Use specialists for special problems. Specialists are doctors with in-depth training and experience in a particular area of medicine. For example, a cardiologist has years of special training to deal with heart problems. A visit to a specialist often costs more than a visit to your family doctor, and the tests and treatment you receive may be more expensive. Of course, specialists often provide the information you need to decide what to do about a major health

When your primary doctor refers you to a specialist, a little preparation and good communication can help you get your money’s worth. Before you go see a specialist:

• Know the diagnosis or suspected diagnosis.

• Learn about your basic treatment options.

• Know what your family doctor would like the specialist to do (take over the case, confirm the diagnosis, conduct tests, etc.).

• Make sure that any test results or records on your case are sent to the specialist.

s Ask your regular doctor to remain involved in your case. Ask the specialist to send new test results or recommendations to both you and your regular doctor.
7. Use emergency services wisely.

In life-threatening situations, modern emergency services are worth their weight in gold. However, emergency rooms charge two to three times more for routine services than a doctor’s office. Also, your records are not available, so emergency room doctors have no information on your medical
history.

Hospital emergency rooms are set up to handle trauma and life-threatening cases. They are not set up to care for routine illnesses, and they do not work on a first-come, first-served basis. During busy times, people with minor illnesses may wait for hours. Use good judgment in deciding when to use emergency medical services. Whenever you feel you can apply home treatment safely and wait to see your regular doctor, do so. However, if you feel that it is an emergency situation, by all means go to the emergency department.

Prepare for the emergency room:

•  Call ahead, if possible, to let them know you are coming.
•  Call your doctor, if possible. He or she may meet you at the ER or call in important information.
•  If there is time, take this book and your medical records with you:
•  Use page 1, the Healthwise Approach, to help you think through the problem and report symptoms to the doctor.
•  Use page 2, the Ask-the-DoctorChecklist, to organize questions for the doctor.
•  See page 8 to review the medical test checklist.
•  Use your home medical records to discuss your medications, past test results, or treatments. Information about your allergies, medications, and conditions may be critical.

•  As soon as you arrive, tell the emergency room staff why you think it is an emergency.

8 Use hospitals only when you need them. Over half of all health care costs are for hospitalizations. A stay in a modern hospital costs far more than a vacation at most luxury resorts. (And hospitals are a lot less fun.)

If you do need in-patient care, get in and out of the hospital as quickly as possible. This will reduce costs and your risk of hospital-acquired infections.

Don’t check in just for tests. Hospitalization is no longer needed for most medical tests. Ask if the tests can be done on an out-patient basis. If you agree to control your diet and activities, the doctor will usually support your request.

Try to avoid additional days in the hospital by bringing in extra help at home. Ask about home nursing services to help while you recover. With help available, many patients can shorten a hospital stay.

Hospitals are not the only choice for people with a terminal illness. Many people choose to spend their remaining time at home with people they know and love. Special arrangements for the needed care can be made through hospice care programs in most communities. Try “Hospice” in the Yellow Pages or ask your doctor.

If you have ever thought that the cost of your medical care doesn’t matter because your company or health plan pays the bills, think again. You do pay. Most people have to pay co-payments and deductibles. Employers pay for health care coverage by restricting wage increases. Governments pay for health care by increasing taxes or
reducing other benefits. As medical costs go up, there is less money available for housing, education, wage increases, etc. These costs do affect you. If you can help reduce health care costs, you help yourself
and everyone else. Once you become a partner with your doctor, you can do a lot to reduce your health care costs. The goal is to get just the care you need, nothing more, and certainly, nothing less.
Nine Ways to Cut Costs
(but not quality)

1. Stay healthy. Healthy lifestyles and regular preventive services are the best ways to keep costs down. See Chapter 2. Also see Chapters 16, 17, and 18 of this book for ideas on how to stay healthy your whole life.

2. Use self-care when you can. Every time you successfully manage a health problem at home, you reduce the cost of health care for you and for others.

. Get your professional care from a primary care provider. Family physicians, internists, pediatricians, nurse practitioners, and other primary care providers are the best place to start for most health problems. See page 5 for more information.

4. Reduce your medical test costs. Don’t agree to expensive medical

tests until you understand how they will help you. Unneeded tests are often done because “it is standard practice” or to protect doctors from possible malpractice suits. The only good reason to do a test is because the benefits to you outweigh the risks and the costs. No test can be done without your consent. See page 8 for more
information.

5. Reduce your drug costs. Ask your doctor about every prescribed medication. Ask what would happen if you chose not to take a medication. Don’t expect to get a prescription for every illness; sometimes self-care or nondrug remedies are all you need. See page 9 for more information.

