How Can We Be Better Patients?

Exploring How We Can Help Ourselves in the Doctor’s Office

Too often, patients don’t take an active role in their health care, leaving decisions up to their doctors in the mistaken belief that “doctor knows best.” This troubling trend is attributable in large part to patients not having the correct information they need to make good decisions and not feeling comfortable enough to ask questions. In advance of Shannon Brownlee’s visit to Zócalo to discuss the question “How Can We Take Charge of Our Health?“, we asked experts how we can prepare ourselves to make our own informed health decisions.

Engage in Shared Decision Making

A basic right of every patient is to be fully informed and involved in all aspects of their health care. By engaging in shared decision making when there is more than one reasonable medical option, patients and caregivers collaborate to make a health care decision, ensuring that this basic right is respected. The recently published “Salzburg Statement on Shared Decision Making” elaborates on the role patients should play in the decision-making process by calling on patients to:

  • Speak up about their concerns, questions, and what’s important to them
  • Recognize that they have a right to be equal participants in their care
  • Seek and use high-quality health information

Patients must realize the power and say they have with regards to their health care. If a test or procedure does not align with one’s personal preferences and goals, then it is indeed appropriate for a patient to say “no, thanks” to their caregiver. The push for shared medical decision making aims to elicit patient preferences so that decisions are made together, rather than patients feeling as if they must comply with “the doctor’s orders.” In addition, a patient should know the answers to the following three questions before any decision is made:

  • “Do I know my options?”
  • “Do I know the potential benefits and harms of the options?”
  • “Do I know the likelihood of possible outcomes that are important to me?”

Shared decision making is a two-way street; both patient and caregiver must engage thoroughly in order for the best possible health outcome to arise. Patients should play an active and direct role in their health care because the patient, not the caregiver, will be the one living with the results of any medical decision.

Dr. Michael Barry is a professor of Medicine at Harvard Medical School and chief of the general medicine unit at Massachusetts General Hospital.


Do Everything In Moderation

What you do “for” or “to” yourself is probably going to be more important than what any doctor can do for you.

One of my favorite sources is a physician in the Midwest who tells his residents: “If you want to be healthy, do all things in moderation. And stay the hell away from people like us.”

Too often, worried patients go for multiple tests, which can lead to false positives and unnecessary treatments. While some people in this country receive too little health care (the uninsured and underinsured) the well insured (including Medicare patients) often are over-treated and over-medicated. As a result, they are exposed to needless risks.

Unnecessary hospitalizations are a major problem. Hospitals can be dangerous places: if patients don’t really need to be in the hospital, they are exposing themselves to hospital-acquired infections, medication mix-ups, and other medical errors that lead to serious injuries and death. People who work in our hospitals are not sloppy or unconcerned. But in our health care system, care is not well coordinated, and hospitals are very busy. Many health care providers are multi-tasking. And the systems in our hospitals do not give doctors and nurses the support that they need to do their job well.

Maggie Mahar is a fellow at The Century Foundation. She is the author of Money-Driven Medicine: The Real Reason Health Care Costs So Much and Bull! A History of the Boom, 1982-1999 and writes the blog HealthBeatM.


Make Sure You Understand, Ask Questions If You Don’t

Taking control of our own health care is an essential personal responsibility. The increasing complexity of our already hard-to-navigate health system makes our job as patients more difficult and more important than ever to improving our health. So how can we be better patients? Here are a few ideas:

    • Be a source of facts.

Clinicians make diagnoses and recommendations based on facts, and we as patients are an important source of those facts. Bringing this information and communicating it clearly to your clinician is crucial. Know and bring your personal history and family history. And bring a list of your current and past medications. Giving your doctor or nurse as much relevant information as possible is one of the most important duties for patients.

    • We don’t need to be doctors and nurses.

Although our input is essential, it’s not the patient’s job to research our symptoms, reach conclusions and bring those conclusions to our caregivers. Bringing our own self-diagnoses can limit our ability to hear, process and understand what the doctor or nurse is telling us.

    • Take notes, ask questions, clarify and understand.

Seeing a health care provider can be stressful, especially when you’re worried about your health, and remembering everything from a stressful encounter is hard. Bring a notebook. Jot down what you think is important and ask the clinician what they think you should write down. Ask clarifying questions. If you don’t understand something immediately, ask the doctor or nurse to explain it in a way you can understand. Don’t leave with lingering questions or uncertainty. Understanding is a two-way street, and you and your clinician share the responsibility.

Maureen Bisognano is president and CEO of the Institute for Healthcare Improvement. She is also an instructor of Medicine at Harvard Medical School and a research associate in the Brigham and Women’s Hospital Division of Social Medicine and Health Inequalities.


Be Informed and Active

In this era of health care reform, it will be incredibly important for patients to be informed about all the incredible and exciting change that is to come. Soon, 32 million individuals will be added to the rolls of the insured. A large group of these individuals may never have had health insurance in the past, and as such, they may not be familiar with how to maneuver within an increasingly complex health care system. Perhaps the most vulnerable among these are minorities and those with limited-English proficiency. Latinos, our nation’s fastest growing and now largest minority group, will need to understand how to make the most of this new opportunity and become activated, insured health care consumers. As a Puerto Rican physician whose patient population has always been between 60 to 85 percent Latino, I have witnessed several issues that we must address with our community to assure they can take charge of their health.

First, we must communicate the importance of health, wellness and personal responsibility. I say this fully understanding many of the challenges our communities face, but with the sense that we can do more to address the current epidemics of obesity and diabetes that cannot be prevented in the doctor’s office.

Second, we must encourage members of our community to be active partners in their care. In my experience, many Latino patients don’t want to bother the doctor after hours if there is an emergency; they don’t feel comfortable asking questions or communicating when they don’t understand something; and oftentimes they may not be sure what medications they take or what tests they’ve had. We must empower our community to be active patients–with their medications, previous tests, questions and concerns all at the ready when they see their health care provider.

Finally, we must orient patients to how this complex health care system works so they can navigate it effectively. These are issues that are important for all patients, but may be particularly important for minorities and patients with limited English proficiency: those who may be made especially vulnerable by low general and health literacy, lack of previous experience with health insurance, cultural concerns around asking questions and limited knowledge about prevention, health and wellness.

Dr. Joseph Betancourt is director of the Disparities Solutions Center as well as director of Multicultural Education at Massachusetts General Hospital. He is also senior scientist at James J. Mongan, M.D. Institute for Health Policy and associate professor of Medicine at Harvard Medical School.

*Photo courtesy of Image_D.