4. Take Charge
Once you decide what you need, work to make it happen
Even the smartest patient can be shocked into silence by the words "the biopsy came back malignant" or "there's a problem with your heart." But the biggest challenge, after you've absorbed the blow, researched the diagnosis, and decided to move ahead, is how to go about obtaining the care you believe is best. What if the specialist or hospital you want is a thousand miles away and, of course, not in your health plan? What if you can't get past an implacable assistant? ("Sorry, but he doesn't have any times open for six weeks.") There are tactics that can open doors and get the best specialists to pay attention. Part of being a smart patient is learning how to work the system.
Ideally, you'd prepare for this moment well ahead of time, starting with your choice of primary care provider. You'd look for a doctor who has privileges at an academic medical center, even if the doctor's office is a few miles farther from home than you'd like. It's a worthwhile trade-off, says Pamela Gallin, ophthalmologist and surgeon at New York-Presbyterian Hospital and author of How to Survive Your Doctor's Care . Such a doctor will have connections to specialists, if the need arises, who are constantly boning up on the latest findings and technology and honing their skills.
Yes, it's elitist--justifiably. "People don't realize that it's a privilege to practice among good doctors," says Gallin. Moreover, you are tapping a powerful team of what she calls the "invisible" doctors. "If you come to me as a surgeon," she says, "you're getting the anesthesiologist, the pathologist, the radiologist, and any other doctor you're going to see." Call up teaching hospitals within a few hours' drive and ask if they have an affiliation with any community hospitals near you. Pick your doctor from those.
Oh. You say you picked your primary care doctor out of your health insurer's directory, you've never even met the guy, and now you're confronting a serious diagnosis or treatment? Your instinct may be to grab the first available opening with the first specialist willing to give you one. Slow down--many conditions that have taken years to develop can wait a bit, and even those with a sense of urgency rarely require a decision that day or even that week.
Translation: Don't let yourself be pushed into choices you're not ready to make. "We spend a lot of time researching what car to drive, but we're not willing to spend the time and effort to look for the best treatment for a serious illness," says Alma Rodriguez, an oncologist at M. D. Anderson Cancer Center in Houston.
Out of network. You may find that the best doctor is at a far-flung hospital most definitely not in your network. Depending on your insurance plan, you might still get some reimbursement, says Kim Calder, manager of health insurance initiatives with the National Multiple Sclerosis Society. If you're in a managed care plan, lean on your in-network doctor to get you a consultation or at least ask him to chat with the specialist about your case. If your plan is self-insured, with your employer paying out of pocket for care (if you don't know, ask your benefits manager), you can write a letter of appeal to your employer detailing why this doctor is the best for you.
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