The Enlightened Patient

Consider your brain. Of the body’s two dozen major organs, it’s the only one burdened with the complaints of all the rest, not to mention some 206 bones and 600-plus muscles. And when something actually goes wrong with any of the aforementioned, it’s up to that same brain to kick into high gear and decide where to go, who to see, what to ask. So give it something to work with. We’ve packed the following pages with ideas from local doctors, hospital execs, insurance experts, and consumer watchdogs for finding first-rate healthcare resources (including our annual Top Doctors list), along with tips on making the most of them. Just open up and say, “Aha!”

1. In a city where you can’t swing a blood-pressure cuff without hitting a world-renowned specialist or U.S. News–touted medical center, there are plenty of good healthcare choices to make. The key is making a great one.

After searching painstakingly, sometimes desperately, for the best medical care in the world, every year thousands of patients hailing from Amman to Zurich pack their bags for Boston, Massachusetts: home to cutting-edge research teams, prestigious med schools, and a list of top-ranked hospitals longer than your femur. And when these medical pilgrims check in for treatment, odds are they’ll be far savvier consumers than you, the native Bostonian in the next bed over.

“We are blessed with a lot of excellent healthcare,” says Dr. Thomas H. Lee, head of the Boston-based physicians group Partners Community HealthCare. “But people tend to presume a general equality of hospitals and doctors, which isn’t always the case, even in this city.”

So, where to start? While a Zagat guide to Boston healthcare hardly seems forthcoming (“Regulars rave about the ‘great IV drips,’ but give bedside manner ‘a big thumbs-down’”), there’s still a staggering amount of consumer information out there—from U.S. News & World Report’s annual hospital rankings to Consumer Reports’ newly launched Health Ratings Center. For those who prefer hard-core data, websites like Hospital Compare and the Leapfrog Group [see “How Hospitals Get Rated,” right] compile reams of federal stats and voluntary reporting that can show, for example, how many heart bypass operations an individual hospital performs annually and how well its patients fare afterward.

Physician ratings are harder to come by, partly because what makes a good doctor is in the nuances—diligence, caring—as much as the numbers. But peer surveys and patients’ feedback are increasingly attempting to fill in the blanks, whether for the M.D. report cards that consumer-review group Angie’s List introduced this spring, or for this magazine’s own Top Doctors list [see “How M.D.s Get Graded,” right].

Just bear in mind that all these rankings, stats, and surveys are a means to an end, rather than an end in themselves. Use them to spark questions and explore the possibilities in your search for not “The Best” healthcare provider, but the best one for you and your family.

 

2. Vast online resources make learning about your health, or your illness, easier than ever. Just make sure you know where YOUR newfound savvy ends, and your DOCTOR’s expertise begins.

Last year some 122 million Americans were tapping away on laptops, sifting through newspapers, and talking with friends in pursuit of that rarest of healthcare commodities: peace of mind. That’s according to the Center for Studying Health System Change, which reports that more than half of us sought information about a medical concern from sources other than our doctors in 2007, up from 38 percent in 2001.

That’s not lost on local M.D.s. “We’ve absolutely seen a change in the way patients prepare for visits, coming in with questions and printouts they’ve collected from the Web,” says Dr. Margaret Sullivan, an OB-GYN at Tufts Medical Center. “There’s a lot of misconceptions and misinformation out there, yet overall I think it’s a good thing, that you’re participating more in your own care.”

Yet all this data can have a startling downside: patients actually acting as their own PCPs. “Increasingly, people are arranging on their own to see multiple specialists,” says Dr. Dale Magee, immediate past president of the Massachusetts Medical Society. “But that often results in a bunch of doctors who don’t talk to each other, and a lot of dangerously mixed-up prescriptions.”

So take down your shingle. Even better, don’t hang it up in the first place. Smart patients use the Web critically; they also log off and seek advice from real people. But most of all, they find (and hang on to) a good physician who can keep track of the big picture.

 

3. Doctors and nurses can’t read your mind. So to make the most of that office visit or hospital stay, get things off your chest—you’ll feel better.

Foreign smells. Native garb. The buzz of unfamiliar words. Whether you’re shivering on a gurney or simply going in for a checkup, entering the healthcare system can be like landing in another country (and a seriously bureaucratic one, at that).

This is no time for sitting passively on the tour bus, however: Patients who get involved in their care not only chart higher rates of satisfaction, but end up healthier, too. Ask your doctor to wash his hands, and cut your risk of infection. Double-check your prescription, and help head off medication errors.

Little wonder, then, that when we asked more than 200 local doctors to share their top advice for patients, nearly half the respondents called for better communication. “[Patients] are our partners in keeping them healthy,” says Dr. Jessica Fewkes, a dermatologic surgeon at Mass Eye and Ear. “Asking questions, pointing out things, reminding us of previous issues—it allows us to deliver the best possible care.”

A stay in the hospital may feel more overwhelming than a trip to the doctor’s office, but the same rules apply. Bring a family member, friend, case worker, or other advocate who can help you speak up. Get to know the staffers and treat them as members of your team. And for God’s sake—don’t just lie there.

 

4. When complications arise—be they issues with your bill, or tensions with your M.D.—here’s how to make a smart recovery.

In talking about the patient experience, much is made of “giving” and “receiving” care, suggesting the gentlest transference of healing. Less frequently mentioned: the wheedling, wrangling, dissecting, arguing, and defending of care that is often necessary, as well.

With the average Bay Stater laying out more than $6,600 a year for healthcare, or 27 percent more than the national average, that bottom line needs round-the-clock observation. There are advocacy groups that help cut through hospital and insurance company bureaucracy, consumer tipsters with smart ideas on trimming health costs—so make the most of them.

It isn’t just about money, though; it’s about value, too. Refuse to settle for subpar care. Break out of customer-service hell. After all, you should get what you’ve paid for.