 Synergy recently talked to Ruthann Russo, author of the book 7 Steps To Your Best Possible Healthcare. If you ever have a significant health problem, this book can help you cut through the maze of doctors, treatment options, hospitals, and health plan benefits and get the healthcare you seek. It's an insider's view into how to be a strong advocate for your own care. Here's Part 1 of our talk.
 SYNERGY: Most of us can relate to how hard it can be to navigate the "healthcare system." What motivated you to write this book?
RR: I worked in healthcare my whole professional life. I've been very fortunate that my family hadn't had any significant healthcare issues until a couple of years ago when my daughter, who was a freshman in college, had a grand mal seizure. We went through a battery of tests until she was finally diagnosed with something called juvenile myoclonic epilepsy. It's pretty much a lifetime challenge that you have to manage. And this threw me into the healthcare system from a very different perspective. I had always been on the other side, working with hospitals and academic medical centers and large doctor groups, and now I was a healthcare consumer - representing my daughter.
For anybody who is a parent, you know that it is much more difficult when it's your child, or a parent or someone else who you love very much, seeing them go through it. The motivation for the book was that it took us almost two years to get to the right solution for my daughter. It was extremely difficult and complex to navigate through the healthcare system and find the right solution for us. We went through, I think, seven different second opinions, many different doctors, and a few different academic medical centers until we found a good fit.
At some point, my husband and I said "Imagine how difficult the system must be for people who don't have the kind of information that we have available to us!"
SYNERGY: You talked about getting second opinions. In fact, it sounds like you got a lot of second opinions. What happens if two doctors say different things? What's your next step?
RR: If you seek a second opinion and you get disagreement, you have a couple of choices. One is that you can get a third opinion. We got to the point where we were actually on our seventh doctor before we came up with options that were workable for us. But if you're really dealing with two very, very different opinions, take the time to step back and look at the background, experience and credentials of the two individuals that you've talked to.
In the end, we ended up with two doctors who had great credentials, were backed by very good academic medical centers, and who were fairly agreeable. They also supported some non-traditional complimentary and alternative medicine.
SYNERGY: In some cases, you may have a doctor who isn't so happy that you're getting a second opinion -- but it's your right, and your job, to take care of yourself.
RR: If you have a doctor who is put off that you're looking for a second opinion, you need another doctor anyway.
SYNERGY: Is it true that you should always go with the physician with the most experience or credentials?
 RR: There will be times when somebody who is not a doctor can really assess what's going on, such as nurse practitioners and physician assistants. They are almost better at treating the day-to-day issues that people have. In hospitals, for example, nurses often pick up on things and will alert doctors, such as when patients are dehydrated or have a bed sore or something like that.
SYNERGY: Also, a high-ranking person may be looking at something with narrow blinders or just not have the approach that you're looking for.
RR: I absolutely agree, especially if it's your day-to-day kind of care. Let's say you go to a surgeon because you have an ingrown toenail. Well, a surgeon is a surgeon and they are coming from the mindset where they want to operate. That's how they have their mindset. That's spending more money than you need to -- and wasting your time.
SYNERGY: You talk in your book about the concept of a medical mentor. What is that?
RR: A lot of academic medical centers have programs where they train individuals to be medical mentors. Let's say you need a kidney transplant. A mentor is someone who has already had a transplant, and who has gone through a program where they train to be a mentor to you. That individual knows what all the different issues are, not from a medical perspective, but as a real person. They help you understand the kinds of things that you are going to deal with -- regarding your health plan, day-to-day issues, and making decisions.
A medical mentor is really a trusted individual who you work with on an ongoing basis. Your medical mentor can also be a family member, relative, or friend. It's somebody to help you think clearly, make good decisions, and face your particular situation.
SYNERGY: So, a mentor is somebody who is with you in the hospital, listening to the doctor, then giving you some feedback?
