by Dr. Sam Benjamin "More is not necessarily better," especially when it comes to using the health care system - and that's true whether you're talking about conventional or alternative medicine. As part of your decision-making process, you need to know the inherent dangers of the medical system.

According to the government's Agency for Healthcare Research and Quality (AHRQ), medical errors can happen anywhere, including your doctor's office, an outpatient client, a pharmacy, a hospital, and more. The mistakes can be in a diagnosis, use of equipment, prescription errors, surgery mistakes, and lab results.



To stay healthy, develop a relationship with a primary care doctor you have confidence in. This relationship often takes a few years before you're both comfortable and can make good decisions together. So changing your primary doctor often isn't a good idea. When you shop for a doctor or other health care professional, ask lots of questions. Don't be afraid to speak your mind.



It's your primary care doctor's job to be sure you get the best possible care, including consultation with a specialist only when necessary. The idea that a specialist is always better than a primary care doctor is dangerous, according to Barbara Starfield, MD, MPH, director of the Johns Hopkins University Primary Care Policy Center. Dr. Starfield says that easy access to specialists can cause you to undergo unnecessary and potentially harmful tests and therapies.



Your health care provider has an obligation to talk to you about any test or procedure ordered for you - and to tell you if the decision is based on fact, opinion, or tradition. Before you have any test or procedure, ask these questions:

• Why are we doing this test?
  
  
• What will it tell you that you don't already know?
  
  
• How much will it cost me, my insurance company, and my employer?
  
  
• Could it harm me?
  
  
• Do you have something I can read about the test that will help me understand it?
  
  
• What outcome do you expect?
  
  
• What data do you have to support your opinions?

If you need a treatment, check it out on the National Guidelines Clearinghouse™ at www.guideline.gov.



Since it's usually a specialist who is recommending surgery, ask your primary care doctor or another surgeon whether you actually need the procedure. Don't ask for a second opinion from someone in the same medical group as your surgeon.



If your doctor wants to give you a prescription, talk with him or her about the benefits versus its short-term and long-term side effects. For example, if you have arthritis, NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) such as Motrin, Naprosyn, and aspirin can decrease inflammation, improve mobility, and reduce pain. But - in the long run - they can increase the risk of heart attacks, congestive heart failure, gastrointestinal hemorrhage, and kidney disease.

Remember Vioxx? It's off the market now because some users had fatal heart attacks. We now know that hormone therapy - which has been prescribed for years t menopausal and post-menopausal women - has been associated with an increased risk for heart attacks and breast cancer.

If you do take medicine, tell your doctor about all prescriptions and over-the-counter medicines, as well as dietary supplements, such as vitamins and herbs, that you are taking. Also mention any allergies or bad reactions you've had to medicines. Make sure you can read the prescription the doctor writes and the medicine label when you pick it up. And check with the pharmacist to be sure you are picking up the medication the doctor ordered with the correct dose. One study showed 88 percent of drug errors involved the wrong dosage or the wrong drug.



Don't automatically assume that a "name brand " hospital is the best one for you. Not all hospitals are equal - in terms of services provided, quality, or good outcomes. It's your responsibility to make sure that the hospital you are to be admitted to is the best for you. You have some hard questions to ask. And some Internet research to do. Identify what type of hospital it is - teaching hospital, community, specialty, etc. Also look into whether it's received any awards or recognitions for outstanding health care. Then look at:

• Outcomes of similar procedures
  
  
• Safety record
  
  
• Use of technology
  
  
• Nursing quality and staffing
  
  
• Quality ratings

The Leapfrog Group has a Website that identifies hospitals in your area that have voluntarily submitted their information about safety and quality.

Check it out at: www.leapfroggroup.org/cp.

How many procedures like yours are done at the facility? Since not all hospitals participate in this program, check to see if your hospital has a Website and try to learn what its specialties are.

Also do a "google" search for information on your hospital and the kinds of surgery/treatment/procedure you plan to undergo. Go to www.webmd.com and www.mayoclinic.com to find out as much as you can on the topic.

The Leapfrog Group site has research that shows patients receive the "recommended health care only 55 percent of the time and that 30 percent of health care costs are due to poor care." It also notes as many as 98,000 deaths per year are due to medical mistakes.



What's your doctor's relationship with the hospital? Not all hospitals are equal, even when it comes to top medical conditions such as heart disease or cancer. A recent study showed great disparities among hospitals for heart surgery and heart procedures in women. So you need to identify -in a tactful way - if your doctor is biased in favor of the hospital where he or she admits patients, whether or not it is the best place for you. What is good for your doctor may not be in your best interest. Be respectful in your questioning, but let your doctor know you are counting on him or her to do what is best for you.

Who will do your surgery? Make sure your surgeon is performing the surgery and not delegating it to someone else. Check out your surgeon's credentials. Is he or she the most experienced in the procedure you need?



While insurance companies have come under fire for limiting your choice of hospitals, more often than not the insurer is seeking both the best prices for your care and the best outcomes. Some of the hospitals your insurer recommends - with the most advanced technologies and the most experience - are often the most cost-efficient.

References:
www.ahrq.gov/consumer/20tips.htm

www.mayoclinic.com/health/hormone-therapy/WO00046

www.healthfinder.gov/news/newsstory.asp?docID=526534
Citing: Allan V. Prochazka, M.D., M.Sc., professor of medicine, University of Colorado Health Sciences Center School of Medicine, Denver; David L. Katz, M.D., M.P.H., associate clinical professor of public health, and director, Prevention Research Center, Yale University School of Medicine, New Haven, Conn.; June 27, 2005, Archives of Internal Medicine

www.leapfroggroup.org/for_members
The Leapfrog Group's mission is to encourage "safety, quality and affordability of health care" through improved consumer decision-making, and giving incentives to health care providers to improve quality. The Leapfrog Group believes our health care has a long way to go towards these goals, and that by identifying and rewarding providers who make these efforts, improvements will come quicker.