Secrets of Great Doctors

Become a Smart Patient

To be a smart patient, you can't be passive; you need to be a first-rate Sherlock Holmes. Like Holmes, smart patients ask intelligent questions and have the instincts (and guts) to politely challenge things they don't understand. They don't need to know the most esoteric medical details, but they need to put at least as much effort into finding out the basics about their health as they did in getting the driving directions to our office. Ultimately, you are the person most responsible for the success of your health. Here, what great doctors know that great patients can learn.

1. Get your stories straight. Bring your spouse or partner to your doctor's appointment when you're giving your health history or describing a problem; there are a lot of questions that only a partner can answer (such as how many times an hour you stop breathing while asleep). But beware the doc's sixth sense. When you tell us that you rarely tear into the Pringles after 8 p.m. or that you've been taking your cholesterol-lowering drugs with the discipline of a Marine, your spouse will shoot you (or us) a look that says, "Are you kidding me?" We never miss it. And hey, sometimes your spouse wants to blow your cover. It's called love. But if you try to snow us, we might try to trip you up. For example, we'll ask if you're fit enough to climb three flights of stairs. You'll say yes, unless you're over 85 or bedbound. Then we'll ask, "When was the last time you climbed three flights?" You'll say "Maybe a month... " and your spouse will send a look that says, "You haven't climbed three flights of stairs since we voted for Ike."

2. Truth or consequences. We know you bend the truth a little when telling us the good and bad you do to yourself. That's why we at least double, up or down, the most fudged claims. For example:

Patient Says: Doctor Hears: I have two drinks a day. I might drink a case a week. I exercise about twice a week. I rarely exercise. I smoke a few cigarettes a day. I'm a pack-a-dayer. I eat about two hamburgers a week. I eat cheeseburgers most other days. I'll follow up with you -- I won't forget. I'll stop back when the kids are grown.

3. Nurses know it all. One way to find a great doctor is to grill the head ER or ICU nurse at the largest local hospital, preferably a teaching hospital. These nurses get a battlefield view of doctors at their best and worst. If you're visiting someone in the hospital, you may be able to swing into the unit. If all hell isn't breaking loose and the nurses have a few relatively quiet minutes, you'll have a chance to politely approach one and make your inquiry. A nurse may say, "Well, to be honest, Dr. Addison is a complete jerk and everybody hates him, but if you're in serious trouble, there's nobody better." Endorsements like this aren't unusual in medicine.

4. Get friendly with your pharmacist. Your pharmacist is the least expensive and most accessible health resource you have. While it might seem easier to forge a personal relationship with one pharmacist at a small mom-and-pop pill dispensary, smart patients can and do establish great relationships with superstore pharmacists too. You can see her anytime you want, without an appointment -- all consultations free. In medicine, that's extraordinary. Your pharmacist has an amazing wealth of knowledge at her fingertips, which means at your fingertips. Many also have access to new technology that can answer questions (such as, Is it safe to take this brand-new medication with this even newer medication?) in a blink. What's more, they get a soldier's-eye view of patients with similar conditions using different medications every single day. They see who improves, and who complains about side effects. And they know which side effects could mean serious trouble. Why do so few people take advantage of this golden resource? It baffles us.

5. Learn the shorthand. When your doctor hands you a script (that's doctorspeak for "prescription"), she knows you can't understand the arcane Latin-y squiggles and abbreviations. Doctors typically write the name of the medicine first, then the form (say, capsule or tablet), dosage, amount (say, 30 tablets), directions for taking it, and finally the number of refills. Here's the medical shorthand:

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6. The waiting game. When you're anxious for test results, don't think, No news is good news. It's no news. Too many patients wait for the doctor to call them with results, or they figure that silence means everything's fine. Smart patients always ask when the results will likely be in, and they call the office that day. And the next day, and so on. It's an extra reminder for us to call the lab if it's running behind. A postcard from the lab may have been lost. And in a bustling office, records can sit for a day or two without us knowing. So be a nudge.

