Introduction
In simpler times you could successfully navigate the health system just by having a good family doctor and knowing the location of the nearest hospital. Today that is not enough. Health care has become far more complex. Your successful navigation will be enormously aided by information, by insight into the ways of the system, by a questioning attitude, and by advocacy.
Rule one: Stay healthy
You will fare better, no matter what your condition, if you take better care of yourself. It seems almost pedes¬trian to recite the simple things you can do to improve the status of your health, but here they are in case you haven’t read a newspaper or watched a television in the past 20 years.
First, smoking is actually bad for you. You should quit. The good news is that there are lots of quite effective smoking-cessation aids—everything from the patch to counselling—to get you off the noxious weed. Second, being physically active can reduce your risk of heart disease or cancer. Physical activity could be as easy as walking more or as challenging as going to a gym and working out. Being involved in an active sport will help. The third in this trinity of things that make you a healthy navigator is what you eat. What you eat is what you are, and there are both good and bad things you can eat. Despite newspaper stories that seem to vacillate on some subjects—for example, whether coffee is good or bad for you—for a long period of time medical evidence has consistently shown the virtues of a balanced diet.
There is lots of evidence on the virtues of dark leafy vegetables and an abundant wealth of information on why eating greasy fast food will not increase your health—in fact, it will have the opposite effect. If you find it hard to believe that fast food is so damaging, take a trip (please walk) to the nearest video store and rent the movie Super Size Me. It will likely put you off everything but the salads at McDonald’s, Burger King, and Wendy’s for the rest of your life. On second thought, be careful of even the salad dressings—the ones at McDonald’s contain more fat than the cheeseburgers.
Increasingly, the health care system is trying to save you from yourself and your choices. This is not an act of altruism. Facing rising costs, health care professionals want to postpone your need for treatment for as many years as possible. You can help by staying healthy and making better choices.
Rule two: Know as much as you can
You need to become informed not only about the condition or disease that you are coping with, but also about the resources in the health system. You need to know how to find care, and find it swiftly. You need to know how to determine if care is safe and high quality. You need to know your insurance coverage, whether that is coverage paid for by your tax dollars through government or supplementary private insurance paid by your employer, or whether you’re going to pay out of your own pocket. You have more and more choices to make, important choices that will affect your health care.
You need to know what to expect in your treatment and what you can do to improve your chances of a good outcome. The good news is that this information is often available on the Internet. Because information on the Internet can be disorganized and of uneven quality, you need to separate the good information from the not so good. Today, many reputable organizations and institutions provide basic and reliable information on their websites.
Being an informed sailor is the most important rule of naviga¬tion, and that rule applies if you’re a patient travelling through the health care system. It may be true that ignorance is bliss, but not when it comes to your health or health care. In health care, ignorance can make your patient journey longer and more difficult and your outcome worse. Just as a good sailor needs to know the winds and currents of the ocean, you need to know the winds and currents of the health system. Having a good knowledge of the health care system, particularly those centres of excellence within it, can be the difference between getting first-class care and waiting a long time for care that wasn’t worth the waiting.
Find out what you need and what is covered in your province or territory. Like real estate, health care services have a lot to do with “location, location, location.†We often confuse “universality†with “uniformity.†We might have a “universal†health care system, in which every resident and citizen is entitled to medicare, but we do not have a system in which the services and products to which we are entitled are the same from coast to coast. Nor is there a guarantee that you will automatically get what you are entitled to receive.
Rule three: Organize your care team
Your care team will likely start with your family doctor, but as you age, you need to expand that team far beyond just your doctor. Simply finding a family doctor is a challenge for many Canadians. In addition, many of us now take a complex set of medications, so the pharmacist with whom you deal is a vital member of your team. Befriend your pharmacist! A pharmacist is quite capable of being a solid adviser on the use of not only prescription medication but, more important, the over-the-counter remedy that is often the best option for minor ailments.
The pharmacist may be your first and only stop for treating minor rashes, illnesses, and aches and pains. However, beyond the physician and pharmacist, you may also need the services of a nurse, nurse-practitioner, dietitian, nutritionist, physiotherapist, or massage therapist. For example, if you are managing lower back pain and wish to avoid surgery that will leave you with a rigid spine, you may need a prescribed set of exercises.
The point here is that as medicine and health care become more complex, so does the range of skills you need access to—hence the team! Look to all members of the team for coaching in the management of illness, particularly chronic illness. Remember that you will spend a few hours a year with your team and over 8000 hours a year self-managing your condition.
Rule four: Have an advocate
You need someone who is in your corner, particularly if you are dealing with hospitalization or a serious illness. During your patient care journey, you may not always be sufficiently strong or focused or even conscious to deal with what’s coming at you. You need someone who has the dual qualities of caring deeply about you and not taking no for an answer. You need your advocate to ask the questions that you may forget to ask. You need your advocate to write down the answers you may forget. In most cases, your advocate will be a family member or close friend. If you do not have a close family member or friend, you may need to seek the support of a profes¬sional patient advocate.
Rule five: Take control of your care
You need to adopt a questioning, skeptical attitude. Don’t presume that all your care providers know your full history. Don’t presume they know your allergies. Make a careful point of communicating fully. Often one specialist is unaware that another specialist is treating you with medication, and drugs can interact in negative ways.
You need to be in control and keep your care team fully informed. You also need to own and control your health record. You should not be at the mercy of paper-based medical records systems that make it difficult to retrieve essential test results, X-rays, and other information. Sometimes important records are lost or are not available when needed.
Build your own medical record either electronically or in a simple file. Keep track of illnesses, medica¬tions, test results, and your family’s medical history. If you have drawn up an advance directive or living will, you need to ensure all those caring for you are aware of your choices. Only then can you be assured your wishes will be respected and implemented.