The Patient's Playbook: Find the "No-Mistake Zone"

by Leslie D. Michelson

Overview

The Patient's Playbook is a call to action—to change the way you manage your health and the health of your family. 

Too many Americans die each year as a result of preventable medical error—mistakes, complications, and misdiagnoses. And many more of us are not receiving the best care possible, because we don't know how to get it.

Leslie D. Michelson, the founder, chairman, and CEO of Private Health Management, and former CEO of the Prostate Cancer Foundation, has devoted his life's work to helping people achieve superior medical outcomes at every stage of their lives. His real-life stories impart lessons and illuminate easy-to-follow strategies that will enable you to become a smarter, better health care consumer—and to replace anxiety with confidence. 

EXPERT ADVICE TO HELP YOU:
• Choose the Best Doctors
• Select the Right Treatment Plans
• Do Better Online Research
• Organize Your Support Team
• Prevent Medical Errors 

Product Details

ISBN-13:	9780804170437
Publisher:	Knopf Doubleday Publishing Group
Publication date:	10/18/2016
Pages:	368
Product dimensions:	6.10(w) x 9.10(h) x 1.20(d)

About the Author

LESLIE D. MICHELSON is the founder, chairman, and CEO of Private Health Management, a unique patient-focused company dedicated to helping individuals and corporate clients obtain exceptional medical care. He is a highly sought-after expert who has spent the last thirty years guiding thousands of people through our complex health care system. Prior to founding Private Health Management in 2007, Michelson was the CEO of the Prostate Cancer Foundation. He received his B.A. from Johns Hopkins University and a J.D. from Yale Law School. He lives in Los Angeles with his wife, Beth.

Read an Excerpt

Introduction
 
After I was born, in 1951, my mother went into a major postpartum depression. For the first six months of my life, she couldn’t get out of bed, leaving me in the care of my father and maternal grandmother.  I actually didn’t learn about this until I was forty-five,   and someone casually mentioned it at a party. Sadly, the stigma of psychiatric illness was so great at the time (and still can be today) that families touched by chronic depression often had to carry the burden in silence.  My parents had been counseled by doctors that they shouldn’t discuss it, so they didn’t.

My mother  eventually  recovered, but  then  she  became bipolar, which meant there were days, months,  and years when she’d be  fine,  and then long periods when she was incapable of getting up, making dinner,  or holding   a conversation. During  her manic phases, she’d be on a high  for  days or weeks, talking  nonstop  and sometimes  being cruel  to me and others  I know she loved. I couldn’t predict when her disease would take control of her. Coming home from school, I never knew if I’d be greeted by a fire-breathing dragon or a smiling mother with a glass of milk and a plate of cookies.  I had to feel around the edges of the door for danger, the way they teach you in fire safety training.

When  I was  ten,  my  mother   screamed at me  for forty-five minutes because I left  a sneaker  on the steps.  The only ten-year-old who hasn’t left a sneaker on the steps is a ten-year-old who doesn’t have sneakers or steps.

During an ugly scene when I was twelve or thirteen, I physically held my mother down in a chair and told her, “You will stop yelling at my brother right now.” That moment changed everything between us. She was my mother, and I loved her, but her disease was dangerous, and I had to be assertive.

Although my mother’s illness was hard on me, it had to have been worse for my father. The instant I was born, he lost his wife. And yet he remained extraordinarily positive and strong. He was a genuine role model, the moral center of gravity for every community that he was in—whether it was our larger family, the synagogue, the Boy Scouts, his business, or his trade association. He was the guy who would solve other people’s problems. I could talk to Dad for hours.

By my early teens, I was actively involved in helping with my mother’s care. That was when she received her first electroshock therapy treatment for recurring depression.  Later, we had her on daily lithium, a mood stabilizer. I had to grow up and become a responsible caregiver at a very young age.

And here’s where the story gets complicated. When I was in high school, my father came home one evening, clearly agitated. For me, the sun came up at night when my father walked through the door. As tired as he was, those hours with him were absolutely precious. If he came home anxious or upset, that was a big deal.

He had gone for his annual physical that day with his primary care physician, a man with   whom he’d attended high school in Newark, New Jersey. The doctor had recommended that my father see a certain cardiologist. A week or two later Dad came home even more rattled than before.  The cardiologist had told him he needed to have open-heart surgery.

