OK, so Marcus Welby, Dr. Kildare and Ben Casey have all retired. And, maybe your expectations about having a warm and fuzzy relationship with an all-knowing, all-caring, hands-on family doctor who always has time to listen to your complaints and aches and pains have been shattered by the realities of managed care. It’s still possible to have good relationships with the professionals who provide your family’s health care. Just because it is different, doesn’t mean it is necessarily all bad.

We have been through a lot of changes in the past decade; some have been traumatic and some just seemed to occur while we were looking the other way. The bottom line, however, is that the way healthcare is delivered has been forever altered. We can work to improve the new system, but it won’t do any good to sit around reminiscing about the "good old days" when doctors made housecalls and a visit to the emergency room cost less than $100.

One healthcare futurist I read regularly, Joe Flower, uses the typewriter to make a point about where medicine is going -- of course, young adults under 18 probably don’t even know what a typewriter is. In any event, if you make typewriters and the world is ready for a computer, you either retool and stay ahead of the wave (like IBM), or you continue to make typewriters (like Royal) and fade quietly into history. This futurist warns that healthcare -- not just the business of providing it -- is on the threshold of still more dramatic change. When he said that, he meant not just what providers do and how they do it, but the whole way we as individuals manage our own healthcare decisions -- our life stages, birth, fitness, wellness and even death. In all these decisions we will be responding to technologies so "out there" that today "we don’t even recognize them as medicine." 

Few people believe that the managed care style of medicine will linger long into the new millennium. Why? Because everyone hates it. Consider this: -- even under managed care that was supposed to be the prescription to contain rising costs -- the federal Health Care Financing Administration predicts that healthcare costs will double by the year 2007 to a staggering $2.1 trillion. Catapulted by this upward spiral, a better, more cost-effective way to organize and manage it will surely emerge. Thanks, too, to public acceptance, we have already seen costs drive alternative therapies -- acupuncture, herbal and natural remedies, and chiropractic -- right onto our healthcare superhighway, and there are no stop signs in sight. 

Innovative physicians are expanding their practices to include a broader range of patient services, including diagnostic imaging and on-site labs. The truly visionary providers are even creating their own outpatient suites to perform a variety of procedures that were once only undertaken in hospital operating theaters. And wellness is becoming paramount: the cheapest patient is a well patient.

So, during this period of transition in the world’s most sophisticated -- if not the most desirable -- healthcare system, how do average patients...you and me...get along with the people who keep us well and fix things that go wrong?

Developing a positive, open relationship with your family’s healthcare providers will take some effort on your part. There are some actions that patients can take, however, that will not only lead to better communications with physicians and medical personnel, but may also help keep their healthcare costs under control in the process.

During your first visit to a physician’s office, ask for a copy of their patient brochure so that you can familiarize yourself with office and financial policies. Read the information carefully and ask about anything you don’t understand. If, for example, you are expected to pay for each office visit as you go, and file your own claims for insurance reimbursement, it is better to know this up front. It is more likely that you will have some form of co-pay amount to cover at each visit. Regardless of the kind of insurance plan or managed care program you participate in, make sure that you and the medical office accounting personnel are on the same page.

Medical offices, like other service providers and businesses that follow appointment schedules, usually have some internal procedures to help manage their daily routines. On any given day, a busy physician’s office may "see" hundreds of patients, depending on the number of doctors in the practice. A busy office also takes a significant number of calls from patients about medications or symptoms or appointment requests. To make the office run more efficiently, patients may be asked to place their calls about medications during certain hours, or expect the doctor to return patient calls during specific hours. Other "rules" simply involve good common sense...like having the pharmacist’s name and telephone number handy if you call a doctor’s office about a prescription or refill. The office staff should not have to do your leg work for you.

Don’t expect your physician or medical staff to be mind-readers. Explain any symptoms clearly and succinctly; write them down in the order they occurred to make sure you don’t miss anything. Be as specific and as complete as possible. Sometimes, it is important for a physician to know what may seem to be unrelated details -- that you felt dizzy when you got out of bed, for example, but that the feeling went away after breakfast -- to reach an informed diagnosis. Your doctor’s ability to assist you in caring for your health in a cost-effective manner is in large part dependent on your ability to provide all the information needed to do a thorough and competent job. That means you must make a point of compiling all the data and gathering all the facts that your doctor or health care provider will need before appointments.

n Keep an accurate list of all medications you have taken -- and what they were prescribed to treat -- and make a note of the types of side effects, if any, and the results they achieved. Include over-the-counter medications that you routinely take (such as antacids, analgesics and -- of increasing importance -- herbal therapies) because they sometimes can aggravate or interfere with medications your physician may prescribe.

n Keep a list of the names, addresses and phone numbers of the physicians you have seen over the years. In case you ever have to reconstruct your medical history, this will help you track down medical information retained by doctors who may have moved over the years. Also, keep a list of all the hospitals or skilled care facilities to which you have been admitted.

n Ask for and keep a copy of your medical records in your possession and store them in a secure place. Make sure your family members know where these important records are kept. This will not only make the information immediately available to any physician who needs to know your medical history, but it will also document the tests and procedures you have had that may not need to be repeated. This can save you time and money.

n Answer the doctor’s questions truthfully. Physicians are not there to judge your vices; the information may be critical in evaluating medication interactions or in reaching a diagnosis. If you smoke or drink, tell the truth about how much.

n Write down any questions you want to remember to ask the doctor. Don’t save the important topics for last when the physician may have to get on to the next patient. If a particular topic or question is important to you, say so. The doctor can’t be expected to correctly interpret or prioritize your concerns without your input.

Medical research continues to reveal familial relationships in a variety of diseases such as colon, breast, prostate and uterine cancers. Information about a patient’s family’s medical history can often provide clues to aid physicians in the early detection of some life-threatening diseases. Unfortunately, many people are able to provide only very general medical histories because their parents may be deceased and family members scattered around the country. When parents and grandparents, for example, all died of heart disease, a person’s risk of having a heart attack is significantly higher than that of someone without the family history. There are tests and screening procedures today that can identify heart problems in early stages and, with the help of some lifestyle modifications, even a "high risk" person may successfully avoid a heart attack.

Far too many patients do not take prescribed medications or follow through with dietary instructions, or quit smoking -- even when physicians warn of the consequences not to. About 100 million prescriptions go unfilled each year and at least half of all patients receiving prescription medications make mistakes about dosage or frequency in taking them. If you don’t understand your doctor’s instructions, ask for clarification while you are still in the office. Take a pen and paper with you to make notes and use them. Common sense suggests that you are less likely to comply with treatment instructions if they are not clear. And, noncompliance means you have wasted both your time and money without any benefit to your health.