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'The Smart Patient': How to Get the Best Care

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'The Smart Patient': How to Get the Best Care

Health Care

'The Smart Patient': How to Get the Best Care

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(Soundbite of music)

NEAL CONAN, host:

From NPR News in Washington, DC, I'm Neal Conan, and this is TALK OF THE NATION.

What's the most important thing to bring with you to the doctor's office, a living will, your spouse, a crisp $50 bill? Dr. Mehmet Oz says the answer is an accurate health profile, and he advises a little advance research into your problem.

Dr. MEHMET OZ (Co-author, You: The Smart Patient): The ability to go to the Internet has allowed patients to come in, first of all, knowing the right terminology which saves a lot of headaches for the physician. It also changes the mindset of the patient. They come in knowledgeable and wanting more.

CONAN: A new handbook on how to get the best healthcare, You: The Smart Patient. Plus, an unlikely new champion sites memory secrets of the ancient world, and your letters. It's the TALK OF THE NATION. First, the news.

(Soundbite of music)

This is TALK OF THE NATION. I'm Neal Conan in Washington. Your doctor tells you you need an operation, you've gotta find a surgeon, so which medical professionals are the best to ask for a recommendation? What questions should you ask your doctor when he or she writes you a new prescription, and what object in your hospital room is the most germ ridden?

Those are just a few of the questions that help make up the Smart Patient Quiz, part of a new book written by two physicians, Michael Roizen and Mehmet Oz. It's called You: The Smart Patient: An Insider's Handbook for Getting the Best Treatment.

In their book, the authors lay out what patients can do to get the best treatment possible, from how to talk with sometimes distant doctors, how to navigate Byzantine hospital bureaucracies or, the ultimate terror, dealing with the insurance company phone tree. Doctors say their patients and their doctors share responsibility and that too often both fail.

Later on in the program, the mistake that threatens to unravel the government's case against the so-called 20th hijacker, a memorable feat of recollection, and your letters. But first, as we continue our series on how to get the best healthcare, You: The Smart Patient.

If you have questions or advice about what doc, what patients can do to find the right doctor, the right surgeon, or the right hospital, what patients can do to help their doctors do better and to minimize the risk of mistakes, our number here in Washington is 800-989-8255. That's 800-989-TALK, and the e-mail address is talk-at-npr-doctor-org.

Doctor Mehmet Oz, who's also professor and vice-chairman of surgery at New York Presbyterian Columbia University's Medical Center, joins us from our bureau in New York, and it's nice to have you today on TALK OF THE NATION.

Dr. OZ: Thank you very much, Neal.

CONAN: And Doctor Oz, let's begin with those questions we asked in the beginning. If somebody needs surgery, who is the best medical professional they should go to for a recommendation?

Dr. OZ: Well, it turns out it's probably the nurse, and the reason for that is because a nurse deals with all the doctors. Physicians have a little bit of insight into what their specialty may be, but they often don't follow in great detail what other doctors do in other areas. Nurses, especially in the emergency room, have a broad array of exposure, so they often can have insights that others in the healthcare community don't, and...

CONAN: Hmm. It's interesting you say that because in your book you say the anesthesiologist.

Dr. OZ: Well, the anesthesiologist among physicians is probably the best to contact because they deal with all the surgeons.

CONAN: Aha.

Dr. OZ: But as a healthcare professional, it's one of the other quiz questions if you keep reading...

(Soundbite of laughter)

CONAN: OK.

Dr. OZ: ...we focus on things that patients can do that are practical. Here's the real epiphany. We actually had one more partner, sort of a silent partner in this book, and they were the Joint Commission. The Joint Commission is sort of the watchdog group for American health safety. They spend their time paroling our hospital corridors and our doctors and trying to figure out where the problems are occurring that hurt Americans, and we estimate that they're close to 100,000 lives lost a year from medical mistakes.

What that really means, Neal, is that two out of five listeners, 40 percent of Americans, will have their lives touched by a medical error. So how do you get the system to work better? The Joint Commission came to us and said, you know, despite all of our efforts, we're not having the desired impact because we're missing the single biggest element, the patient. It's the people listening to this program who will change American medicine, not people talking on it.

CONAN: Mm hmm. The patient, you say, has some duties, too. It's not just the doctor's responsibility, or, basically, you want two sharp minds working on this at minimum.

