Editor's note: It's time to take control of your health care... Income Intelligence editor Dr. David "Doc" Eifrig says that the only person who truly knows your body is you. And as Stansberry Research's No. 1 retirement expert, Doc's goal is to ensure that retirees have control of their health. But if you put your physical well-being in someone else's hands and hope for the best, Doc believes you're endangering your health... Today's Masters Series is taken from the April 2, 2020 and April 7, 2020 issues of Doc's free Health & Wealth Bulletin e-letter. In this essay, he details the risks of physicians making errors... explains why it's crucial for people to be aware of the medical care they receive... and provides a checklist of things to watch for during your next doctor's visit...
Be Your Own Health Care Advocate By Dr. David Eifrig, editor, Income Intelligence "I will do no harm." It's a famous line from the Hippocratic Oath, which every medical student used to pledge upon graduation. But in the past few years, medical students have started rewriting their Physician Oath. Medical schools might have their own version, or the graduating class may get together and pen their own. It's important to know that there are still echoes of Hippocrates in these new promises, including not bringing harm or injustice to any patient. Yet harm does come to patients. Medical errors are, unfortunately, part of the practice. However, the number of deaths varies based on the reporting source... In fact, it's a hotly debated topic. We lean toward studies like one in The Lancet from 2018 that found about 114,000 deaths per year had medical errors as a direct cause or contributing cause. In addition, 21% of Americans reported that they experienced a medical error. That's from a survey out of the Institute for Healthcare Improvement/National Patient Safety Foundation Lucian Leape Institute. And according to the U.S. Department of Health and Human Services, one in seven Medicare patients in hospitals experience a medical error. The statistic that really makes me pause is that one in 10 doctors surveyed for Mayo Clinic Proceedings admitted they'd made a medical error within the prior three months. And those were only the ones brave enough to admit it. I have tremendous respect for physicians. I remember the physical and emotional strain from pulling long shifts at the hospital. But we need to focus on patient safety. You need to be your own health care advocate. Educate yourself, ask questions, and take notes. It could save your life. One of the top causes for medical errors comes from communication. It's typically doctors and patients not understanding one another. But there are a few things you can do to improve communication. It starts with a checklist. Longtime readers know I love medical checklists. They save lives every day. In 2001, a doctor at Johns Hopkins Hospital here in Baltimore proved it. He studied the often-deadly infections that occurred in patients who needed an intravenous line. The infection rate was 11%. Dr. Peter Pronovost created a simple checklist of the procedures doctors are supposed to do, including washing hands, using clean gloves and gowns, and so on. After he convinced the hospital to mandate use of the checklist for a year, the rates of infection went from 11% to zero. Many hospitals now use the Pronovost checklist. It has cut infection rates everywhere. That's why I want you to make your own checklist for your next doctor's appointment, hospital stay, or any other medical care... 1. Make a list of any symptoms or complaints you have. If it's a recurring issue (like extreme heartburn), keep a log of when it happens and any other factors that might help (like what you ate that day, any activity you did, and how you slept). 2. If your doctor requests bloodwork, imaging scans, or any other test, ask why. Make sure you understand what they're for and what they will tell your doctor. I would also ask about the rate of false positive results. Some tests have a high rate of false positives, which lead to unnecessary treatment. A good resource I use is the U.S. Preventive Services Task Force ("USPSTF"). Ask if the test requested has a good rating from the USPSTF. An A or B grade means the test provides benefit as proven by solid evidence. 3. Ask when and how you'll get the results. Never assume that not hearing anything means you're in the clear. Always check in with the office staff and make sure your phone number is correct. And if you don't get a call in the time frame you expected, don't be shy about calling the office and following up. 4. If you receive a diagnosis, make sure to ask what it is and get it written down for you. Ask if there's confirmation from tests, and if so, which ones. This is especially true for cancer – you want to make sure your cancer diagnosis has a confirmation from a biopsy. 5. Provide a list of medications. You'll want to include every medication you take, why you're taking it, the prescribing doctor, and the dosage. You'll also want to include all vitamins and supplements to make sure there are no interactions. Keep a journal like this: 
On your list, include any allergies you have. Make sure each of your doctors has a copy. Give a copy to your spouse or anyone who will go with you to appointments. If you get a new prescription, make sure you understand how to take it. Ask questions... Do I take this with food? Is there anything specific I should avoid? And remember, grapefruit juice interacts with some medications, so you might need to skip your glass at breakfast. This list is just the beginning of taking charge of your own health care. You can add these tips to your checklist, too...