Medical tests are important tools, but they have limits. Some people think that the more tests they have, the better off they’ll be. Wise consumers know medical tests have costs and risks as well as benefits. To help your doctor make good choices about tests for you, you need to:

Learn the basics.
•    What is the name of the test and why do I need it?
•    If the test is positive, what will the doctor do differently?
•    What could happen if I don’t have the test?
Consider the risks and benefits.
•    How accurate is the test? How often does it indicate a problem exists when there is none (false positive)? How often does it say there is no problem when there is one (false negative)?
•    Is the test painful? What can go wrong?
•    How will I feel afterward?
•    Are there less risky alternatives?

Ask about costs.
•    How much does the test cost?
•    Is there a less expensive test that
might give the same information?

Let your doctor know

•    Your concerns about the test.
•    What you expect the test will do for you. Ask if that is realistic.
•    Any medications you are taking.
•    Whether you are pregnant or have other medical conditions.

•Your decision to accept the test.

Medical Ping- Pong Shared decision-making requires two-way communication, like playing a game of ping-pong.
Ping: You describe your symptoms, main concern, and hunches.
Pong: Your doctor makes a diagnosis and describes treatment options.
Ping: You tell your doctor your personal preferences or ask about other options.
Pong: Your doctor restates the options and how they relate to your preferences.
Ping: You accept one of the recommended options or learn more about what you should do.
With good two-way discussion, the chances are better that you will end up with the treatment plan that is best for you.

If a test seems costly, risky, and not likely to change the recommended treatment, ask your doctor if you can avoid it. Try to agree on the best approach. No test can be done without your permission.
Once you agree to a test, ask what you can do to reduce the chance of errors. Ask about food, exercise, alcohol, or medications to avoid before the test. After the test, ask to review the results. Take notes for your home records. If the results are unexpected and the error rate of the test is high, consider redoing the test before basing further treatment on the results.

1. Let your doctor know what you want. Tell your doctor that you want to help make decisions about what to do for your health problems.

2. Do your own research. Sometimes you need to learn things on your own before you can fully understand what your doctor is saying. See “Do Your Own Research” on page 15 for some ways to get the information you need.

3. Ask “why?” Always ask “why?” before agreeing to any medical test, medication, or treatment. Asking why may help you discover another option that better meets your needs.

4. Ask about alternatives. Learn enough to understand the options your doctor thinks are feasible.

5. Consider watchful waiting. Ask your doctor if it would be risky or costly to wait a while (day, week, month) before treatment.

6. State your preferences. Tell your doctor if you prefer one option over another based on your personal desires and values.
7. Compare expectations. Tell your doctor what you are expecting from the treatment and ask if that is realistic. If appropriate, discuss side effects, pain, recovery time, long-term limitations, etc.

8. Accept responsibility. When you make shared decisions with your doctor, both of you must accept the responsibility for the outcomes.

Except in an emergency, you cannot be given a treatment or test without your “informed consent.” You must be informed of the risks and agree to the treatment. In a partnership, however, informed consent may not be enough. The real goal is shared decision-making, where you actively participate in every medical decision. Why should you help make decisions with your doctor? Aren’t you paying him to know what to do? Well, the choices aren’t always black and white. With many health problems, there is more than one option.

Consider these examples:

You have moderately high blood pressure (160/95). Your doctor says that exercise and diet might bring it down, but most people don’t succeed that way. He recommends that you start on medication to control it. You would rather try exercise and lose weight than take pills for the rest of your life. The best decision depends on your values. Your three-year-old has a headache and a fever. The doctor says it’s probably nothing to worry about. Then you tell her your hunch that it might be meningitis. Some testing may be appropriate. You have been suffering from carpal tunnel syndrome for several months. Your doctor is now recommending a wrist splint and a steroid injection. You would prefer trying just the splint with aspirin first. If that doesn’t work, you will consider other medications. Your doctor agrees that is a good plan. In each case, the treatment you choose will have an effect on your life. Therefore, the best medicine for you combines your doctor’s medical expertise with your personal values.

The Advice Nurse
Many health plans and health maintenance organizations (HMOs) offer an advice nurse telephone service. Advice nurses are registered nurses who have special training to help you decide what to do about symptoms, how to manage minor illnesses, and answer your questions about health problems. A call to the advice nurse can often save you a doctor visit, or help you decide if you need an urgent or routine appointment.
Advise nurses can also help when your doctor diagnoses a health problem or recommends a test or treatment that you don’t fully understand. Sometimes the advice nurse can answer your questions. Other times, he or she may help you come up with questions you can ask your doctor at your next visit.

Charge Doctor
Not everyone wants to be a partner with their doctor. Maybe you don’t like to ask your doctor questions and you don’t want to share in any decisions. Would you rather just let your doctor tell you what is best for you? If that’s what you prefer, tell your doctor. Most doctors have a lot of patients who don’t want to be a partner. Let the doctor know what you expect.

