In The Patient’s Playbook, Leslie Michelson offers the wisdom he’s gained from 30 years of helping people get health care. Michelson, trained as a lawyer, is the founder and CEO of Private Health Management, which aids individuals and corporate clients seeking optimal medical treatment. He lives in Los Angeles. Here is an edited version of his conversation with the Toronto Star.
You help Americans, mostly the very wealthy, get top-notch health care. We have such a different medical system. Is your advice applicable to Canadians?
There are differences in the systems, but also a lot of similarities. Our physicians are trained in the same ways and our hospitals are accredited in the same ways. Both systems suffer from significant preventable errors. So in both systems, it’s imperative for patients to learn to be more assertive and to gain control of their own medical destinies.
You talk about preparing for falling ill. What are the top things a person should do?
We prepare for things such as college tuition or retirement, but people don’t prepare for illness. First, you need to document your family’s medical history. More and more we’re learning that genetics is part of our health destiny.
Second, collect all your medical records — the diseases you’ve had, medications you’ve taken, weight and blood pressure over time. And third, develop a strong and enduring bond with a primary care physician so you can benefit from health care developments in prevention and detection.
What should you look for in a primary care physician?
You want someone who listens and respects you, and someone you will listen to. It should be someone whom you can get in to see when you need to. It should be someone who supports your wellness goals and will help you focus on the issues when you lose focus.
Overall, what are the biggest mistakes patients tend to make?
Becoming passive and doing nothing or doing whatever the physician recommends without asking questions, educating themselves or becoming partners with the physician.
What’s the “no mistake zone”?
It’s a multi-step process that reduces anxiety and ensures you make better choices. First, make sure your diagnosis is accurate and complete. In the U.S., we lose 100,000 lives a year from diagnostic errors. Second, make sure you understand when and why you need to be treated.
Third, educate yourself online about your disease and treatment options. Fourth, meet with one or more physicians who specialize in precisely your condition. Use databases, such as expertscape.com, which lists physicians who’ve published articles on a particular disease. Expertise matters. No realm of knowledge is more complex than human biology. And there’s no realm where advances come more rapidly than biomedical research.
In your book, you encourage people to do what they can to jump the queue. Is that the right thing to do?
I’m not suggesting someone whose treatment can wait four to six weeks should assert themselves that it needs to get done today. But if it is a condition that needs treatment now, you need to figure out how to assert yourself and get everyone’s attention that a delay would irreversibly affect the clinical course.
But when someone is ill, reason often goes out the window. Emotions take over. Everybody wants treatment now.
That’s why it’s important to have a health-care quarterback, someone with less direct emotional involvement. That person will learn about the patient’s condition and understand the real urgency, as opposed to yielding to anxiety.
It’s difficult for any individual to manage a tough diagnosis on their own. We encourage people to tap into their community, close friends and family, to put together a support team.
Once in hospital, how can a patient stay safe?
Hospitals are miraculous institutions, but they’re also dangerous. That’s why it’s great to have an advocate with you. One thing that person can do is make sure the reason for any change in medication is understood. That person can make sure all doctors and nurses are co-ordinated. The endocrinologist managing the patient’s diabetes has to be made aware of the changes in medicine the cardiologist has recommended.
You need to make sure every person who touches you in hospital has washed their hands to reduce infection from dangerous germs. Finally, when you leave hospital, the discharge instructions are so important. A lot of mistakes in medicine happen at the intersections — when a patient moves from the emergency room to intensive care to a regular bed to discharge.