Dr. OZ: At minimum, and I think a good physician will always appreciate a smart patient who's asking probing questions. And there's no question, Neal, I'm not naïve to the reality that many patients will be embarrassed. They don't want to hurt that precious covenant that they have with their doctor. And, you know, if you're the only one speaking up, yes, you might get shot. But, in general, if everybody starts to speak up together, we'll start a movement...

CONAN: Mm hmm.

Dr. OZ: ...and that's why we wrote the book, to get folks to think differently about the role they play in healthcare.

CONAN: One of the questions that you do propose that patients ask, particularly when matters get serious, is should I get a second opinion on this, and that's a question that doctors often don't welcome.

Dr. OZ: Well, they don't welcome it, but here's the scary reality. Second opinions will change the diagnosis or the treatment in one-third of cases. Think about that. One in three cases will be changed in how they're conducted by a second opinion. I mean, you wouldn't buy a car, Neal, without getting a second opinion. Why would you have heart surgery? It doesn't make sense, and yet we don't want to rock the boat.

CONAN: Hmm.

Dr. OZ: I'm here to tell you, we need to rock the boat because it's not flow, it's not floating the way we want it to right now.

CONAN: Again, one of the questions we posed at the beginning, what object in your hotel room is the most germ ridden? Well, we'll ask you for the answer to that, but also, you know, one of the goals of the smart patient is to stay out of hospitals as long, as much as possible.

Dr. OZ: Well, we wrote a book that came out last called You: The Owner's Manual which did quite well, and we realized when we wrote that book that we were giving advice to people about how to stay out of the hospital. But the unfortunately reality, Neal, of course, is that people do sometimes get ill, and when their lives are touching the healthcare system, they needed a guide, they needed an owner's manual, and that's why we took that same advice, I'll have to admit irreverent, sometimes we write with some attitude in the book, but we want folks to enjoy what they're learning, but to take it to heart and act on it.

And with regard to the question, what's the most dangerous thing with regard to infection in your hospital room? It's the clicker for your television.

CONAN: Hmm.

Dr. OZ: Because think about it. Everything else gets sterilized 12 times over. But the patient before you, who had all kinds of potential infections, was using that exact same television clicker as you.

CONAN: Hmm. You also suggest that if you sneeze, you shouldn't immediately touch the infected area. That's another good lesson, but anyway, let's get some listeners involved in the conversation. Our number is 800-989-8255, 800-989-TALK. E-mail us, talk@npr.org. What's the best way to become a smart patient? If you have advice, give us a call. And let's turn to Stacy. Stacy's calling from Phoenix, Arizona.

STACY (Caller): Yes, hi.

CONAN: Hi.

STACY: I have stage four cancer, and so I am in and out of doctors' offices a lot, and I've tried to be a smart patient, but I've always tried to be a cooperative patient. I'm getting tired of being cooperative. The problem that I have that I'd like some advice on is that I had a PET scan a week ago, and I still have not been able to talk to my doctor about the results and about what she recommends that we do next.

So my question is should I be looking for another doctor? Should I, is there a way I can approach her to get an answer to this question? And in general, how do we make this whole thing more patient-centered when we know that the information belongs to me, but everybody but me seems to have it?

CONAN: Hmm. Doctor Oz?

Dr. OZ: Very common problem, and we actually address it head-on in the book. When you leave your physician's office next time, you should have a very concrete covenant with them about when you're going to speak again about the test.

STACY: Uh huh.

Dr. OZ: And that is something that we take for granted. Oh, the doctor will get back to me when they have a chance. It's a different arrangement if you say, I understand the test will be done today, it should be read by day after tomorrow, can we arrange to speak the following day? Because if they don't do that, they actually broke a promise to you.

STACY: Uh huh.

Dr. OZ: As opposed to letting the test get done and, you know, when the cards fall the right way, maybe they'll, the Tar they'll get back to you. One thing to point out, the average physician will wait about 23 seconds before interrupting you, and...

STACY: Wow.

Dr. OZ: ...that's, by the way, that's up five seconds from what it was 10 years ago, so there's some improvement.

(Soundbite of laughter)

But the unfortunate reality is less than two percent of patients finish their opening statement, so...

STACY: Yeah, I've noticed that. I have trouble telling her what's going on because she talks over me.

Dr. OZ: Well, one way of getting around that is to say I've got 60 seconds of stuff to tell you, and here it is real quickly.

STACY: Uh huh.

Dr. OZ: I'm not going to deviate off to the left or the right and talk about a couple of sidebar issues. Here's the fundamental three things that are bothering me. If you frame it that way, it makes it very awkward, just from a social interaction perspective, for the physician to interrupt you.

