Health care providers and their agents operate with enormous freedom- -and almost no accountability. If you feel powerless against the medical monolith of doctors, hospitals, and insurers, you’re not alone. But there are simple ways to safeguard your health. The following are major problems with our medical care system, and what you can do to protect yourself against them.
1. Medical care can be dangerous to your health. A study released by the Public Citizens Health Research Group in January reported that between 150,000 and 300,000 people are injured or killed annually as a result of medical mistakes. Every year, approximately ten thousand people die due to anesthesia mishaps alone. Up to 10 percent of all hospitalized patients acquire an infection they did not have upon entering, and 2 percent of those die from it.
What to do: When you’re in doubt about your diagnosis or are contemplating a high-risk or relatively new treatment, get a second opinion. If the second opinion contradicts the first, seek more opinions until you are satisfied.
Find out how often your doctor and/or hospital perform the procedure. Studies have found that the more often a practitioner performs a procedure, the more likely it is to be a success.
2. Most states require only a minimal amount of continuing education once medical licenses are granted, and many do not pursue claims of incompetence or malpractice with significant effort. In any given year, less than half of 1 percent of physicians are disciplined by state medical licensing boards for any reason.
What to do: Contact your state medical licensing board to determine if it has taken any action against your physician. Check with your local courts to see if any lawsuits have been filed against him or her. Finally, ask your doctor if he or she has ever been sued or had privileges suspended or revoked by a hospital.
3. Any licensed physician can hang out a shingle as a specialist without training in, for example, sports medicine. The fact is that being a specialist in some fields is as simple as getting a medical license. In some cases, it’s even legal for doctors to make up their own specialty.
What to do: Ask your doctor if he or she is “board certified” in the specialty. Ask specifically what board did the certifying. Board certification is not government-granted or related to licensure. Some boards require rigorous standards and frequent testing; others only require attending a few sessions of a local seminar.
To find out more about medical specialties and the more legitimate boards, contact: American Board of Medical Specialties, 1007 Church St., Suite 404, Evanston, IL 60201, or call 1-800-776-CERT.
4. The federal government maintains a list of doctors who have lost or settled malpractice suits, been disciplined by a hospital for thirty days or more, or had actions taken against their license by a state medical licensing board. But this list is not available to the public. The National Practitioner Data Bank was designed to prevent doctors disciplined in one state from jumping to another undetected. But to protect doctors who settle in order to avoid lengthy legal battles, the legislation was amended to exempt it from the federal Freedom of Information Act. As a result, only medical entities, such as hospitals and state licensing boards, have access to the data.
What to do: Write your U.S. senators and representatives and tell them to support amending the law to make this information available to the public.
5. With the exception of X-ray equipment, doctors can load up on high-tech medical equipment from lasers to beepers without any state, federal, or county inspection. What’s worse, there are no training requirements for physicians to fulfill before operating these space- age products.
What to do: Ask your doctor when he or she last had a piece of equipment calibrated or inspected. If you question the outcome of a test involving a piece of equipment, such as a blood pressure cuff, have another test taken at another facility. While there may be a cost involved, it is probably worth it.
6. Many Americans have health insurance policies under which an insurer pays 80 percent of the stated cost and the policyholder pays 20 percent. Unfortunately, some consumers may pay more than 20 percent of the actual cost, because their insurance companies have negotiated discounts with hospitals and other providers. When the insurer receives the bill, it pays 80 percent of the negotiated discount, yet the policyholder is required to pay 20 percent of the full charge.
What to do: Read your policy carefully. If it is issued through your employer, ask for a full explanation. Contact the insurer directly to find out if you have a “stop loss” provision that caps the total amount you have to pay. If all else fails, negotiate directly with your doctor or hospital. Amazingly enough, you can often successfully negotiate fees with either entity.
Charles B. Inlander is president of the nonprofit People’s Medical Society, America’s largest consumer health advocacy organization. The People’s Medical Society is headquartered in Allentown, Pennsylvania.