7. Get with the plan! If a doctor doesn't accept your insurance, but he is really your top choice, don't give up. Call the insurance company and ask if it would consider adding this doctor to the list. If it won't, ask why. Sometimes, if even just a few patients ask the insurer to add a doctor, and the physician approves, the company will agree. Likewise, ask your doctor if you could persuade him to begin accepting your insurer. And every year when you renew your health insurance (a lovely period, usually in the fall, called open enrollment), call your doctor's office and make sure it intends to keep accepting this insurance plan. When we're deciding which insurance carriers we'll work with, we can be swayed by just a few small factors -- and if dropping a plan will create big problems for two or three regular (and well-liked) patients, that can carry weight. So speak up.

8. Learn from the past. Consider having an autopsy performed on your parents when they pass away. Few are done today compared with decades ago, as it's rarely thought necessary when a cause of death is clear. Although it can be expensive, there's much value in knowing if your 82-year-old father has undiagnosed prostate cancer that had been advancing since his 50s, or heart disease even though it was a stroke that did him in. This is especially useful if the death was due to an accident. Reassure your living parent this doesn't mean that foul play is suspected, there can't be an open casket, or the body will be shipped to a CSI sound stage.

9. Need surgery? Hunt for the specialist's specialist. You don't just want a doctor who is comfortable with performing a particular surgery as part of a wide repertoire; you want the surgeon who is obsessively focused on the exact technique you need done. Today, one surgeon can gain so much experience with one very specific surgery that her patients have fewer complications than the national average. Aside from asking your regular doctor to point you to the maestro of your surgery, doing Internet research can help you locate such a hyper-specialized surgeon. You just have to hope that one works at your hospital (and takes your insurance plan), or a road trip might be in store. And make sure your hospital is Joint Commission accredited for quality and safety. Go to qualitycheck.org to find the best hospital for you.

10. Meet the doc behind the scenes. If you're having surgery in a hospital, you need to meet the anesthesiologist face-to-face and give him some dirt on you, such as the last time you had general anesthesia, exactly how much you drink, what drugs you use and how often. People who recreate with substances can keep their habit hidden from lots of people, but they'd better be up-front with the anesthesiologist, since narcotics and other drugs can increase the amount of anesthesia needed, and you don't want to be wide-awake when the surgeon asks for the knife. The anesthesiologist also needs to know how physically fit you are, any allergies you have, and (for the umpteenth time of your hospital stay) every medication, herbal remedy and supplement you take. What about those nightmarish stories you've heard about patients waking up during surgery? It's rare, but it happens. Talk to your anesthesiologist about this, and ask if a medical device that monitors wakefulness is available and should be used.

11. Customize your living will. The two words living will evoked about as much emotion as life insurance did not long ago. But that was before Terri Schiavo captured the country's attention in 2005. Living wills became a vogue subject, even among people under 40. Yet there's no one-size-fits-all living will. If things should take a particularly unhappy course and you can't speak up for yourself, you can tell hospital staffers ahead of time which measures you do or do not want to receive, such as:

Artificial breathing. No, not via the services of one of the more attractive hospital staff members, we're afraid. Instead, you're placed on the machine called a ventilator, which pumps air into your lungs.

Artificial feeding. If you're unable to eat, you can be given nutrients through an IV or a tube that's inserted into your stomach. Some of our more industrious friends have asked if they could have this procedure done just as a matter of convenience, but we tell them to slow down, take a break and eat a real meal.

Cardiopulmonary resuscitation (CPR). You know, the organized theatrics you've seen in TV shows and movies, when a hospital team tries to revive you after your heart stops beating or you stop breathing -- unless you request a do-not-resuscitate order (DNR). Unlike on television, however, there is not a 99.9% chance that you will be revived successfully and to full consciousness within five seconds by a tanned actor, but we'll try our best.
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