What can patients do to get better care?

As the health-reform law takes effect over the next several years, some 32 million newly insured Americans will gain access to a regular doctor. They will soon learn what others already know: Getting the best care from your doctor requires navigating a complex relationship within the 20 or so minutes allotted for the typical office visit.
In an online poll of a national sample of 660 primary-care physicians conducted by the Consumer Reports National Research Center, doctors revealed what patients can do to get better care.
Their top gripe? Patient noncompliance with advice or treatment recommendations. Most physicians said it affected their ability to provide optimal care and more than one-third (37 percent) said it did so “a lot.”
In the poll, conducted in September 2010, physicians named these top challenges:
— More than three-quarters (76 percent) of doctors said when it came to getting better medical care, forming a long-term relationship with a primary-care physician would help “very much.”
— Next on the list: being respectful and courteous toward doctors, with 61 percent saying it would help “very much.” More than two-thirds (70 percent) said since they had started practicing medicine, respect and appreciation from patients had gotten “a little” or “much” worse.
— Forty-two percent of physicians said health-plan rules and regulations interfered “a lot” with the care they provided.
— When it comes to minimizing pain and discomfort for their patients, only 37 percent thought they were “very” effective, though almost all (97 percent) thought they were “somewhat” effective.
Patient perspectives
The Consumer Reports National Research Center also conducted a subscriber survey in 2009 (its readers may not be representative of the U.S. population as a whole). The CR subscribers surveyed said that as patients they were highly satisfied with their doctors. But they still had complaints ranging from the irritating, such as having to sit too long in the waiting room, to the substantive, such as ineffective treatments. Other findings include:
— Thirty-one percent of patients said they wished they had more information before choosing a doctor.
— More than one-quarter of patients indicated some level of discomfort with their doctors’ inclination to prescribe drugs.
— Only 9 percent of patients said they e-mailed their doctor directly in the previous year.
Tips for getting the most from an office visit
To get the most out of the 20 or so minutes allotted for the typical office visit, Consumer Reports provides the following tips:
— Plan ahead. Jot down a list of questions or concerns to address during the appointment, and prioritize them to get the most important ones answered first.
— Take notes during the appointments. Eighty-nine percent of doctors said that keeping an informal log of treatments, drugs, changes in condition, notes from previous doctor visits, and tests and procedures could be helpful. But only one-third (33 percent) of patients routinely did so.
— Research online, but carefully. Sixty-one percent of patients said they researched health information on the Internet to help with their medical care. Almost half of physicians surveyed said online research helps very little or not at all. For information on a condition, consumers should go directly to a few reliable sites like government sites and high-quality academic treatment-center sites, such as the following:
— Centers for Disease Control and Prevention (www.cdc.gov)
— Food and Drug Administration (www.fda.gov)
— MedlinePlus (www.medlineplus.gov)
— National Cancer Institute (www.cancer.gov)
— Mayo Clinic (www.mayoclinic.com)
— Cleveland Clinic (www.clevelandclinic.org)

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