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Dec 1. 2003 -Getting The Most From Your Doctor

Most people do not get the full benefit from a consultation with a doctor. I think patients can improve this. You hear endless stories of mishaps with the medical profession. If you listen to bits of passing conversations on the sidewalks you will notice that many are health system or illness related. The main topic is horror stories of "what went wrong", malpractice, and mistreatment.

I have not seen research on the subject, but it may be that medical mishaps, diseases and doctors have replaced the stories of monsters and witches of fairy tales of yester-year. We never know what really happened in these scary medical tales, but as a doctor I know that mistakes happen; and only some of these mistakes are the doctors. Many mistakes occur as a result of the patients (consumers) doing or not doing something; or not understanding how the health system works. If you can improve your use of the system, we can cut down the chance of making a mistake.

Lately patient expections (and even demands) of the health system are very high. Patients expect to be "informed" of all stages of the medical process - diagnosis and treatment. The medical consumer ( you ) is expected to choose the doctor and speciality, suggest the "workup" and discuss the differential diagnosis ( the possible diagnoses ) and then decide on the best course of treatment!

The assumption that patients can fulfill this role is mistaken. The medical literature in 2001 began discussing a Health Illiteracy epidemicin the US. Experts estimate that up to 50% of the people in the United States do not fully understand the patient-doctor consultation, or do not have the capacity to understand the written instructions about an exam or medication.

The AMA (American Medical Association) is working with the U.S. health authorities to treat this epidemic.

In Israel we use less written instructions with patients, and still do not implement "informed consent" fully. We have less expectations that patients will read about their illness and treatment options. Undoubtedly we also suffer from a similar "health illiteracy" status. The old fashioned "paternal" medicine in which the "fatherly" doctor makes all the decisions and the patient just has to follow instructions has changed over one generation to a partnership. Patients are expected to be partners in medical decisions. If your physician doesn't want to cooperate with you, then you should find a doctor who does. On the other hand, if your doctor wants you to be involved in the decision making, and you don't want to; clarify the issue!

I don't think one should learn medicine in order to cooperate with your physician on your health issues. You can and should learn about the health system. Learn its limitations and its pitfalls to best navigate and improve your medical care. This is especially important in public and Kupat Holim (HMO) medicine.

We all are irresponsible with our health. Almost all of us have daily habits known to be unhealthy; and avoid things we know to add to our health. In order to get the most out of modern medicine one must take responsibility. One must think, one must learn, you must make decisions and follow though with them. We can assume responsibility for our health. It may be a burden and inconvenient, but we can become active participants in the health process. Once we decide to take responsibility and to act upon our decisions we are on the road to maximizing our use of doctors and modern medicine.


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