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, even though it’s readily available and we’re entitled to it. The key is knowing how to access it.
The Patient’s Playbook is a call to action. It will change the way you manage your health and the health of your family, and it will show you how to choose the right doctor, coordinate the best care, and get to the No-Mistake Zone in medical decision making. Leslie D. Michelson has devoted his life’s work to helping people achieve superior medical outcomes at every stage of their lives. Michelson presents real-life stories that impart lessons and illuminate his easy-to-follow strategies for navigating complex situations and cases.
The Patient’s Playbook is an essential guide to the most effective techniques for getting the best from a broken system: sourcing excellent physicians, selecting the right treatment protocols, researching with precision, and structuring the ideal support team. Along the way you will learn:
Why having the right primary care physician will change your life
Three things you can do right now to be better prepared when illness strikes
The ten must-ask questions at the end of a hospital stay
How to protect yourself from unnecessary and dangerous treatments
Ways to avoid the four most common mistakes in the first twenty-four hours of a medical emergency
This book will enable you to become a smarter health care consumer—and to replace anxiety with confidence.
|Publisher:||Knopf Doubleday Publishing Group|
|Product dimensions:||9.40(w) x 6.10(h) x 1.50(d)|
About the Author
Read an Excerpt
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
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