.7285