The more you can make those kinds of very concrete arrangements at the get-go, I'm getting my test results, call me on Friday, or I'll call you, or who do I speak to in place of you, those kinds of proactive steps take the physician error out of the system.

CONAN: Hmm.

STACY: OK, so I need to be a little more assertive.

Dr. OZ: It's not just assertive. It's smart and, I don't want people out there being abrasive because I really do think most physicians are doing their best, but I think that patients can help the system by creating mechanisms where you don't fall through the cracks. And, yes, maybe you shouldn't have to do this, but in modern American medicine, unfortunately, it's falling to you.

CONAN: Hmm.

STACY: Yes. Yeah. OK, I'm very happy to hear this. I'm going to try some of the things you suggested, and I think I'll go get your book, too.

CONAN: OK, Stacy. Good luck.

STACY: Thank you.

CONAN: Bye-bye.

STACY: Bye-bye.

CONAN: Let's go to, Kristen, Kristen's calling from Indianapolis.

KRISTEN (Caller): Hi, thank you for taking my call.

CONAN: Sure.

KRISTEN: I was wondering what your guest thought on a surgery that more technologically advanced. I was wondering, what are your thoughts on the medical device company and the medical device industry? How they play a part in how patients are (unintelligible) and how we talk to our physicians?

Dr. Oz: Well, one of the challenges that we have in healthcare today is that we don't change information quickly. Most of what we learn, we learn from companies that are doing the research. It's one of the reasons that I feel a true solution in healthcare today in America is to create a more open information and exchange architecture.

So if you had something done in Indiana, I know about it New York almost immediately, so I can update my experience and share that with patients. If we don't have that system, which we don't today, then we're going to have to resort to having companies tell us what they're finding out.

CONAN: Mm hmmm.

Dr. OZ: Because that's the best source of information. Now that stated, I have to agree with you that the direct to consumer marketing, which drives a lot of pharmacy and device use is unfortunate. But these are the laws that we have in our nation and it's up to physicians to hopefully correct misperceptions that are taken away from some of this advertising.

CONAN: Kristen, thanks very much.

KRISTEN: Thank you.

CONAN: And, Dr. Oz, again consumer reports doesn't publish ratings of doctors in your town or even of hospitals.

Dr. OZ: Consumer reports does not, but I happen to practice in New York State, at New York Presbyterian Hospital and my numbers, with my name linked to them, are published and publicly available in the state. So I know exactly how I did, so does everybody else in the state, or the nation for that matter.

These types of data bases exist, and as a heart surgeon, it's true around the country. Now for most of us, only 11 percent of patients use the information. So it's not just a matter of getting the data out there. People have to be willing to use it. The change behavior, and that's why The Smart Patient is such an important movement, because if 10 percent of patients are smart enough to use the information, they will shift the market. It will begin to make a difference in my practice, or my hospital's function if we're not doing a good job, so we'll have to change what we do, for example, to call people like Stacy back in a timely fashion.

CONAN: Mm hmmm. And this can be used by--well Internet specifically can be used by patients to look up your rating, your hospital's rating and information about various procedures.

Dr. OZ: It's absolutely out there, in the book by the way we put lots of URLs for Web-savvy readers to go and search for information about hospitals, doctors, particular practices. We give some benchmarks for the minimum number of certain procedures. Because, well, you know, if you do more of them you're probably better at them.

CONAN: Mm hmmm.

Dr. OZ: And we, by the way, have the, an abstract of the book with many of these URL's available at Realage.com, R-E-A-L-A-G-E.com. And if you go to it, it's right in the front and you can open it up and find a lot of these sites and quickly access them.

CONAN: And if you're interested, you can read and excerpt from the book: "You Are the Smart Patient," "You, the Smart Patient," on your rights as a patient at our Web site NPR.org, so that's not a bad place to start either.

We're going to take a short break, when we come back we'll talk more about becoming a smart patient and getting the best healthcare for yourself with Dr. Mehmet Oz and more of you calls as well.

If you'd like to join the conversation, the number is 800-989-TALK, that's 800-989-8255; the e-mail address is TALK@NPR.ORG. I'm Neal Conan; this is TALK OF THE NATION from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION; I'm Neal Conan in Washington.

Faced with decisions about healthcare, we're often at a loss to determine the best way to proceed. So how do we find the best doctor, how should we construct a health profile for ourselves and for our families?

