Unlike Joan Rivers who died in a surgi-center during a routine procedure, I would only be given general anesthesia on a hospital campus.

My first experience in taking anesthesia seriously was in 1970 as the Administrative Officer (with the rank of second lieutenant) of the Department of Surgery at Wilford Hall USAF Medical Center. I met an oral maxillofacial surgery resident (a dentist) who was doing a rotation in anesthesiology. Did the patients know who was putting them to sleep?

Around the year 2000 when I had Achilles tendon surgery (It would great if I could tell you the injury was caused by some outrageous athletic adventure, but it just happened….zip, zip, zip, pow!). A doctor walked in the pre-op room, said he was going to do the nerve block, sign here. When I asked his status, I had to ask, he said he was a chief resident. I told him I wanted to see the attending who came in and insisted the resident was better than he was at this. The attending did the nerve block when I insisted he do it.

In 2002 the New York Times reported: “Massachusetts has indefinitely suspended a surgeon’s medical license because he left a patient anesthetized on an operating table with an open incision in his back while he went to a bank several blocks away.” (1)

(Settlement Reached in Joan Rivers Malpractice Case. “In 2015, Ms. Rivers’s daughter, Melissa, filed a lawsuit in State Supreme Court in Manhattan against Yorkville Endoscopy, a for-profit outpatient surgery center where Ms. Rivers, 81, was undergoing a relatively routine procedure when she died in 2014. The suit also named Dr. Gwen Korovin, an ear, nose and throat specialist; Dr. Renuka Bankulla, the main anesthesiologist, and two other anesthesiologists; and Dr. Lawrence Cohen, who stepped down as the clinic’s medical director.”) (2)

Over the years many family members and friends have called me about their research on getting the most appropriate and best surgeon for a serious problem. When I asked them about anesthesia I cannot recall one case where they knew who was putting them to sleep and what type of anesthesia was going to be administered.

So here are some basics.

1. Who will be directly administering the anesthesia? For example; an M.D. trained and board certified (or not) in anesthesiology; an anesthesiology resident-in-training; a sub-specialist such as a cardiac, neurosurgical, obstetrical or pediatric anesthesiologist; an M.D. in residency training in another specialty (e.g., general surgery, ob/gyn, dentistry) rotating through anesthesiology; or a Certified Registered Nurse Anesthetist (CRNA).

2. What type of anesthesia will you be getting?

“In general anesthesia, you are unconscious and have no awareness or other sensations. There are a number of general anesthetic drugs – some are gases or vapors inhaled through a breathing mask or tube and others are medications introduced through a vein.

In regional anesthesia, your anesthesiologist makes an injection near a cluster of nerves to numb the area of your body that requires surgery. You may remain awake, or you may be given a sedative, either way you do not see or feel the actual surgery taking place. There are several kinds of regional anesthesia; the two most common are spinal anesthesia and epidural anesthesia.In local anesthesia, the anesthetic drug is usually injected into the tissue to numb just the specific location of your body requiring minor surgery.” (3)

3. Where will your procedure be done? In a hospital operating room. In an OR in a surgi-center on the hospital campus. In a free-standing surgi-center in the community. In a doctor’s office with an operating room. In a dentist’s office.

4. Is the anesthesiologist in-network?

A rule-of-thumb worth considering. The more serious the surgery and the use of general anesthesia, have the procedure done in a hospital “O.R., or in a surgi-center on a hospital campus.

Talk to your surgeon about anesthesia options well before the day of surgery and discuss whether you should meet with whoever will be administering your anesthesia too. And…it is always a good idea to talk to your primary care practitioner, the clinician who knows you best.

(1) http://www.nytimes.com/2002/08/09/us/surgeon-who-left-an-operation-to-run-an-errand-is-suspended.html

(2) http://www.nytimes.com/2016/05/13/nyregion/settlement-reached-in-joan-rivers-malpractice-case.html?smprod=nytcore-ipad&smid=nytcore-ipad-share

(3) https://www.asahq.org/lifeline/types%20of%20anesthesia

Note: This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.

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What’s in your wallet? Are you prepared for a medical emergency while on vacation? Some suggestions…

When preparing for your vacation here are some health care preparedness steps to consider taking.

