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An Ounce of Prevention…

Now, simply going online and studying medical sites does not make us doctors.  We all know this, even though some 60% of us check the web first before scheduling a doctor’s appointment.  Having access to a lot of information and understanding what it means and developing the clinical judgment to know when and where and how to apply it – that’s a whole different world.

Still, paying attention, speaking up and doing some health information homework can make us far better patients.  Remember that doctors love good outcomes – i.e., patients that live.

So we are in quest of the Golden Mean.  And Aristotle himself would doubtless recommend some of the following suggestions we can use when working with a doctor or other health care provider to reduce the risks of wrong medicine/wrong treatment:

  1. Be an active part of your health care team.  This seems self-evident but many people abdicate here.  Take part in all the decisions relating to your care.  Involved patients do better.
  2. Make absolutely sure your doctor knows about your allergies or previous adverse drug reactions.  Do not be afraid to repeat yourself.  Do not assume he/she knows.
  3. Tell all of your doctors about everything you take: medications, over-the-counter remedies, supplements, the lot.  Do not be embarrassed or shy here.  They need to know what’s going on.  They are there to help, not scold!
  4. Make sure you can read the doctor’s prescription.  If you can’t, what makes you think your pharmacist will be able to?
  5. Ask at least 2 times about your prescriptions – when they are prescribed and again when you pick them up at the pharmacy.  Make sure you understand everything about them.  In language you are comfortable with.  What is it for? How do I take it, and for how long? Are side-effects likely?
  6. Be sure to ask, when you pick up your  prescription: is this the medicine that my doctor prescribed?  Nearly 75% of medicine mistakes involve wrong drug/wrong dose.  Again, do not worry that you are annoying the pharmacist – it’s your body, after all!
  7. Ask questions about the directions on the Rx bottles.  Drug labels are notoriously complex and confusing.  Take ‘four doses daily’ for example: is that every six hours, meaning I get up in the night and take it, or just during my regular waking hours?  It matters!
  8. Be sure to ask how to measure out the doses.  Household teaspoon?  Little cup with lines? Dosing syringe?
  9. Keep the written info about side effects.  Sometimes adverse reactions take a day or two or something totally unexpected happens.  You will need to report these things right away and the information may help.
  10. If possible, have your surgery or procedure performed at a hospital that does it a lot.  The more experience they have with your condition, the better.
  11. Thorough hand-washing remains a crucial step in infection control.  Should you be hospitalized, do not be afraid to ask health care workers in direct contact with you whether they have washed their hands – with soap, too.
  12. Upon discharge, ask for your treatment plan.  You will need to understand your medications, your return-home activity levels, diet, when you need a follow-up appointment, the lot.
  13. Before any surgery, be sure you, your doctor, and your surgeon are all on the same page.  You all agree on what will be done and where.  Wrong-site surgery is 100% preventable.
  14. If you cannot speak up, ask a friend or family member to be with you and advocate for you.  It really helps.
  15. Keep in mind that ‘more’ is not always better.  Despite what we said with Number 10, above, this is a different kind of more/better.  You may not need that test or treatment being recommended.  Ask questions.
  16. No news is not necessarily good news.  If you have had a test and have not heard anything, ask about the results.
  17. Learn about your condition from reliable sources.  Check with your doctors and nurses.  They may also have suggestions for good resources.
The team approach really does help minimize errors in health care.  Poor health literacy (which disproportionately affects the elderly, the poor and new immigrants) is a very serious problem in this country.  If we want our health care system to be reformed and improved – and we surely do! –  we have to do our part, too.  
(Special thanks to Dr. Neil Baum for his excellent article on reducing preventable mistakes in medical care – see MedPage Today)
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