We recently came across “The Patient’s Playbook” by Leslie Michelson. The book’s focus is how to get the best medical care, especially if you have a complicated medical situation. Mr. Michelson encourages us all to have a personal relationship with our primary care physician. When you are looking for a new PCP, focus on the PCP’s willingness to invest in a personal relationship and to coordinate with specialists to manage care.
Recently, I read The Patient’s Playbook, by Leslie Michelson. It doesn’t discuss any disorder specifically, but how to get the best medical care, especially if you have complicated medical circumstances. Here are some highlights from Part I.
According to the inside cover, Mr. Michelson is the founder, chairman, and CEO of Private Health Maintenance, a patient-focused company dedicated to helping people “obtain exceptional medical care. He has spent the last 30 years guiding thousands through our complex health care system. Prior to founding Private Health Management in 2007, he was CEO of the Prostate Cancer Foundation. He received a BA from John’s Hopkins University and a JD from Yale Law School.”
Not surprisingly, Michelson cites that the root of the healthcare problem, from a consumer standpoint, is insurance companies pay per office visit and procedure. Bean counters tell doctors they must see x-number of patients per day to cover the costs of running a clinical operation, resulting in a single doctor following the health of 2,000-4,000 patients at once. How could a single physician possibly keep in mind each individual even if very few of them have complex health concerns.
Of course, this is Michelson’s point. Most of us don’t have a primary care physician (PCP) who is familiar with the details of our health, but we should have, especially as we age and if we do have complex health issues. Michelson explains that NOT having a personal relationship with our PCP often results in two common difficulties.
1. Misdiagnosis, either because the doctor is not able or willing (time-wise?) to delve into the patients history and connect the dots. He or she hears a complaint, treats the symptom, and never follows up – or – makes a note about a possible follow up, which never happens, resulting in the patient returning repeatedly, taking years (if ever) to find the underlying cause.
2. “The Specialist Shuffle in which every new doctor performs diagnostics to determine whether the patient has a condition that is within his realm of expertise, and if he can’t diagnose her, he’d prescribe medication to try to relieve symptoms, and if that doesn’t work, he’d pass her on to the next specialist, who’d go through the same process. This exposes patients to unnecessary tests and treatments that cost a lot of money, time, needless anxiety and stress. For patients with nonspecific symptoms, the shuffle can go on for years with no resolution.”
The answer? Ask for referrals for a good PCP, and the reasons why they come recommended (so they don’t just share a love of golf with the person you’re asking), interview candidates, even pay a premium to retain your choice. Michelson doesn’t believe credentials, research and publishing are the mark of a good PCP (that’s a good specialist). What you want are organization, hospital privileges, willingness to invest in a personal relationship with you and to coordinate with specialists to manage your healthcare. Chapter 2 goes into some detail about how to find the right PCP for you.
Other recommendations to avoid misdiagnoses, delayed diagnosis, or medical mistakes are:
1. Create a family health history to share with your doctors. Because of genetics, include immediate family members ailments, even if they never received a diagnosis. Seemingly unrelated symptoms, undiagnosable in past decades, can lead to a quick diagnosis for you today.
2. Collect your medical records and continue to maintain and update a personal copy. The HIPAA law protects your right to your own medical records. Guidelines for what information is important, depending on various different medical circumstances, is specified in Chapter 3, as well as how to organize records for easy review by physicians.
3. Take inventory (make a list) of your: diagnoses and major surgeries, allergies, drugs/medications your taking (including supplements), a roster of your physicians, emergency contacts, and insurance information. Keep this in your wallet or purse.
The last bit of advice in part I, How to Be Prepared, is to develop a support team. It’s up to you to coordinate your care, even though most of us are ill equipped, especially through overwhelming emotions when you suddenly learn you have a serious problem. It is unlikely one person has the skills, time, and energy, so carefully select a team. Chapter 4 goes into some depth as to what skills are needed and how to go about bringing it up with family and/or friends.
Coming soon: Part II, Experts and Emergencies.
– Denise