First, make sure you carry all medications (prescription and “over-the counter”) that you take daily, or when needed, with a few extra days worth in case you are delayed getting home.

Second, if travelling abroad make sure your vaccinations/ immunizations are up-to-date.

Third, carry the following information:

1. All your health insurance and prescription drug cards and the “800” numbers to call if you need “prior approval” or are “out of network” (if you have a card listing copayments, that too)

2. The business cards of your PCP and any other physicians you see regularly

3. A list of all the medications you take daily (and as needed)

3. Your immunization record ( I still have mine from the Air Force circa 1967)

4. A card with anything you are allergic to….medications, foods, stings etc..

5. If doable how to connect to your Electronic Health Record (EHR or EMR)

6. Ask your physician if you should carry a copy of a recent EKG

7. And for seniors your Living Will and Health Care Proxy

Go over this list with your Primary Care Physician.

Make sure a family member knows what you are carrying or has a complete set as well.

And remember EMERGENCY ROOMS are not all created equal!    http://doctordidyouwashyourhands.com/2016/04/emergency-rooms-are-not-all-created-equal/

Note: This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.

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About Jonathan

http://icahn.mssm.edu/profiles/jonathan-m-metsch

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Hospital web site archeology

When “googling” for hospital information we often wind up at hospital web sites.

Hospital web sites are marketing based so how does one find and aggregate key elements and then do comparative analysis?

You can use these web sites for this exercise, all hospitals I have been involved with

Jersey City Medical Center (I was President & CEO from 1989-2006)   http://www.barnabashealth.org/Jersey-City-Medical-Center/About-Us.aspx

Mount Sinai Hospital (various positions at the medical school and medical center from 1979-1989, leaving as an SVP)   http://www.mountsinai.org/?lastName=O

CarePoint Health/ Hoboken (I was on the Board of the Hoboken Municipal Hospital Authority for three years)   https://www.carepointhealth.org/hoboken-university-medical-center#xDk1A

Meadowlands Hospital Medical Center (was part of LibertyHealth with Jersey City Medical Center) http://meadowlandshospital.org/

Ok, let’s get started:

Find ABOUT US. This is the picture painting how the hospital wants to be envisioned.

Find the MISSION STATEMENT, a formal summary of the aims and values of the hospital, as approved by the Board of Trustees and required for accreditation.

Compare ABOUT US and the MISSION STATEMENT. Are they clear and consistent?

Find ACCREDITATION. This gets trickier. A long list of certifications is not in of itself important. What is important is are they evidenced-based, completed by an arms-length review, and for a fixed period of time then must be renewed. You can google the agency and find the methodology used.

Find QUALITY. Again quality recognition awards should be evidenced-based, completed by an arms-length review, and for a fixed period of time then must be renewed. You can google the agency and find the methodology used.

Find AFFILIATIONS. A medical school affiliation is an excellent benchmark, however is it robust or ceremonial?

Go to LEADERSHIP/ BOARD OF TRUSTEES. Are Board member recognized community leaders?

And then go to

HOSPITAL COMPARE https://www.medicare.gov/hospitalcompare/search.html At this MEDICARE site you can compare hospital performance metrics.

THE LEAPFROG GROUP http://www.leapfroggroup.org/compare-hospitals an independent organization where you can compare hospital quality metrics

AGENCY FOR HEALTHCARE RESEARCH AND QUALITY http://archive.ahrq.gov/consumer/qnt/qnthosp.htm “How can you choose the best quality hospital for the care you need?”

AVOID for-profit “hospital quality” web sites which sell marketing packages to hospitals which pay to be surveyed!

 

 

 

 

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Every clinician with a doctoral degree has earned the respect to be called doctor.

Over the past five years teaching in a health care MBA program, I had a number of students who were physical therapists. They had DPT (Doctor of Physical Therapy) degrees, worked at prestigious academic medical centers in NYC, but did not want to be, or were not called Doctor at work.

At one of the community hospitals in our system when I was a CEO, orthopedic surgeons (M.D.s) and podiatrists (DPMs) shared on-call for ankle (trauma) surgery. It was never clear enough for me that the patients were appropriately informed.