RR: Yes, usually it is somebody who will sit in on the visits with you when the doctor is talking about the decisions you have to make. When doctors are getting your informed consent, they want to make sure you really understand what's going on. The medical mentor is somebody who is a part of the process.
SYNERGY: Let's take the case of somebody who is just starting off in the healthcare system. They've got a symptom, maybe a pain of some sort. They've tried some self care and it hasn't helped, so they go to their primary care provider. How can a primary care provider, who is only going to spend five or ten minutes with you in a very rushed situation, do anything other than diagnose and treat something that's pretty routine? A lot of people just find themselves going from doctor to doctor and they never find the person who can spend some time with them to properly look into and diagnose the problem and get to the bottom of it.
RR: The average medical visit in this country is 16 minutes for a first time visit and 8 minutes for a follow-up visit, so there you have it in terms of the expectations of doctors. There are a couple of things that you can do as a healthcare consumer. The first is really to spend a good amount of time picking out your primary care provider.
There are doctors who will spend more time with you. Take the time to research them and their background. Talk to the people in their office. The people who are often the most successful at finding the best primary care providers are those who actually interviewed the doctor. If you can find a doctor who is willing to spend a couple of minutes with you to actually answer your questions about whether or not you want to be their patient, chances are pretty good that they will spend some time with you to deal with your situation.
Then, when you go to the visit, be as prepared as possible. With the internet today there is so much information available to us. Do some of your own research and come prepared with good questions and detail about what is going on with you. If it's pain, for example, talk about the dates when you had pain, talk about your pain on a scale of 1 to 10, things that doctors will ask anyway. It saves a heck of a lot of time. If you have medical records, bring those with you.
SYNERGY: And doctors like you coming with that information?
RR: I have never had a doctor who has not appreciated a prepared patient. Usually, they say "this is really great, this is really helpful" because often doctors are sitting there trying to figure out what questions to ask to get the right information out of you. Just cut to the chase and have that information.
 SYNERGY: If you have been on the internet and you come across some treatment options that you want to explore, can you say "I'm ready to try this." Is that going too far, is that getting a little too aggressive with the doctor?
RR: If you're the kind of person who wants to make recommendations for your care and your doctor is not open to it, then you need a different doctor because that person is not working for you.
In terms of showing up with information, do this in a way that is helpful to the doctor and not overwhelming. For example, I have a friend who had prostate cancer. After doing research on the internet, he was interested in this new robotic surgery. So he brought the article to his doctor. If you take this approach, you're deflecting the issue from you to information that appears to be credible. The doctor can't really get mad at you because it's information that he has to weigh in on. And doctors like to do that.
SYNERGY: More and more doctors are used to people coming in and saying "I've heard about this treatment, does it apply to me?" As long as your questions are to the point and create a structured conversation, they should be willing to work with you.
RR: When you're looking for a primary care doctor, I would also recommend that you understand the other health providers the doctor works with on an ongoing basis. Let's say you've got chronic back pain. The only thing that your primary care provider can really do is write you a prescription for pain, and that's probably not the best solution for most people. So what you need to understand is the referral network - for example, the physical therapists, acupuncturists, and licensed massage therapists - who the doctor has worked with for a long time. It's a team approach.
SYNERGY: How do you know which health providers they work with?
RR: The receptionist can usually answer that question. The receptionist or office manager has all those contacts and will have an idea of how frequently they are used.
I would outright ask the question: "Could you just tell me a little bit about the other practitioners that Dr. Jones works with or might refer patients to?" Not that you want names, because they won't give names unless you are actually a patient. But try to get as much out of them if you can. Ask, "Could you tell me a little bit about those people, is it primarily physical therapists? Do you have just one physical therapist that you work with or a group?"
SYNERGY: We're going to stop here for now. In the next issue of Synergy, we will continue our discussion and talk about a little-known resource at health plans called a "health advocate." Join us next time!
For links to useful resources, visit Ruthann's website at:
www.ruthannrusso.com/ruthannrusso/links.php
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