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1. If you have advance notice, research your hospital first. I've encouraged my readers for years to find the best hospitals near them for certain types of care they may need. You want to know the best centers for cancer, heart, gastrointestinal, joint surgery, and more. I recommend looking at the rankings from U.S. News & World Report. It ranks hospitals based on data like number of patients, survival rates, infection rates, and the nursing staff. See its latest ratings right here. It's also important to see which ones are in-network for you – going to an out-of-network hospital can cost you thousands of dollars in hospital bills. Be sure to check your insurance provider's website to see its list of in-network providers. You can see Medicare's list here. 2. Ask if your surgery or procedure can wait. If you're looking at a teaching hospital, it's best to avoid it during the summer months. Doctors in training, referred to as "residents," start training every year on July 1. So in June, the senior residents are about to leave for the real world and aren't focused on caring for you... They are thinking about getting out of there, finding real jobs, and starting to pay down their six-figure debt. The new doctors coming in on July 1 just graduated from medical school. Most can't yet find their way out of a paper bag. But worse... the hospital's senior doctors, called "attendings," who are supposed to supervise the new kids, are taking summer vacations. Most let the senior residents run the show. The good news is that this is temporary. Once September hits, the new doctors have a few months of experience under their belts... The attendings are back at work and supervising again... And the hospital is as safe as it gets. 3. Research your doctor, too. The right doctor can mean the difference between life and death. Courts file about 85,000 lawsuits for malpractice every year in the U.S. But according to Stanford University, the worst 1% of surgeons are responsible for nearly a third of all malpractice claims. As I've advised before, ask your surgeon for a printout of their statistics. They should keep them on a computer... If not, run out of the office. In addition, check their status with the American Board of Medical Specialties. Your doctor should be up to date on their exams and certified in surgery. You can find that right here. You can also search by state for criminal convictions and malpractice claims for your surgeon. Go here to learn more. 4. Whether you go for a planned visit or are in an emergency, there's one important question you must ask. Am I an inpatient? If you stay overnight at the hospital, your doctor may "keep you for observation" rather than admitting you as an inpatient. This allows them to collect far more from Medicare Part B. For instance, any medications you receive, you'll have to pay for, instead of Medicare covering them. Once you're an inpatient, you're covered under Part A (hospitalization), and the hospital collects far less. Worse, you could get stuck with thousands of dollars in medical bills because of it. And if you need any sort of nursing care after you leave, you won't qualify for Medicare coverage unless you've been an inpatient for at least three days. So after one night in the hospital, make sure to ask your doctor if you are an inpatient. If not, get it in writing that you are there under "observation status." And argue that if your care is medically necessary, they need to admit you. This can be a difficult argument... but try enlisting the help of the hospital's discharge planner if needed. 5. Make sure everyone washes their hands. Don't worry about coming off as too demanding. Vigilance is extremely important, and you need to remain vigilant about folks washing their hands when entering your hospital room. Similarly, if you have any concerns about cleanliness... ask. It's always better to be overcautious than risk infection. 6. Go over discharge plans. Take the time to make sure you review your discharge plan and ask lots of questions. You'll want to have someone present with you as well, in case you're on medications and may not remember everything discussed. Take notes and ask if there's a number to call should you have any issues when you get home. You may need to ask your doctor if he has an on-call service. 7. Finally, take the time today to write out your final wishes. Let's say the worst happens... You're in an accident or have a sudden medical emergency and can't make your own decisions for your health. Who do you trust to make those calls for you? You can choose anyone... a spouse, significant other, sibling, parent, or close friend. Make sure it's someone you trust and who knows what kind of care you would want. Name them as your health care proxy or durable medical power of attorney (these are the same thing). Then take it another step and give them your wishes written out for end-of-life care. I'm talking about living wills and advance directives. The names vary by state, but it's essentially a legal form outlining what you want done to keep you alive. Things like feeding tubes, cardiac resuscitation, etc. Having this laid out ahead of time will make decisions easier for the person you choose to look after your health when you can't. Here's to our health, wealth, and a great retirement, Dr. David Eifrig
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