I went to the VA Hospital for a hearing test and was seen by Dr. Jones, an audiologist (Au.D)

The discussion became a kerfuffle by an article in the New York Times: “HI. I’m Dr. Patti McCarver, and I’m your nurse,” she said. And with that, Dr. McCarver stuck a scope in Ms. Cassidy’s ear, noticed a buildup of fluid and prescribed an allergy medicine. It was something that will become increasingly routine for patients: a someone who is not a physician using the title of doctor. Dr. McCarver calls herself a doctor because she returned to school to earn a doctorate last year, one of thousands of nurses doing the same recently. Doctorates are popping up all over the health professions, and the result is a quiet battle over not only the title “doctor,” but also the money, power and prestige that often come with it.” *

We are familiar with M.D. and D.O. (physicians). Many other clinicians are called doctor such as your dentist (D.M.D.), chiropractor (D.C.), and optometrist (OD), occasionally confused with ophthalmologists (M.D.).

Now many disciplines have doctoral degrees.

A patient (and family) on an acute rehabilitation medicine unit at a teaching hospital might be treated by a team of doctors including: a physiatrist (M.D.); a nurse manager (D.N.P., Ph.D, or Ed.D); a pharmacist (Pharm.D); a physical therapist (D.P.T.); a social worker (D.S.W.); a  psychologist (Psy.D.); an audiologist (Au.D.); an occupational therapist (DrOT); and a speech pathologist (SLP.D).

Every clinician with a doctoral degree has earned the respect to be called doctor but should be wearing a name tag that includes name, degree, and clinical profession such as: Mary Green, M.D., Neurology Resident; Stan Brown, D.N.P., Nurse Practitioner; or Chris Magenta, Psy.D., Clinical Psychologist.

If you are not certain who is treating you, ASK!!!

 

*When the Nurse Wants to Be Called ‘Doctor’

http://www.nytimes.com/2011/10/02/health/policy/02docs.html?pagewanted=all&_r=0

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YIKES! The out-of-pocket costs of my health insurance are clobbering me.

Back in the day we got health care indemnity insurance at work with no contribution toward the premium, and a modest deductible and co-pay.

Employer based health insurance and health insurance obtained from a public or private exchange now includes cost-sharing, disincentives and penalties. Most policy holders don’t know how much risk-sharing is involved until they get a big, unexpected bill after submitting s claim.

It’s important to learn the new health care insurance vocabulary and to be an educated consumer.

“Patients who don’t grasp fundamental health and insurance concepts are less likely to make smart decisions about when and where to seek care, experts said. In fact, people with low “health literacy,” as experts put it, are more likely to be hospitalized and use costly emergency rooms, according to the Institute of Medicine.” (1)

With this array of policy limitations, it is important that physicians consider affordability (out-of-pocket costs) as a factor in ordering diagnostic tests, suggesting referrals to specialists, and writing prescriptions.

So let’s get started:

REFERENCE PRICING.  “Reference pricing serves as a reverse deductible. Rather than the patient paying up to a defined limit and then the insurer covering the remainder, the insurer pays up to a defined limit and the patient pays the remainder. This has the remarkable feature of exposing the patient to the variation in prices for treatments that are above deductible thresholds. And the patient’s contribution isn’t limited by an annual out-of-pocket maximum. “(2))

FIXED INDEMNITY PLANS. “Fixed indemnity plans typically pay a limited cash benefit, with no deductible, to people who are hospitalized or encounter other medical costs. But the federal government said it was concerned that people might confuse those plans with standard health-insurance plans, and that the fixed indemnity plans alone couldn’t be considered to be coverage under the law’s requirement for most people to have insurance or pay a penalty.” (3)

VALUE BASED INSURANCE. “The additional cost when patients choose procedures that research shows are unlikely to help their condition is a key element of ….value-based insurance, the premise of which is that a mix of financial carrots and sticks can steer patients toward medical services that will help them and away from ineffective or unnecessary ones.” (4)

CONSUMER DIRECTED HEALTH PLANS.  “Consumer-directed health plans (CDHPs), which feature a high deductible and a personal health savings account, can reduce medical spending by employers and consumers.” (5)