Today we're talking about becoming a smart patient. Now, our guest is Dr. Mehmet Oz. He's the author of You, The Smart Patient, an insider's handbook for getting the best treatment. He's with us from our bureau in New York.

And, of course, you're invited to join the conversation: 800-989-8255, 800-989-TALK. E-mail is TALK@NPR.ORG.

And let's go to Brad, Brad's calling from Salt Lake City.

BRAD (Caller): Hi, thanks for taking my call.

CONAN: Sure go ahead please.

BRAD: I wanted to do a follow-up to some of the discussion from before about having public access to databases regarding physicians and quality of care.

CONAN: Mm hmmm.

BRAD: And stuff like that.

CONAN: Mm hmmm, yep.

BRAD: It seems to me like there's an underside to this whole process, specifically with regard to serious procedures and surgeons. And that's this idea that if the public has access to information about, you know, how successful, say a surgeon is, for example in, you know, saving or not saving patients and that kind of thing. And, you know, if we start looking at ourselves as consumers in that particular framework, then I think it creates a situation in which physicians, particularly surgeons, become less likely to even attempt to treat high-risk patients.

CONAN: Ah ha. Might that be a, might that be a bit of blowback Dr. Oz?

Dr. OZ: Might be a bit of blow back and in fact in New York State it actually happened. Here's what really happened, though Brad. People who were having surgery done at a high risk centers were now being referred to centers that had more expertise with those cases.

And so we saw a migration of patients away from some hospitals towards others, but guess what happened in the end? Across the state, the mortality rates dropped. So the real message is, that information will drive some centers to do the different kinds of cases, and God bless them, maybe they should be doing different kinds of cases.

I think if we think about it in that context and allow consumers to drive quality in the system, it's the best check and balance system for something like healthcare.

CONAN: Hmm.

BRAD: But doesn't it still also create, like if you have a top-rate surgeon, like a heart surgeon, you want the best surgeons performing the highest risk procedures, and isn't that going to undermine the possibility of that happening?

Dr. OZ: It did not happen in the experiences today in this nation. There's no question that some surgeons shied away from those cases. But if your practice was built around the ability to take care of more challenging procedures, in fact those cases became referred to you, and you ended up getting better results with them than individuals who perhaps did not have an expertise.

At the end of the day, the bigger problem, Brad, is that people pick their doctors based on the three A's. And they are Availability, Ability, and Affability. Unfortunately the order in which you pick them is not that, affability becomes number one usually. And so does availability. But ability, which is the most important predictor of how you're going to do, gets left off third or fourth place. And so, many physicians end up not being rewarded for taking the extra effort to take care of patients in the high-risk categories. And I'm pushing for that to become more transparent.

CONAN: Brad, thanks for the call.

BRAD: Thank you.

CONAN: Let's turn now to Larry, Larry's calling us from Kansas City.

LARRY (Caller): Hi, how are you?

CONAN: Very well, thanks.

LARRY: Well here's the thing, talking about trying to have a discussion with a doctor doing an exam, routine exam or any kind of exam. I had this problem where they wanted to put me on more medication for a raise in blood sugar. And I said, well, what's different between this year and last? Well they raised the bar. I said, well let me cut back on my sugar intake and I'll change my diet. No, we want you on a pill.

Anyway after I discussed it with him a little bit, I don't want another pill, I'm taking too many now. He left and another doctor comes in and on my chart he had marked "combative." I'm thinking I'm back in school, where you go from third grade to fourth grade and you get marked as this patient.

CONAN: And that really is your permanent record.

BRAD: Yeah, it becomes a record. And the only time one doctor finally reads the chart that another doctor has filled out, because they always ask you the same information twice anyway, is where it has the word combative on it.

CONAN: Mm hmmm.

BRAD: So go figure. How do you get around that? And I'll take my comments off line, thank you.

CONAN: Thanks, Larry.

Dr. OZ: Well it's unfortunately a reality that doctors like teachers, and by the way doctor comes from the Latin for teacher, that's where the doctorate comes from. So we are teachers and we do sometimes share some of their habits, and we sometimes brand a patient inappropriately.

That's one of the risks you may have to take in order to get yourself the best healthcare possible. But I can tell you if you're in Kansas City and you want to get your blood sugar down by improving your diet, you're doing the right thing, whether it's there or Los Angeles, New York or anywhere else in the world. And there are going to be times when folks are not going to respond favorably. But that may be one of the best ways for you to screen your doctors.

CONAN: His doctor may be right to prescribe another pill too, but he should also explain why.

