What Patients Can Do as Consumers to Improve Health Care

Every day seems to bring a new article or news story about health care reform and change. Consumers are reported to be ready for change, fearful of altering what they have, anxious about the cost of care and trusting in their physicians. Eric Hoffer, the American longshoreman philosopher once said something like “when one doesn’t know what one wants or needs, one can never have enough”. I might add: especially when there are few costs charged up front.

Seemingly powerless and ill-informed, the consumer of health care in the US seeks some form of control, and much of this should be encouraged, because without such control there can be no responsibility, and without responsibility, no engagement. There are of course a host of simple things that everyone can do to improve health care and the performance of the system.

First, reduce hospital use. Most people find themselves in the hospital because of a personal choice. They refused to exercise. Ate too much and too often and the wrong things. Or, they engaged in risky behavior ranging from biking with out a helmet, to unsafe sex, tobacco use, and driving and drinking. For the most part, most of us know what we should and shouldn’t do, but find it hard to change our ways. Instead we wait until calamity befalls us and hope that the white coats can pull us through. This has to stop. This is not a call to be a nation of puritans. In fact a little more enjoyment, rest and relaxation should be added to what we need more of. We simply need to make changes in our lifestyle that can lead to a big return at the health care bottom line.

Second, deal with end of life before it becomes pressing. In calmer times it is important to assemble the simple documents that are now available in every state and with a loved one answer a few straight forward questions about desires and preferences when the end of life approaches. We spend countless billions on care every year that no one really desires. Perhaps we should change the default of the system to less aggressive care unless heroic interventions have been specified beforehand. But until then, the act of an advance directive will do much to protect loved ones from hard decisions and save money that need not be spent so futilely.

Know your medical history and record. As medical data is becoming more readily available, it is important to start gaining access to it and developing the skills in its management. Full access is not available in all places, but this will change. There are useful guidelines for beginning this and they should be used to develop personal health portfolios, the same way we use new tools to manage financial portfolios.

Fourth, join a self-help group that interests you. The group can be actively engaged in managing a current condition such as diabetes or migraine headaches or it can be a more prevention orientated group focused on diet or exercise. But the group experience will allow you to begin to understand health as something that is mediated by someone other than those in the white coats. In fact, such actions may be the quickest path to remaking the system we have today into a formal “sickness” system, while the rest of the health care system grows up around it driven by individual action and responsibility. The purposeful social engagement with the group is also in and of itself likely to be a health promoting activity, especially if you take a friend or neighbor along who would not likely be the type to join such an activity.

Finally, take the time to develop one personal health management regimen. It might be blood pressure measurement, weighing in daily, a fifteen minute mid-day walk, or a lighter meal three lunches a week. Becoming systematic with one activity and observing the change will lead to a commitment to do more and bring better control to health.

None of these things done individually will change the health system. But any one of them done by an individual will change that person’s health profile and attitude. As more people do these things, they will collectively change the trajectory of a health care system that desperately needs such reform.