EMPLOYER DEFINED CONTRIBUTION. “The idea that employers might decide to drop their health plans and replace them with a “defined contribution” for employees has been around for years. It’s one way for employers to control their expenses in the face of relentlessly rising health care costs. Now that the health law has created new online marketplaces where people can shop for coverage and made the individual market more accessible and affordable, the idea is gaining traction.” (6)

SHORT-TERM POLICIES.  “Consumers who missed open enrollment on the state health insurance marketplaces this spring or who are waiting for employer coverage to start don’t have to “go bare.” Short-term policies that last from 30 days up to a year can help bridge the gap and offer some protection from unexpected medical expenses. But these plans provide far from comprehensive coverage, and buyers need to understand their limitations. ” (7)

INSURANCE WITHOUT HOSPITAL BENEFITS.  “Lance Shnider is confident Obamacare regulators knew exactly what they were doing when they created an online calculator that gives a green light to new employer coverage without hospital benefits. “There’s got to be a problem with the calculator,” said Jost, a law professor at Washington and Lee University and health-benefits authority. Letting employers avoid health-law penalties by offering plans without hospital benefits “is certainly not what Congress intended,” he said. (8)

SKIN-IN-THE-GAME INSURANCE. (High Deductible Health Plans). “A report out today puts numbers behind what hit many workers when they signed up for health insurance during open enrollment last year: deductible shock. Premiums for employer-paid insurance are up 3% this year, but deductibles are up nearly 50% since 2009, the report by the Kaiser Family Foundation shows. The average deductible this year is $1,217, up from $826 five years ago. Nearly 20% of workers overall have to pay at least $2,000 before their insurance kicks in….”  (9)

OUT-OF-NETWORK EMERGENCY CARE. “When you need emergency care, chances are you aren’t going to pause to figure out whether the nearest hospital is in your health insurer’s network. Nor should you. That’s why the health law prohibits insurers from charging higher copayments or coinsurance for out-of-network emergency care. The law also prohibits plans from requiring pre-approval to visit an emergency department that is out of your provider network.  (Plans that are grandfathered under the law don’t have to abide by these provisions.)

Although the law protects patients from higher out-of-network cost sharing in the emergency room, if they’re admitted to the hospital, patients may owe out-of-network rates for the hospital stay….” (10)

GEOGRAPHLICALLY LIMITED HEALTH PLANS.  “UnitedHealthcare’s Oxford division is launching a New Jersey-only network of doctors and hospitals that will provide lower-cost health plans to employers who use the 18,000 doctors and 65 hospitals in the new Oxford Garden State Network.”

“It limits access to New Jersey-only providers and it is a solution for New Jersey employers where a smaller network offers a reduction in cost…,” (11)

DRIVE-BY DOCTORING.” In operating rooms and on hospital wards across the country, physicians and other health providers typically help one another in patient care. But in an increasingly common practice that some medical experts call drive-by doctoring, assistants, consultants and other hospital employees are charging patients or their insurers hefty fees. They may be called in when the need for them is questionable. And patients usually do not realize they have been involved or are charging until the bill arrives.” (12)

HEALTH-CARE SHARING MINISTERIES. “…… religious alternatives to enrolling in the federal insurance program in which members pool monthly payments to help cover one another’s medical expenses. So, unlike most uninsured Americans, (members of H-C SH) did not have to buy health insurance or risk a fine under the Affordable Care Act.” (13)

FEE-FOR-VALUE MODEL. “Horizon Blue Cross Blue Shield of New Jersey, the state’s largest health insurer, announced Thursday that it plans to offer new lower-priced insurance policies that offer discounts for care provided at 34 selected hospitals.” (14)

(1)    http://khn.org/news/many-patients-struggling-to-learn-the-foreign-language-of-health-insurance/

(2)    http://www.wsj.com/news/articles/SB10001424052702303448104579152111004814066

(3)    http://www.wsj.com/news/articles/SB10001424052702304547704579566401099222522

(4)    http://www.reuters.com/article/us-usa-healthcare-insurance-idUSBRE9BI04X20131219

