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Ubiquitous injustices permeate every level of today's health care environment. Mismanaged funds, unethical business practices and ambiguous complacency have contributed to a health care delivery system laden with obstacles to optimal health care. A steady decline in third party reimbursements has resulted in shortened lengths of stay in hospitals, leading to an increase in re-admissions. Emergency room visits have increased, partially due to patients' inabilities to access timely care through their primary physician.

Many third party payers contract with physicians to pay a fixed amount per member per month, regardless of the treatment administered. Consequently, physicians have become more prudent in ordering diagnostic tests because their clinics must absorb the cost.

Clinics are designed to treat as many patients as possible. The employment of nurse practitioners and physician assistants enables an increase in numbers of patients seen in one day. These employees are not paid as much as physicians, so, from the provider's point of view, are cost effective. A screening system in the front offices are designed with the goal to avoid time-consuming, unnecessary communication with the physician. This, in turn, facilitates the growing frustration and mistrust felt by patients.

The proceeding information is geared to assist patients and their families through a portion of the health care maze. Knowledge is the tool with which consumers can empower themselves. Recognize the relationship between you and your health care provider as a partnership. Most physicians are dedicated to providing the best possible care to their patients. They are not omnipotent healers, however. Your input is a necessary ingredient. Become knowledgeable about your body and symptoms so that the time you spend with your doctor is used to your maximum benefit. Write down your concerns and queries, and have your list in hand when you go into the examination room. Physicians and others who provide medical care respect the patient who is actively involved in his or her care. Time is used most efficiently when communication is focused and direct.

The journey beginning with your initial phone call to request an appointment and ending with your meeting your doctor in the examination room can be riddled with annoyances. You are either captive to an automated system requiring you to find an option, trapped with unsolicited music while on hold, or handed from one person to another. When your voice finally lands on the ear of the appointment clerk, there are usually no appointments available, or the only slot available is with an ancillary practitioner.

Avoid some of these irritations by getting to know the persons in the physician's office by first names and duties. When you need an appointment, ask to speak to that specific person. If you need assistance with insurance issues or need to acquire some part of your medical record, you will know for whom to ask. Most doctors' offices close between 12:00pm and 2:00pm, so plan your call before or after those hours to avoid the answering service or the automated phone system.

A key person to get to know in that office is your doctor's nurse. Be aware that offices these days usually have only one nurse per doctor, so don't establish communication with a medical assistant, thinking he or she is the nurse. Know the nurse's name and speak with her in person when in the office so that when the need arises for you to speak to her on the telephone, there is a better chance he or she will remember you. The nurse can address your questions directly, or ask the doctor. If you feel you need to speak directly to your doctor, she is the one who can get that information to him.

When arranging an appointment for a routine examination, call at least a month ahead of time. You may be told that the physician's assistant or nurse practitioner can see you when your doctor isn't available. If you are not comfortable, insist on an appointment with your physician. Many people prefer to see the care giver with whom they have established a relationship.

If you feel you need to see you doctor right away, state that. Most physicians leave two or three appointment slots open for just this reason. The appointment clerk may tell you that the only person(s) available are the ancillary staff, or that there are no appointments available. Your options here are to accept an appointment with the physician's assistant or nurse practitioner, to ask to speak to the nurse, or insist on seeing your doctor. If you haven't been successful, your final options are to repeat your need to be seen immediately and that you will be at the office fifteen minutes before closing to see your doctor. You can also state that if you aren't seen, you will need to go to the emergency room. This statement usually initiates a flurry of additional attempts to get you in. Most third party payers require the primary care physician to see the patient or find a medical doctor who is available. An emergency room visit resulting from an unsuccessful attempt to see the primary care physician is costly for that doctor.

Be assertive regarding tests your doctor has not ordered for you. For instance, if you have had a persistent cough and he or she does not order a chest x-ray for you, request one. If you have had a fever that has plagued you for two or three days and no blood work as been ordered, tell your doctor you want a complete blood count. Cost effectiveness is a necessity, but not at the expense of anyone's health.

Know what medications you are taking and why. Take a list of your medications and their dosages with you to your appointment. Many times, symptoms are indicative of interactions between medications or dosage problems. Your medical record should have a complete list of your current medications. Information can get misplaced or transcribed incorrectly, so keep your own record. Improving our health care system is a mountainous undertaking. As proactive consumers, we can maximize the effectiveness of our health care and that of our families through self-education and polite persistence.

Tidbits:

Your appendix is on the right side of the body, but if inflamed, can hurt when the left side is pressed. This is called rebound pain.

Pain on either side of the lower back could be from the kidney(s).

Nausea, vomiting and visualizing yellow spots or rings are symptoms of toxicity from a common heart medication.

Most fluid pills, or diuretics, wash potassium out of the body. Potassium is an important ion for the maintenance of a healthy heart rhythm. Too much or too little can wreak havoc on the pump, causing dangerous irregular rhythms.

Swollen feet, shortness of breath and a wet sounding cough are signs of heart failure requiring immediate medical attention.

A list of web sites to assist you in your search for knowledge:

www.healthfinder.gov
Maintained by the US Department of Health and Human Services

www.graylab.ac.uk/omd
A searchable medical dictionary with over 65,000 definitions

www.familydoctor.org
From the American Academy of Family Physicians

www.cdc.gov
US Centers for Disease Control and Prevention

www.ama-assn.org/aps/amahg.htm
Provides information on every licensed physician in the US

www.mentalhelp.net
Online mental health directory

www.fda.gov
Site of US Food and Drug Administration

www.aarp.org
American Association of Retired Persons


Cheryl Nicholas is a registered nurse, with a Bachelor of Science in Nursing earned in Louisiana. She also is a freelance author and contributing editor for Moondance's Inspirations Section. She lives with her teenage daughter in a small town nestled in a valley next to the foothills of the North Cascade Mountains.

E-mail Cheryl at: Ldytru@aol.com


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