Is it Time for a Change?
If you are unhappy with how your doctor treats you, it may be time for a change. Before you start looking for a new doctor, tell your current doctor how you would like to be treated. Your doctor would probably be pleased to work with you as a partner-if only you would tell him that’s what you want. Otherwise, he may think that you, like many of his patients, want him to do all the work.

If you don’t have a family doctor (primary care physician), now is the time to get one. Everyone needs a regular doctor. A host of specialists working on separate health problems may not see the whole picture. In choosing a doctor there are lots of questions to ask, but these three matter the most:

•    Is this doctor well-trained and experienced?

•    Is this doctor available when needed?
•    Will this doctor work in partnership
with me?

Training and Experience

For most people, a good choice for a family doctor is a board-certified family practice doctor or internist. These doctors have broad knowledge about medical problems. See page 12 for a brief description of medical specialists

Availability

Because health problems rarely develop when it’s convenient, it helps to have a doctor who can see you when needed. Call or visit the office. Tell the clinic receptionist that you are looking for a new doctor. Ask these questions:
•    What are the office hours?

•    If I called right now for a routine visit, how soon could I be seen?

•    How much time is allowed for a routine visit?

•    Will the doctor discuss health problems over the phone?

•    Does this doctor work with nurse practitioners or physician assistants? These primary care providers have special training for managing minor and routine medical problems. For many health problems, these professionals can often see you sooner, spend more time with you, and help you just as well as a doctor. Also ask if the doctor is eligible for maximum payments under your health plan.

Partner Potential

During your first visit, tell your doctor that you would like to share in making treatment decisions .
Pay attention to how you feel during the visit.
•    Does the doctor listen well?
•    Do you think you could build a good working partnership with this doc-
tor?
If the answers are “no;’ consider looking for another doctor.

Is it okay to call your doctor? Of course it is. Often a phone call to the doctor or advice nurse is all you need to manage a problem at home or determine if a visit is needed. Here’s how to get the most from every call:

Prepare for your call.

• Write down a one-sentence description of your problem and why you are calling (list two to three questions at most).

• Have your symptom list handy.

• Have your calendar handy in case you need to schedule an appointment.

Leave a clear message.

• Tell your one-sentence description to the person who answers and ask to talk with a doctor or advice nurse.

• If no one is available, ask the receptionist to relay your message and have someone call you back. Ask when they might call.

• If a call-back is needed, keep the phone line clear so you can take the call.

Follow through.

• When the doctor or advice nurse calls back, briefly describe your problem, ask your questions, and describe any major symptoms.

1. Take good care of yourself.

Both you and your doctor would prefer that you don’t get sick in the first place. And if problems arise, you both want a return to good health as soon as possible.

2. At the first sign of a health problem, observe and record your symptoms. Your record of symptoms will help both you and your doctor make an accurate diagnosis. And, the better job you do recording early symptoms, the better you and your doctor can manage the problem later. Keep written notes on the symptoms. Record when, how long, how painful, etc., for each symptom.

•    Note anything unusual that might be related to the problem.

•    Measure and record vital signs.

•    Add regular updates and watch your progress. Are your symptoms getting better or worse?

3. Practice medical self-care at home.

As the front-line partner, you can manage a lot of minor health problems on your own. Use this book, your own experience, and help from others to create a self-care plan.
• Learn all you can about the problem. ‘” Keep notes on your self-care plan
and what you do.

Note whether horne treatment seems to help.

Set a time to call a health professional if the problem continues. See page 5 for more on calling your doctor or advice nurse.

4. Prepare for office visits.

Most medical appointments are scheduled for only 10 to 15 minutes. The better organized you are, the more value you can get from the visit.

•    Prepare an Ask-the-Doctor Checklist like the one on page 2.

Update and bring your list of symptoms and your self-care plan.

•    Write down your main concern (chief complaint) and practice describing it. Your doctor will want to hear that first.

•    Write down your hunches or fears about what is wrong. These are often helpful to your doctor.
•    Write down the three questions
you want answered the most. (There may not be time to ask a long list of questions.)
•    Bring along a list of the medications
you are taking.

5. Play an active role in the medical visit.

•    State your main concern, describe your symptoms, and share your hunches and fears.

Be honest and straightforward.
Don’t hold anything back because of embarrassment. If you don’t intend to fill a prescription, say
so. If you are getting alternative treatment such as acupuncture or chiropractic treatments, let your doctor know. To be a good partner, your doctor has to know what is going on.

•    If your doctor prescribes a drug, test, or treatment, get more information.

•    Take notes. Write down the diagnosis, the treatment and follow-up plan, and what you can do at horne. Then read it back to the doctor to be sure you have it right.