(5)    http://content.healthaffairs.org/content/31/5/1009.abstract

(6)    https://www.washingtonpost.com/national/health-science/defining-what-defined-contributions-means-for-work-based-health-insurance/2014/05/13/a963ae06-da7e-11e3-a837-8835df6c12c4_story.html

(7)    http://www.webmd.com/health-insurance/20140807/shortterm-health-plans-might-offer-some-relief-but-they-have-significant-gaps

(8)    http://khn.org/news/employee-insurance-hospitalization-coverage/

(9)    http://doctordidyouwashyourhands.com/2015/02/employer-health-plan-deductibles-see-big-5-year-jump/

(10) http://khn.org/news/beware-of-higher-charges-if-you-go-to-an-out-of-network-emergency-room/

(11)http://www.njbiz.com/article/20140820/NJBIZ01/140829979/UnitedHealthcare’s-Oxford-starts-NJ-only-health-care-network

(12)http://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html?_r=0

(13)http://www.nytimes.com/2014/12/26/us/for-members-of-health-ministries-in-texas-caring-means-sharing-the-bills.html?_r=0

(14)http://www.nj.com/healthfit/index.ssf/2015/09/horizon_blue_cross_forms_network_with_22_hospitals.html

 

Note: This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.

To get posts by email subscribe (free) at http://doctordidyouwashyourhands.com/

 

Jonathan M. Metsch, Dr.P.H. http://icahn.mssm.edu/profiles/jonathan-m-metsch

Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai

Adjunct Professor, Zicklin School of Business, Baruch College, C.U.N.Y.

Adjunct Professor, Rutgers Schools of Public Health & Public Affairs and Administration

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EMERGENCY ROOMS are not all created equal!

Let’s start with the “GOLDEN HOUR.”

“The golden hour is a window of opportunity in which rapid medical intervention can save a patient’s life or make a significant difference in the level of impairment a patient experiences after recovering from a medical emergency. People often use this term in the context of trauma medicine, where many members of the lay public are aware that rapid transport to a trauma center can make the difference between life and death, but it is also important for treatment of strokes, heart attacks, and other medical issues.” (1)

For stroke patients “… treatment within the golden hour is more successful because patients are candidates for the powerful clot-busting drug known as tPA (short for tissue plasminogen activator), which must be given within the first few hours after a stroke.” (2)

For heart attack patients the “…Golden Hour is a critical time because the heart muscle starts to die within 80-90 minutes after it stops getting blood, and within six hours, almost all the affected parts of the heart could be irreversibly damaged. So, the faster normal blood flow is re-established, the lesser would be the damage to the heart.” (3)

So it is important to get immediately to the right ER rather than always be taken to, or going to the nearest ER. A stop at the wrong ER for  trauma, stroke or a heart attack, then a transfer to the right ER, can pierce the golden hour.

Some states have multiple levels of Stroke Center with different capabilities. New Jersey has two: Primary and Comprehensive. (4)

Some hospitals have been awarded Chest Pain Center accreditation by the Joint Commission. (5) Cardiac Centers should have interventional cardiac catheterization laboratories; an excellent standard is in-house interventional cardiologists 24/7.

It is worth knowing that some hospitals have separate psych and pediatric ERs. And there are now some separate geriatric ERs and obstetrical ERs.

Next you should know the training of the physicians who staff an ER. The Gold Standard is board certified Emergency Medicine trained physicians 24/7.

“Emergency medicine focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization, and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. A high-pressure, fast-paced, and diverse specialty, emergency medicine requires a broad base of medical knowledge and a variety of well-honed clinical and technical skills.” (6)

Beware of ERs staffed by “moonlighter” from other specialties and/or “on-call” specialty consultants who bill fee-for-service. And while an ER might be in-network for the hospital charges, it is possible (though unconscionable) that the ER physicians and specialty consultants are out-of-network and will not accept what your insurance pays them, leading to “balance billing.”

