How to Get the Healthcare You Want, by Laura L. Casey. Austin, TX: Life Press; 2007. 234 pages, $23.95 (hardcover).
This book is to guide patients through the labyrinth of a myriad of healthcare situations. This book could be especially helpful to those who are thrust in to an advocate role for a friend or family member facing a healthcare crisis. The book begins with short vignettes or situations that any patient could face on any given day. The author lists what commonly happens in waiting rooms, offices, laboratories, and imaging centers across America. She then lists how it should happen in Utopia, United States with perfect patients, no emergencies, perfect staff, and integrated systems [horizontal ellipsis] a far cry from reality or even an attainable standard of care.
The contents include an introduction; chapter 1, What Are Your Goals? (figuring out what needs do you want met by your healthcare providers); chapter 2, The Communication Cycle: Our Role as Patients (how to inform your providers of what you want from each encounter); chapter 3, Access: "Hold, Please" (how to make note of how much time is wasted at each appointment and how to spot "poor performers"); chapter 4, Close Encounters of the Clinical Kind (how to select the best physician or facility for your needs); chapter 5, Cash Management-Will It Hurt (how to differentiate insurance plans and how to decipher insurance coverage-also helping you to determine how much the care you need or may possibly need will cost); chapter 6, Creating and Maintaining Your Own Health Record (what information you should keep on your self, children, or others you advocate for and how to keep it seamless between providers); chapter 7, Resources (lists of medical boards by specialty, lists of types of surgeons and each states' board of healing arts); and lastly a glossary. The author has provided many tables for the patient to copy and use as their own. Examples of these include care analysis of lost lifetime pages (a measurement tool for how much time redundant healthcare wastes); an anxiety level chart (to measure your response to poor healthcare); personal health record (patient demographic information, allergies, history, family medical history, immunizations, medications, diet and nutrition, insurance and employer information, personal preferences, and expectations); insurance forms (Plan Comparisons and Coverage worksheets); healthcare contact sheets and clinician evaluation sheets.
As I began reading this book, I hoped to find it full of common sense like a "Healthcare for Dummies" manual that we could nonchalantly set in our waiting room for patients to devour. However, I was disappointed. Immediately, the author starts with personal experiences regarding her mother. I know the old adage of "write what you know" has merit but in this situation it felt a bit too emotional. The author repeatedly uses the experiences of her mother throughout the writing. The reader cannot help but wonder if the biography on the author that states she is in fact an "experienced patient advocate" whose career "spans more than 20 years," why she could not use other examples that were just as powerful. I am sure she does have some interesting real-life tales that prove her points just as well. The first 2 chapters help you decide what is important to you and how you can get this at each visit. Chapter 3 is the bulk of the book. The author opens this chapter with a misplaced analogy of taking her car in for service. She speaks of how quickly the appointment is made and how easily she is ushered in to the office and quickly sent on her way in a loaner car. The reader's frustration mounts as you mentally list all the ways that the human body and mind and your physicians office are, like your car and your auto service center. Your car never remembers it has been having libido problems for months and mentions it at an acute care appointment for cold symptoms. Your car never has chest pain and has to be run down to the emergency department. Your car never brings in all its little children who also complain of nausea and diarrhea when only one of you made an appointment. The author writes as if she wishes it could all just run as smoothly in the healthcare setting as it does in an auto shop. We all do. The variable is the patient. Working in healthcare is a challenge-every day for every single staff member. We have bad days too. We get frustrated at the system and our powerlessness to make changes. The most important thing we can all remember is that we are working with real people with real feelings. If we make mistakes, this can have BIG ramifications for people. I used to tell my students, "patients only remember you if you are a really great staff member or a really horrible one." What do you want to be remembered for?
In Chapter 3, "Access: Hold please," she covers an important consideration of geography. Many patients may live in one area and receive care in another. Whether you have a patient with an aggressive form of cancer, en route to a specialty hospital or one who falls ill while on an exotic vacation, you run into obstacles with the distance the knowledge has to travel. The author fails to mention one crucial tool that closes the chasm. That is the electronic health record (EHR). If your current provider utilizes EHR it is easier to get information where and to whom it needs to go. Ideally, all major health systems would use EHR, and they would all be integrated to decrease redundancy. The healthcare system is aware that patients are frustrated with redundancy and inefficiency. We have just not moved to the level where it is affordable for every provider to adopt these solutions. In Chapter 5, "Cash Management" the author brings up an important point. When you visit a facility (hospital or surgicenter or outpatient procedure facility), you will receive more than 1 bill. Many patients receive their first bill from the big health system and think that is the total (however overpriced it does seem). But a patient need only wait days, weeks, months, or in rare cases years to receive a stack of other bills. This is confusing for patients and I do not have a solution. In Chapter 6, "Creating your own healthcare record," there are extensive lists and forms that you can copy or transfer for use in your own record keeping. Although I do think a personal health record is a smart idea for most people, I find her forms excessive in some areas while lacking in others. In Resources and Glossary, the author has done an admirable job of listing many important contacts and terms. If patients came armed with this information before facing a health crisis or choosing a surgeon, it would be reassuring for all of us.
One important item that is merely mentioned in this book is that if you are receiving poor care let the physician know. Patients wrongly assume that physicians know the manner in which their staff is treating their consumers. Of course, most practitioners are confident in the manner in which their patients are treated. But unfortunately, some staff members present a different set of behaviors to patients and their families versus colleagues. Tell your doctor or other providers about any instances of rudeness-then let them deal with the offender.
Consistently, the author reminds the reader that we have to expect the utmost in care at all times. Although it is an admirable goal, it is not realistic. She holds providers to strict standards mentioning that if she has an appointment scheduled for 8, she expects she will be in a room speaking with her provider at that time. This is not going to happen 9 times out of 10. She may be punctual to all encounters and may even have a doctor who runs on time frequently. However, she forgets that healthcare is not something every patient seeks by appointment. She forgets that most patients arrive at the reception/front desk area at their appointment time and not 15 minutes early. She forgets that we have emergency department physicians calling to consult regarding a patient or a stat laboratory result that has to be reported.
This book is relevant to the state of healthcare today. In this election year, we are all looking for better solutions to our day-to-day healthcare issues. Many consumers are looking for a better way overall to get it right. Sadly, I feel Ms Casey has missed the mark. If every patient who encountered a poor performer took the time and energy to complete the forms she recommends, they would waste away waiting for remedies. I do not think this book is truly applicable for most patients. I hope that patients who read this book come away with the morsels and tidbits I highlighted above. As for me, I am still waiting for that magic manual to set out in our waiting room.
-Brooke Cannon Poindexter, RN, BSN
Kansas City Family Medical Care, Kansas City, MO