Parade; New York; Feb 24, 2002; Rosenfeld, Dr. Isadore;

The importance of being fully informed about your medical condition---given the problems with America's health-care system today--- cannot be overemphasized. In this article, Parade's Health Editor spells out what patients need to know and do to get the best results from their physician, hospital and insurance provider.

The truth is, medical care is rationed in this country. Physicians are spending less time with their patients. Many now work for insurance companies or managed-care providers who have the last word on what tests or treatments they'll pay for. You may not even be told that there are better options than what you've been offered. So now, more than ever, you're essentially on your own when it comes to protecting your health and well-being.

What can you, the patient, do to maximize your chances of getting the best care possible? Basically, you must acquire as much information as you can about your particular illness---and insist upon your rights. One of those rights is a say in the choice of a doctor. You also should be comfortable discussing all your treatment options before making or accepting a final decision.

As we go through life, we all experience a wide range of health problems. Symptoms appear that demand explanation and action. For example, suppose you've noticed that when you walk quickly up an incline, have sex or are under stress, you develop discomfort or pressure in your chest, maybe even a little pain. It lasts only a few moments and doesn't really bother you.

If you have done your homework, you know that, depending on your age and sex, you probably have angina (due to narrowing of one or more arteries in the heart). That knowledge should lead you to call your doctor, who must then take the time to listen to your description of your symptoms. Listening is extremely important. Doctors are so pressed for time these days that they often replace the critical face-to-face interview with a printed questionnaire with "Yes" or "No" answers. That's acceptable, as long as you also are given the time to elaborate on your symptoms. In this case, the diagnosis of angina can be made from your description alone.

Your doctor must now confirm what he or she suspects. There are several steps that can be taken. The preferable options may cost more and therefore not be offered to you (depending on your insurance coverage). You should know which ones to insist upon. Angina is serious and, unless diagnosed and treated properly and on time, can cost you your life.

This is only one example of how important it is to understand what your symptoms mean and the best way to evaluate and treat them. Other examples include the clarification of neurological symptoms: Do they reflect Alzheimer's or a stroke? If you have a persistent low-grade fever, is it due to an infection or a hidden cancer? Suppose you have early prostate cancer. What's your best bet: hormones, surgery, radiation or watchful waiting?

Knowledge is power. You should have as much information as possible about your condition---and your rights---so that you have the confidence to share in the decisions that affect your health, the quality of your life and survival itself. The better prepared you are to ask informed questions, the better your chances of receiving optimum medical care.

What To Insist On
You have the obligation to yourself---and the right---to participate actively in the decisions concerning your health care. Here are some of the important rights to keep in mind:

1 You have the right to select your doctor. Choose a health plan that allows you to find a physician with whom you are compatible. It's nearly as important as selecting a spouse. Joining an HMO usually means you have to leave your doctor of many years. That's traumatic enough. At least make sure you have several names to choose from, and insist on meeting him or her before you make a commitment.

2 You have the right to be fully informed about your health status. There are many ways to diagnose and manage illness. If your condition requires medication, there usually are several to choose from. One may be better for you than the others---and also more affordable. If you need surgery, there are differences in techniques and expertise among physicians. Insist on being told all your options before the therapy plan is finalized.

3 You have the right to a second opinion. When your life is on the line, ask for a second opinion. Two heads are better than one. If possible, the consultant should come from outside the group that is caring for you: Doctors in the same clinical environment tend to think alike. You deserve a fresh and independent approach. Don't worry about "offending" your doctor. Your welfare is more important than his or her ego, and a good physician making the right diagnosis and recommending what's best will welcome confirmation of his or her decisions.

4 You have a right to preventive medicine. An ounce of prevention is worth a pound of cure. Some health plans still refuse to reimburse you for doctor's visits when you're well. Make sure that your plan does reimburse. Routine screening can detect vulnerability to heart disease, so you can start preventive measures in time; many cancers can be cured if they're found early enough; and some diseases in full bloom go unrecognized until you have a thorough physical exam. (The best examples are an underactive thyroid gland whose symptoms mimic those of depression; angina pectoris that's attributed to arthritis or indigestion; and bleeding from colon cancers dismissed as coming from hemorrhoids.)

5 You have the right to know your surgeon's and hospital's track record for the procedure you need. How many operations does the surgeon perform each year, and what is the success rate? The more experience that he or she has, the better your chances of a successful outcome. This information is not posted on any bulletin board. You have to seek it out. The best source is the hospital administration. Don't hesitate to ask. They are obliged to tell you- --but only if you ask.

6 You have the right to know about any financial relationship between your doctor and your insurance provider. This may influence your medical care. Doctors sometimes receive a bonus or other benefits for successfully cutting health costs---or, put another way, for depriving you of the best treatment. You need to know if this is the case with your doctor. Ask him or her about it. You're entitled.

7 You have the right to a rapid medical-review process. If your claim for reimbursement has been denied, and you know enough to realize that you are being short-changed, appeal the unfair decision. Any plan for which you sign up should provide an impartial appeal mechanism to hear such complaints when you know the rejection is arbitrary. Such panels are required by law in 41 states and Washington, D.C.

Reprinted with permission from Parade and Dr. Isadore Rosenfeld ©2002. All rights reserved. Further reproduction or distribution is prohibited without permission.