I was overcome with worry. Was my dad going to die? Losing him wouldn’t just mean I’d  be an orphan,  practically  speaking; it would mean I’d  have to take full responsibility  for my mother. That was not a reality I could handle.

That night I couldn’t sleep. The next day I couldn’t concentrate at school. I got home that afternoon and picked up the phone to dial Lenox Hill Hospital in New York. Although we lived in suburban Union, New Jersey, I read The New York Times every night, and somehow I recalled “Lenox Hill” always being mentioned.  I knew that when you wanted to go to a nice restaurant, see a good play, or go to a top hospital—you went to New York.

“Can I please speak to the head of cardiology?” I asked.   I’m sure my teenage voice must   have cracked on the line as I spoke, but I wasn’t going to aim low.

“Dad,” I announced when my father got home, “I set up an appointment for you to get a second opinion   from the chairman of cardiology at Lenox Hill.”

“You know, that’s a good idea,” he said. “I’m gonna do it.” And that was that.

On the day of his appointment, I waited at home in agony. This had to go right. I couldn’t imagine a future without him. I was seeing the walls coming down.

It was all I could do not to knock him over when he walked in the door. “What did he say, Dad?  What did he say?”

“He said, ‘There’s nothing wrong with your heart, and the doctor who recommended surgery should be shot in a public square.’ ”

Exact words. He was ecstatic. And I still remember where I was standing in the kitchen when he said it. I remember this better than I remember what I had for breakfast today.

My father never had any heart problems.  No high blood pressure, no calcium in his coronaries, no leaky valves. He passed away in 2007, succumbing to something totally unrelated to his heart. But back in 1988, when I was building my first company, I met Dr. Robert H. Brook, who was then the vice president and director of RAND Health, a health policy think tank. He had just published research showing that many of the major surgical procedures being done in the United States were harming rather than helping patients. In fact, when it came to coronary  artery  bypass  graft  surgeries—what  my father  was told  he needed—14  percent were done for “inappropriate reasons,” and 30 percent were done for “equivocal” reasons. I thought, My God, this doctor has found scientific evidence of what I suspected was going on some twenty years ago.

I still think of my father every day and how his “case” ignited my passion for helping people to get better care. Managing serious illness is not easy, but armed with  the knowledge in this book, and the support  of a trusted primary care doctor,  I truly believe that everyone can—and must—become  a  more powerful  and effective health care consumer.

Table of Contents

Foreword ix

Introduction: How to Save a Life 3

Part 1 How to be Prepared: The way you interact with doctors and hospitals could be dangerous to your health. Here are your take-charge steps: Find and partner with a good primary care physician, complete your personal health binder, and round up your wellness team. 19

1 Why Having the Right Primary Care Physician will change your life: How to view this essential relationship-and what your doctor should be doing for you 21

2 How to find the best Primary care Physician for you:…or develop a better relationship with the one you have. Plus: advice from doctors on dealing with them 37

3 Three things you can do right now to be better prepared: Write your family's medical memoir, collect your records, and take inventory.

4 Develp a Support Team: Why you need to recruit an effective health care quarterback-and how to ask 77

Part 2 Experts and Emergencies: When a potential health crisis looms, how to get to the bottom of the problem and the top tier of medical care. Plus: how to handle yourself in an emergency (room).

5 Overtreatment can be as dangerous as Undertreament: How to find the right level, no matter your condition 89

6 How to find and Interview the Medical Experts you need: Don't just Google it-here are smarter ways to get the right specialists. 107

7 EMERGENCY ROOM IOI: The four most common mistakes made in the first twenty-four hours of a medical emergency 139

Part 3 What to do when serious Illness Strikes: Get to the No-Mistake Zone by following the four steps of Intensive Case Management. 165

8 Patient, M.D.: You've got a major health problem. Approach it like a pro. 167

9 Step I-Immerson: Learn everything you can about your illness and the doctors who are passionate about it. 175

10 Step 2-Diagnosis: How to be sure you've been correctly diagnosed? Follow the carpenter's rule: Measure twice, cut once. 197

