Handling Medical Issues

by James Holland, M.D.
Professor Emeritus of Urology, Northwestern University
NSV Founding Member

The first in a series of periodic commentaries on medical issues.

When you're facing a serious medical diagnosis, you may also find yourself dealing with a daunting array of issues, from insurance coverage to finding the right medical team. While NSV does not provide advice for individual cases, we have connections and resources that may prove helpful. For example:

• Advice about health care insurance plans, problems with coverage, managing debt for medical care, and the options you have can be addressed at no charge by consultants at senior centers. The consultants are knowledgeable and up-to-date because they're in the insurance markets every day.

• North Shore Senior Center, Northfield, Jean Cleland, 847.784.6036
• The Levy Senior Center, Evanston 847.448.8250 
• The Evanston Civic Center, Nan Anderson 847.866.2919
• CJE SeniorLife, Chicago, Rita Goone 773.508.1000
• Mather Lifeways, Wilmette, Kate Paz 773.205.3306

• If you are arranging a series of outpatient laboratory tests or outpatient procedures, proper sequencing and scheduling may be facilitated at a NorthShore University HealthSystem hospital (NSUHS--formerly Evanston, Glenbrook, Highland Park and Rush North Shore in Skokie), either by e-mail concierge@northshore.org or by telephoning 224.364.4968. At St. Francis Hospital, Central Scheduling Service will help: 847.316.6500.

• If you are admitted to a NSUHS hospital, mentioning that you are a NSV member will bring a visit (weekdays during normal business hours) from a hospital administrator who could act as your ombudsman should you encounter problems while in the hospital.

Finding the Right Doctor
If you're satisfied with your current primary care provider (PCP) and hospital connection, then by all means keep them. If not, look for someone who is well-trained and experienced in his or her field, with whom you can easily communicate.

Internists, geriatricians or family medicine generalists usually serve as primary care providers. Internal medicine physicians become board eligible after three years of approved residency training. Geriatricians are board certified (or eligible) internists who have taken an additional year of training in the medical care of the elderly, to become eligible for board certification in Geriatric Medicine (GM). Palliative care specialists are internists, who may be board certified to care for long-term illnesses such as multiple sclerosis, stroke, cancer, complications of diabetes, etc.

Many internists and family medicine physicians have extensive training and experience in geriatric medicine, short of being boarded in GM. This is fortunate because there are too few geriatricians to care for all seniors. Both NorthShore University HealthSystem and St. Francis Hospital have a limited number of geriatricians but have many internists on their professional rosters who are very capable of caring for the elderly. If you're seeking a referral to a geriatrician or internist who has a special interest in providing geriatric medical care, call the Physician Referral Service. Be sure to mention you are an NSV member.

NSUHS Hospitals
Evanston, Glenbrook, Highland Park & Skokie Hospitals 847.570.5020
7:30 am to 7:00 pm Monday-Friday, 
9:00 am to 1:00 pm Saturday

St. Francis Hospital
Evanston 
877.736.4636

The hospital referral services can also give referrals to specialists. However, your PCP should guide such a choice because he or she knows your history and current problems, as well as treatment outcomes of various specialists. 

Be An Informed Consumer
The better you understand your medical status, the more likely you are to choose the best treatment and to stick with the recommended regimen. So you may want to ask your doctor questions like these:

• What is the evidence for the diagnosis, and are there other possible diagnoses?
• What are the side effects of possible treatments? How should they be managed?
• What are the beneficial results of the treatments and possible outcomes?
• What second opinions would be helpful? (You may want to consult a specialist from another related discipline.) Your PCP may be the best source of this advice.
• What is the treating surgeon or physician's experience in handling your condition? (The number of patients the physician has treated is less important than the quality of training, experience and results he or she has had treating this condition.

Review on-line what is pertinent to your illness, but be wary. Advice on Wikipedia or by a source unknown to you may be poorly informed. Trustworthy sources include the NIH (National Institutes of Health), the well known clinics, and such cancer treatment centers as Memorial Sloan- Kettering or M.D. Anderson.

Good Communications Are Critical
When you're worried and under pressure to make significant decisions, having a second pair of eyes and ears to remember details is very helpful. Have your spouse or another trusted relative or thoughtful friend accompany you to consultations to take notes, ask questions and provide support. Advise the doctors that this person will be the "point person" to stay in touch with the medical team, and relay news to family and friends. Be sure to tell your doctor that person's telephone number in case of breaking news.

• If you are alone for a consultation, take notes on what the physician tells you. Be sure you understand clearly what the medical team is saying.
• Consider asking permission to record a consultation. Some physicians may demur that doing so may be intimidating to a frank discussion, but others may have no objection. 
• If you think of questions after you leave the consultation, write them down and send them by mail or e-mail to your physician for a reply. 
• Keep your PCP well informed of results of tests or advice given by consultants. If you wait for official copies to reach your PCP, it may take days or weeks.
• Inform all your doctors of drugs prescribed by other physicians. Piling-on of side effects of conflicting medications can be a big problem.

If You Are Hospitalized
Upon admission to NSUHS hospitals you will be given a Notice of Privacy Practice (required by HIPAA) and a privacy code. Give that code to your spouse or point person so that when that person inquires, your nurse or physician can tell him or her your medical status. The privacy laws are most confusing when it comes to what doctors can discuss and with whom. The NSUHS Chief Privacy Officer offers this guidance: "Communication with family: Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person's involvement in your care." Other hospitals may have a similar plan.

Just in case, write down the names of everyone involved in your care, such as nurses and technicians who conduct lab tests or give you treatments. If you have a problem with your care in the hospital, write to the president of the hospital, detailing your concerns. And of course, a commendation for exceptional care is good for everyone.

Health Education
NSUHS and St. Francis both will conduct topic-specific talks/discussions for NSV members about illnesses common in the elderly, such as diabetes and heart disease. Occasional free clinics, such as screening for skin cancer, are also offered by NSUHS and St. Francis Hospital and may be noted on their websites. NSV will alert you by our newsletter or e-mail. NSUHS also sends out a quarterly publication of services offered (CONNECTIONS) that you will receive as a NSV member, if you agree to be on their distribution list.

These are the hospitals respective web sites:

NSUHS:

Main web site:  www.NorthShore.org

Click here for: Classes & Events

Under "all categories" click on "mature health"
in the dropdown menu.

St. Francis Hospital

www.sfh.reshealth.org

 

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