If you have ever gone to a hospital, clinic, doctor’s appointment, etc., you have probably experienced a myriad of frustrations, disappointments, and failed expectations during the course of your encounter. In the USA, state, federal, and occasionally local regulations make the health care delivery (non-) system overly reliant on defensive practices that are likely well intentioned, but burdensome for care providers and exceptionally challenging for those of us who are users of health care services. Although much work has been done in the past 40 years to reshape both the nursing and medical professions into ones that are more client-focused, neither profession has made lasting changes to health care organizations and facilities that result in a facilitated system of services for ease of use.

For instance, The Joint Commission (formerly JCAHO or Joint Commission on Accreditation of Healthcare Organizations) releases National Patient Safety Goals (NPSG) annually, which member institutions are required to implement. Virtually all hospitals belong to this organization. These NPSGs have made substantial improvements in overall clinical safety. Although much of the NPSGs are directed toward procedures and clinical systems, the burden is placed squarely on the shoulders of those who provide direct care, as it should be. However, what is missing is a requirement that the NPSGs actively involve physicians in the all of the NPSG-directed culture change toward universal patient safety, which perpetuates a split between MDs and other clinicians that is prevalent in American hospitals and clinics.

A complementary client-centered approach is being discussed at the Empowered Health Conference, which is dedicated to revitalizing the moribund American health care experience. Working toward an empowered healthcare user, they offer these tips for navigating and managing the crazy quilt health care system:

• Have a health advocate. Make sure someone helps you through your medical crisis, especially if you are hospitalized. Ask questions and make it clear that you expect answers.
• No news is not necessarily good news. Check on your test results if you don’t hear from the doctor’s office, as items get overlooked sometimes.
• A second – or third or fourth – opinion is appropriate at any time during your treatment, not just in the early stages of diagnosis. An MD who does not appreciate other opinions might not be your best choice for a provider.
• Be aware that federal law guarantees patients access to their medical records. All patients have a right to copies of their records, and they should make it a practice to ask for a copy of everything.
• Always check your medications for drug interactions. Two great resources are the Physicians’ Desk Reference or your local pharmacist, often a highly resourceful professional.
• If you need surgery, find out information about your hospital at the U.S. Department of Health and Human Services site.
• If you are having surgery, ask your hospital to use the World Health Organization surgical checklist or to provide full assurance that the WHO checklist has been incorporated into the hospital’s own surgical checklist.

Here are a few strategies for improving your health care:

• When going for an appointment with a licensed independent practitioner (LIP): an MD, Physician’s Assistant (PA), or Nurse Practitioner (NP), either take a detailed list of your medications or bring all of your drug containers with you. On the list, include the drug name, dosage, and how you take it (by mouth or otherwise).
• When prescribed a new medication, ask for clear instructions on what it is treating, any known side effects, and for how long it is to be used.
• Insist on generic medications, which are chemically identical to brand names, and which are usually dramatically less expensive.
• Discard medications that have been discontinued, unless there is a high chance that you might restart them.
• Check drug name, dosage, and expiration dates before using medications, as pharmacies that dispense prescriptions can and do make mistakes.
• If you are admitted to a hospital for testing or for a procedure, ensure that you have an Advanced Health Care Directive (AD) on file. An Advanced Directive outlines what treatments, if any, are to be provided in case one is incapacitated and cannot make decisions. Complete one in advance and keep clear photocopies in your records, with your MD or LIP, and with trusted friends who can advocate for you should it be needed. Ask your MD or RN if hospitalized for help completing an AD.
• Actively work with legislators and health care professionals to insist that the USA move toward a universal single-payer health care system. This will require the federal government to issue national standards and regulations, which will embrace a culture of patient safety and informed care.

If one does not ask, one will not receive the information or assistance that is required. Be a proactive and interactive user of health care services, which will substantially improve both your quality of health care and quality of life. @DoctorJames