Just because you think you have been admitted doesn’t mean you have actually been admitted. You may be “Under Observation.” “You’re an inpatient starting when you’re formally admitted to a hospital with a doctor’s order. The day before you’re discharged is your last inpatient day. You’re an outpatient if you’re getting emergency department services, observation services, outpatient surgery, lab tests, X-rays, or any other hospital services, and the doctor hasn’t written an order to admit you to a hospital as an inpatient. In these cases, you’re an outpatient even if you spend the night at the hospital. (7)

Like me you may have seen highway billboards “clicking” nearby ER waiting time. While Waiting times are important all ERs triage patients so seriously ill get to the head of the line

For a serious, undiagnosed problem UrgiCare Centers are not alternatives to ERs. UrgiCenters are appropriate alternatives to the ER for situations where you normally go to a doctor’s office or health center. (8)

The Emergency Room is a new hospital “front door” as protocol driven medicine channels only the sickest patients to hospitals. Hospitals take this “high risk” role very seriously and monitor ER quality diligently. But all ERs are not the same and an educated consumer approach is necessary as you consider emergency health care decisions.

(1) http://www.wisegeek.com/in-medicine-what-is-the-golden-hour.htm#didyouknowout

(2) https://www.caring.com/questions/golden-hour-stroke

(3) http://apollolife.com/HealthTopics/Heart/GoldenHourforHeartAttackPatients.aspx

(4) http://www.thenecc.org/images/Mammo.Gizzy.pdf

(5) http://www.jointcommission.org/chest_pain_certification_process/

(6) https://www.aamc.org/cim/specialty/list/us/336838/emergency_medicine.html

(7) https://www.medicare.gov/Pubs/pdf/11435.pdf

(8) http://www.usatoday.com/story/money/personalfinance/2015/12/30/primary-care-urgent-care-er-all-depends-what-ails-you/76979284/

 

Note: This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.

To get a once weekly post by email subscribe (free) at http://doctordidyouwashyourhands.com/

Jonathan M. Metsch, Dr.P.H.

http://icahn.mssm.edu/profiles/jonathan-m-metsch

Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai

Adjunct Professor, Zicklin School of Business, Baruch College, C.U.N.Y.

Adjunct Professor, Rutgers Schools of Public Health & Public Affairs and Administration

 

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How to find the best doctor?

A great way to find out who the best doctors are is to learn who respected doctors themselves see and send their families to see. But this is not so easy unless you are an ”insider” like me having worked as a hospital executive with physician colleagues to ask.

So here is a suggested strategy:

1. Find a well qualified primary care physician (PCP). Usually a physician in family practice, internal medicine, obstetrics/gynecology, or pediatrics who is a patient’s first contact for routine, outpatient health care. (Start with personal recommendations than use Google to get more information.)

2. “Best Doctor” lists are useful but learn to differentiate between lists which are independent publications from ones where physicians can “pay to play.” (can usually be found in an appendix.)

3. Your PCP should be Board Certified. Many specialties now require periodic Maintenance of Certification, beyond initial certification.

4. Look for a PCP who has admitting privileges at a nearby community hospital and a regional teaching hospital. Better yet a physician with a medical school faculty appointment who teaches medical students and residents.

5. Ask if your PCP will participate in managing your care if you are admitted to the hospital, or transfer your care off to a “hospitalist.”

6. Takes your insurance and is not “out-of-network.” And has a an in-network panel for specialist referrals.

7. Uses your preferred medical decision making style – e.g., physician led, shared patient/ doctor discussion.

8. Has convenient office hours and off-hours phone/ email availability or back-up.

9. Listens to you and does not appear to be preoccupied or rushed. And does not continually get interrupted or take phone calls during your visit.

10. Answers your questions clearly in an evidenced-based way.

11. Uses an Electronic Medical Record to share information with your other clinicians, and with a patient portal so you can easily access your medical record.

12. Orders diagnostic test thoughtfully (not defensively) and prescribes antibiotics carefully (and not simply because you ask).

13. Washes his or her hands in front of you every time and is not insulted if you ask “Doctor, Did You Wash Your Hands? ™”

 

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Note: This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.

 

Jonathan M. Metsch, Dr.P.H.

http://icahn.mssm.edu/profiles/jonathan-m-metsch

Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai; Adjunct Professor, Zicklin School of Business, Baruch College, C.U.N.Y.; Adjunct Professor, Rutgers Schools of Public Health & Public Affairs and Administration

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