Saturday, January 13, 2007

Doctor Patient, Relationships Your Doctor and You- First of a Series

Navigating the System

This series will consist of excerpts of chapters from my unpublished book Your Doctor and You. These entries may be a trifle long for instant news-seeking and quick-reacting blog readers. Forgive me. I prefer depth to one-liners and balance to sensational revelations or late-breaking news. I am not the Jack be Nimble, Jack be Quick, Jack Jump over the Candlestick type. I don’t look for current greedy villains. I prefer quiet innovative heroes, many of whom I describe in my upcoming book, Innovation-Driven Care: 34 Key Transformations (Jones and Bartlett, 2007). I will occasionally break up the longevity by inserting a poem or two.

For many of you patients navigating the health system – finding the best specialists, avoiding the worst, selecting the right cosmetic surgeon, choosing a cancer doctor who knows most about your particular malignancy, picking the right health coverage, unearthing care you can afford, and finding help in settling disputed claims – has become an exercise in futility because of the overwhelming complexity of the system.

To whom can you turn? Your employer, your insurance agent, your doctor, your local hospital, your local medical society, or, Internet search engines, such as Google, Yahoo, Netstar, or soon, These sources may help, but in the end you must help yourself as an informed consumer. In desperation, you may even want to turn to this blog.

Human Help Needed\

As good as the Web is for ferreting out health information, it is not enough. Human help is needed. I have tried to provide that help by writing this book for patients in different, sometimes difficult, economic, disease, and cultural circumstances.

This book seeks to instruct patients how to get the best care depending on your situation. i.e., whether you are healthy, sick, old, young, wealthy, foreign-speaking, poor, insured, uninsured, happy, unhappy, neglected by doctors, cultivated by doctors, afflicted with cancer or other dread disease, going to alternative practitioners, or just plain frustrated with the system.

Americans Generally Satisfied with Quality of Doctors, Nurses, and Hospitals

Surveys indicate most Americans are satisfied with quality of their health care: 86 percent are happy with their doctors and nurses, and 74 percent rate the quality of their local hospital as good or excellent.1

Furthermore, Americans are living longer than ever and are approaching an overall longevity of 80 years. Cardiovascular death rates have dropped by two-thirds since 1960.
We have the most advanced medical technology and medial science in the world.

• America has more Nobel Prize winners in medicine than the rest of the world combined.

• Eight of the ten of the world’s most important medical innovations over the last thirty years have been from America.2

• Companies selling eight of ten of the world’s top selling drugs are headquartered in the United States.3

Americans Dissatisfied with Costs, Uninsurance, and Inefficiencies

While Americans like their doctors and approve of the quality of care, they are not happy with the cost. In 2001, 71 percent said they unhappy with health care costs.1

This was higher than your dissatisfaction with crime or poor education. Moreover, according to a recent New York Times series, many of you are unhappy with various pitfalls, bear traps, and potholes in the system (see

Health care defects include high prescription drug costs, long waiting lines, growing uninsurance, information overload, inefficiencies, and spotty quality. A host of critics have suggested how to reform the system. Some recommend government take-over. Others advocate a shift to a consumer-driven, market based system. 4-6


I am a pathologist, writer, editor, speaker, and author of nine books, eight on health care, and one on my beloved French bulldog, Paris
This current book consists of my opinions and observations, refined and cultivated over the last 40 years, on patients and their doctors.

For the last seven years, I have served at historian for The Center for Practical Health Reform in Jacksonville, Florida. The Center espouses structural reform with private-public partnerships and wider coverage.

For the last decade, I have been on the Advisory Board of America’s Top Doctors (A Castle-Connolly Guide, New York City, 2005). America’s Top Doctors is an 1133 page volume containing lists, addresses, phone numbers, and credentials of more than 3000 top specialists nominated by peers and investigated by the Top Doctors staff.

Emmi Solutions, Inc

More recently, I have served on the industrial advisory board of a company called Emmi Solutions, Inc, in Chicago. Emmi stands for Expectation Medical Management Information. Emmi is in the business of educating patients about what to teaching patient what to expect from surgical procedures and chronic disease.

Emmi has come up with an elegant solution, - web-based programs featuring vivid videos guiding people through a soothing empathic conversational voice, plain language, and beautiful medical illustrations. A big part of our health system’s problem is that doctors and others have not taken the time to look and listen and teach – from the patient’s point of view with the right information patients understand at the right time presented in the right way.

Americans need to be more informed health consumers. But is up to we doctors to provide the information you need -- relevant, real time, at the right time when you need it the most.


1. “Survey Results on the Cost of Health Care and Health Insurance,“Market Strategies,: Livonia, Michigan, 2004.
2. Victor Fuchs and Harold Sox, “Physicians Views of the Relative Importance of Thirty Medical Innovations, “Health Affairs, 20 (2001), pages 30 to 42.
3. U.S. Council of Economic Advisors, Economic Report of the President, Washington, D.C., U.S. Government Printing Office, 2004.
4. John F. Cogan, R. Glenn Hubbard, Daniel P; Kessler, Healthy, Wealthy, & Wise: Five Steps to a Better Health System, The AEI Press, Publisher for the American Enterprise Institute, Washington, D.C, and the Hoover Institute, Stanford University, Stanford, California.
5. Richard L. Reece, MD, Voices of Health Reform, Interviews of Leading Health Care Stakeholders at Work, Options for Repackage American Health Care, Practice Support Resources, Inc, Independence, Missouri, 2005.
6. Rashid Fein and Julius Richmond, The Health Care Mess: How We Got Into It and How We Get Out, Harvard University Press, Cambridge, Massachusetts, 2005.

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