3 things every patient should know when dealing with the health-care system

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With millions of people newly covered by health insurance, and 11,000 more becoming eligible for Medicare every day, more people will be visiting doctors and hospitals.

And while that’s a positive, patient advocate Ruth Fenner Barash warns that the U.S. health care system is not always the benevolent safety net many people believe it to be. It can be abusive, incompetent, callous toward patients—and worse.

“Patients and their loved ones cannot blindly turn themselves over to this massive, technology-based system and trust that it will care—or take care of them,” says Barash, who shares lessons learned from extensive health-care experiences in a new book, “For Better or Worse: Lurching from Crisis to Crisis in America’s Medical Morass,” (http://forbetterorworsebook.com/).

Her cautionary tale traces the long medical journey her husband, Philip, endured with her as his advocate. She discovered mismanagement and excess, useless interventions and a sometimes complete disregard for pain—even when there was no hope of healing.

“I learned a great deal from our experience, and with so many people now gaining access to health care, I want others to benefit from what I’ve learned,” she says. “You can navigate the system; you just have to know how.” Barash offers these suggestions for patients and their loved ones, whether it’s a trip to the doctor for a checkup or a diagnosis of a catastrophic illness.

•Avoid the emergency room—for your own sake.  Emergency rooms were developed with the idea that few people would use them—most people would see their physician. But as health care costs rose, they became a primary care facility for those without insurance or the money to pay for services out of pocket. “Patients and their families were not expected to spend a long time in the E.R.—presumably, they would be seen quickly and either admitted to the hospital or treated and released—so they’re not designed for comfort,” Barash says. “They’ve become very crowded, especially in cities, and patients might wait for hours sitting in hard plastic chairs in the waiting room. For someone who’s sick or injured, this can be torture.” Sick people usually are not isolated, so waiting rooms also teem with germs, she notes.

•Be skeptical—question everything.  Too often, we take the first thing we’re told as gospel, Barash says. “If you have the luxury of time, take some of that time to think things through, to research and get second opinions,” she says. Research your physician’s connections. When you’re referred to a specialist, ask why that particular person. If you live in an area with a large academic community, ask around about the physicians and health-care providers with the best reputations. Who has the most experience in a particular niche? Who’s doing the most promising research? How many times have you performed this procedure and what is your success rate?

•Ask what it costs—no matter who’s paying. Our health-care system is absurd in the number of useless consultations, diagnostic procedures and interventions it foists on patients, Barash says. Whether our hospital bills are fully covered by Medicare, Medicaid or private insurance, or we’re paying a portion ourselves, we must all include cost in our discussions with health-care providers. “Part of the blame for having the most expensive health-care system in the world goes to us, the individuals, who don’t question purchases or shop for prices as we would for groceries, clothing, or furniture,” Barash says.  “If a test or consultation is ordered, understand why. Is it really necessary? You can say no!”

Finally, Barash says, we all must come to terms with the fact that death is a given.

“My husband’s problem, and the problem many of us may be doomed to face, is the seemingly endless getting there—a dying we don’t want.”

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