Quality Care

 
 

Good decisions are made "straight from the gut".

Jack Welch

En Español | When communication is effective and productive, it provides the opportunity to convey care and compassion, and to reassure and strengthen the human-to-human connection, based on courtesy and respect. From a patient’s perspective how the message is communicated it is as important as the what is being communicated.

The role of the patient as it was known in the past, in which the patient would simply go to the doctor and follow their instructions has changed. Unfortunately, too many regulations have been put forth by different institutions, jeopardizing the quality of modern health care. Many times doctors act in compliance with the industry, instead of the patients’ best interest. 

 

Patients and physicians can encourage a good communication and good relation with each other if they take the approach of Shared-Decision Making, in which a doctor’s recommendation is derived from evidence-based medicine, their expertise, and the patients’ personal values and preferences. The relationship shifts from the traditional paternalistic approach to be more informative, where the facts and figures, knowledge and skills, are told by the physicians, but the decisions rest upon the patients.

 

By communicating more effectively with their doctors, patients can take control over their health, and thus increased satisfaction. An increase in the amount of questions a patient asks improves the quality of the information received, ensuring that the patient better complies with treatment recommendations, and providing a better overall health outcome.

Tips on How to Communicate with Your Provider

  • Put your feelings into words. Describe how your daily life is being affected by providing descriptive examples of how limiting the pain is and how it has worsen over time.

  • Distinguish between mental and physical distress. Describe how your mental and/or your physical well-being is being affected.

  • Share relevant information. Provide family history as well as research findings.

 

Provider’s Approach for a Shared-Decision Making

  • Inform the patient what different associations, such as the American Cancer Society, recommend.

  • Provide balanced information about potential risks and benefits, addressing both equally.

  • Inform the patient of alternative options.

  • Provide their best advice on which treatment the patient should follow.

  • Allow the patient to choose their treatment based on their own values and preferences.

Questions for your Provider

WHEN A TREATMENT IS PROPOSED

  • What is the physician’s track record with this treatment?

  • Why do you recommend this particular treatment?

  • Under which criteria?

  • Before the treatment was available, what were you doing, and why is this better?

  • What are the alternate options?

  • If one just waits and sees, what could happen?

  • Out of 100 people like me, treated for such amount of time, how many will get benefit?

  • What are the pros and cons of each option?

  • If this treatment does not help what will we do next?

  • How often have you encountered a problem with the proposed treatment?

  • Why is this the best treatment for me?

  • How does this treatment fits me and do I need to change my routine?

  • What would he/she do for themselves?

  • Is this treatment covered by my insurance?

 

IF A PRESCRIPTION is given

  • Ask the doctors name of the drug and the instructions to take them.

  • What condition is this medication being prescribed for?

  • Has this medication been approved for my condition?

  • What kind of side effects can it produce?

  • Can it interact or affect my other medications?

  • What are the risks associated to this medication?

  • Do the benefits outweigh the risks?

  • Out of 100 people like me, how many benefit from this drug?

  • Is this a new drug? (It is better to use drugs that have been in the market for at least three years.)

  • Will I develop tolerance to the drug requiring higher doses and costs in the future?

  • Can I stop taking the medication at any time or do I need to wean myself off?

  • Are there any more affordable drugs that will work for me? Is there a generic drug?

  • Are there other options if this drug is not covered by my insurance?

    Double check all the information at the pharmacy.

    Fill all your prescription drugs in a single pharmacy in order to avoid conflict with other drugs, as each pharmacy keeps its own database and will alert you of any interactions.

            

 Note about Black-Box Warnings

This is the strictest labeling requirement that the FDA can mandate.  They highlight serious and sometimes life-threatening side-effects. Be wary and ask question about how this medication can affect you if prescribed.

 

IF A DEVICE IS RECOMMENDED

  • How does the device work? Has it been approved for this use?

  • Do you have a model I can look at?

  • What is it made of?

  • Can you refer me to any instructional material or research done for this device?

  • Are there any warnings or contraindications? 

  • What are the rates of failure and success? What is the worst that has happened?

  • Out of 100 people like me, how many benefit from this device?

  • Has the device ever been recalled?

  • How many years has this device been in use? (It should be at least three.)

  • Why do you think this is the best choice for me?

  • What are the alternatives to this device? How was the problem resolved before this device existed?

  • Are there other similar products in the market? If so, why is this device better?

  • Do you receive any gifs or compensations for the use of this device? 

  • What is the cost of this device? Will my insurance cover it?

  • If I develop any adverse reactions, how would it be resolved? By who? Will my insurance cover it?

  • What can I expect during the recovery period? How long will it be? What are the signs I should watch out for?

IF A TRIAL IS PROPOSED

  • Are the patients enrolled same like you, same age, same sex, same problems, same fitness, same country? If not, then ask for alternative treatments.

  • Who paid for the trial? If it is the same pharmaceutical company that will eventually profit from the drug being tested, it must be considered.

  • What happens if we do nothing? Meaning what is the natural history or evolution of the disease.

  • What is the number needed to treat? How many people like me need to be treated, for how long, for one person to get benefit? Such as you need to treat 20 people for 5 years to save 1 life.

  • How does it work, what are the side effects, does my insurance cover it? If the unproven treatment that you are being offered is to prevent you from becoming ill, just reconsider it. 

     

If you are sick or suffering the decision is harder, knowing that the treatment you are being offer may help, but it also may not makes it a tough decision to take. You can check the page Tips to Make Decisions for further assistance.

 

QUESTIONS AFTER A SURGERY

  • Where there any complications, lacerations, perforations or excessive bleeding?

  • Where any additional procedures performed that were not planned?

  • Is there any risk for infection or blood clots, if pre-operative antibiotics were given when should they be stopped?

  • What is the likelihood of success or complications?

  • What is the expected course of recovery?

  • What is the plan for care after surgery? Does the patient need to have the blood sugar checked in order to reduce risk of infection or receive any special monitoring?

  • How can you be reached if there is a serious problem?

  • What should I expect in terms of pain? Who will be responsible for managing pain medication orders?

  • When can the patient resume taking their regular medications? If the patient takes blood thinners, be sure to know when these can be taken as the patient can have a stroke or blood clot if this treatment is not restarted as soon as possible.

  • What signs should be watched for? Temperature, vital signs, etc.

  • Will there be any physical therapy after surgery? Who is responsible for scheduling it, and when should one start?

  • When should the patient see the surgeon for a follow up?

 

IF ADMITTED IN THE ER 

  • Be sure that you really need the procedure, ask the medical attendant to explain you what the pros and cons are and if there are any other alternatives.

  • Ask what can happen if you do nothing.

  • Sign the consent form to be treated, but cross out the clause that says one agrees to pay whatever it costs. If presented with an iPad, ask for a paper copy or make a “battlefield consent form” yourself with any paper, stating you agree to be treated and will pay up to twice the cost Medicare will pay, and just for in-network providers.

  • Alternatively carry your own Consent Form.

Resources

Payments Received by Physicians

Open Payment Data

Check for payments made to physicians and hospitals, by drug and medical device companies.

Screening Tests Information

MedLine Plus

Information about recommended and unusual screening tests.