11 Step 3-Treatment: How to identify the right treatment plan?and the best doctor for you 213

12 Step 4-Coordination: How to make sure your doctors are performing like a team 245

13 Competence and Courage: Now that you've got it, lead the way 269

One Final Thought 273

Acknowledgments 277

Notes 283

Index 311

Editorial Reviews

A Word from the Doctors: 

"The decisions you make about your medical care will have a profound impact on you and your family's life.... Successfully steering through the medical system can be a challenge. In The Patient's Playbook, Michelson gives away secrets of the trade—lessons he's learned from more than thirty years of helping people get better outcomes.... He levels the playing field by providing average patients who have ordinary health insurance with the resources, advice, and tools they need to make better medical decisions.... As a patient, you have more power than you think. This book will help you find that power and use it to maximum advantage."
—From the Foreword by Peter T. Scardino, M.D., Chair, Department of Surgery, Memorial Sloan Kettering Cancer Center

"What a tour de force! Every health care consumer (and caregiver) can greatly benefit from this practical guide to achieving better health outcomes. Simple, actionable advice abounds, and each recommendation for how to best navigate the complex health care system is enriched with Leslie Michelson's recounting of poignant stories from his extensive experience. With this playbook, all of us can better protect our most valuable asset—our health." 
—Jonathan E. Fielding, M.D., Distinguished Professor, UCLA Fielding School of Public Health and Geffen School of Medicine, and former director of the Los Angeles County Department of Public Health 

Reviews:

"Trust me—you need this guide because everyone at some point faces a health crisis. Michelson details, step by crucial step, how to navigate the terrifying world of doctors, hospitals, second opinions, drug trials, and insurance so you get lifesaving results."
—AARP Best Books of 2015

"Michelson implores patients to be intensely involved in their own care.... He urges patients...to 'bring their A-game' to the doctor's office...advocat[ing] smart care, not more care." 
—The Wall Street Journal

"In this unique and useful book, [Michelson] maps out a plan to organize competent medical care when needed.... He provides advice and resources that help individuals become medically prepared, make sound health-care decisions, and more likely achieve favorable results.... An invaluable resource, The Patient’s Playbook can effectively assist individuals in navigating the complex and often overwhelming world of illness."
—Booklist (Starred Review)

"Unlike most how-to books, this one is thick with advice and instructions....what's at stake: Your need to obtain the best possible diagnosis and treatment from an expensive but fractured netowrk of health care providers....The steps Michelson offers for negotiating the system mirror what his company does for patients—finding top experts and coordinating care....his insights about the importance of getting your caregivers to notice and talk to you is invaluable."
—Sarasota Herald-Tribune 

"A primer on making the right moves as an active participant in your health care.... Michelson is the CEO of a company that works with patients to get the best possible care—not only from the best possible physicians...but also through guiding guiding them through the process described in this book, one that shifts the role of care director over to the patient....with this useful book, patients can have more say over what direction treatment takes rather than just going along for the ride."
—Kirkus Reviews

From the Publisher

2015-07-30
A primer on making the right moves as an active participant in your health care. Whatever your opinion on the Affordable Care Act, there's an argument to be made that the American health care system is still a confusing mess, driven by cost-cutting, managed care initiatives, and conflicting information. Michelson is the CEO of a company that works with patients to get the best possible care—not only from the best possible physicians (though that often factors in), but also through guiding them through the process described in this book, one that shifts the role of care director over to the patient. The author was in high school when his father was told he needed open-heart surgery. Terrified at the idea of losing his father, he called another hospital and somehow finagled a second opinion with the chairman of cardiology, who went on to discover that Michelson's father's heart was fine. The author addresses our fragmented health care system by essentially moving the system over into the hands of the patient. Akin to becoming an expert on yourself, the patient takes an account of his entire medical history and learns the best ways to empower doctors to deliver the most accurate care. Michelson balances cautiously on the fine line between empowering patients to direct their care and empowering them to know what's best. Sensitive to the volumes of misinformation that are just a Google search away, he advocates for a measured approach, pulling in support and information from a range of medical professionals. Michelson advises using not only personal wisdom, but also the skills and insights of others in a coordinated effort to reach the best outcome. As the author notes early on, health care is one of the few areas where people willingly cede control over to others, but with this useful book, patients can have more say over what direction treatment takes rather than just going along for the ride.

Kirkus Reviews