Dr. OZ: Of course and that's, you know, there, when you're talking about primary care physicians taking care of you day in and day out, it's really all about communication.

CONAN: Mm hmmm.

Dr. OZ: Are they your partner, are they the person that you can turn to, to confide sensitive information, to deal with challenges and how you can get better health in life? Because we cannot have a wealthy society without a healthy society, so these relationships, these, this covenant is critical.

And part of the challenge, of course, is that there's a philosophy or a tradition of professionalism in healthcare and medicine, which has slipped to the corner a bit, as it has I think in the law profession. And one of the ways we're going to help fix this is to get patients more involved in auditing what we do.

CONAN: Let's go to Ralph, Ralph calling us from Madison, Wisconsin.

RALPH (Caller): First, Stacy in stage four, boy, my heart breaks for you. I just want to say that this entire rotten chemical medical system is grabbing billions for their cancer industry and their fake physicians. And all I want to say for those of us with terminal illness, that we go through these conferences with what explosives strapped to our chests-destroy these grafters and blow this rotten money system up, thank you very much.

CONAN: We understand Ralph's anger, but surely he is speaking metaphorically. But his anger is very real, Dr. Oz, and he is hardly the only one.

Dr. OZ: People are very angry, they don't think they have access to the truth that's surrounding their wellness. They don't think they have the ability to confide in their healthcare professional about this. And they find that a lot of the entities that were created to help them, like health insurance, because in fact it was created to help the average Joe...

CONAN: Mm hmmm.

Dr. OZ: ...trying to get health care, are not serving that purpose any more. And I come back to the same concept, which is, we need a vanguard of smart patients, to push the right buttons.

CONAN: Mm hmmm.

Dr. OZ: Because the system will respond, but no one's pressing the buttons. You know, sole voices out there are critical of the system--they're not speaking up in unison. And so it's easier to ignore one or two voices in the wilderness.

CONAN: Well here's another e-mail on similar point from Angela in Ithaca, New York: "It seems this smart patient movement must also be a movement to make patients who are most vulnerable more empowered. What's being done to make sure that low income and minority people can get access to good healthcare, to medical information and to medical literacy?"

Dr. OZ: One of the chapters in the book is dedicated to how to get the most out of your insurance. And it's really aimed at that population directly.

CONAN: There's something like more than 40 million people in this country who don't have insurance.

Dr. OZ: There are probably about 45 million without insurance, you're absolutely right, Neal. And half of those people made the economic decision not to buy healthcare insurance.

And this takes me a little bit off the book, but I'll speak to this since I've spent a fair amount of time in public policy, this discussion's on topic.

I think in America we often mandate that everybody that, if they file an income tax return, has to have health insurance. At the same time, we ought to make it affordable for folks to buy that insurance.

CONAN: Mm hmmm.

Dr. OZ: Now see it's been, this is probably the same for you, Neal.

CONAN: Mm hmmm.

Dr. OZ: It costs us a lot less to buy health insurance because we buy this part of a large company and we get discounted rates and its pre-taxed dollars. The average individual, who's trying to buy health insurance, who's a self-employed $40,000 a year individual salary, has to pay two to three times what we pay.

And so these kinds of burdens are in our system and I think that we can make these changes, but we need folks working in unison.

CONAN: Working in unison for somebody without health insurance, for example, is less likely to be assertive and be the smart patient.

Dr. OZ: Well, we have this date in there as well, for those who are interested, but not having health insurance in America has the same risk factor for causing your death as having diabetes. It's that profound an influence.

I'll say it again, if you have a diagnosis of diabetes, you have the exact same problems in your life expectancy and your quality of life as not having health insurance.

Because think about it, Neal, you walk into the emergency room, it's three thirty in the morning and you are on a ship with no captain. Because no one's coming to help you at that hour, except for whoever happens to be around. And so the lack of insurance is a huge distraction and a cost of the healthcare business in this country.

But again one of the ways you can address this problem is to provide resources for people and there are some that are available in many states. And we try to provide those URLs whenever possible. But independent of all that, the fundamental challenge for most individuals is once they have some entree to this system, whether it's through the emergency room, 'cause you have no insurance. Or whether it's through your private doctor, because you have wonderful insurance, you're still going to run into the same problems, which is how do you guard your body, when you're in a health care system, which isn't always designed to protect it for you?

CONAN: Hmm. Let's get another caller on the line. Andrew, Andrew's with us from Berkley.

ANDREW (Caller): Hello, you had mentioned earlier in your discussion that people who seek a second opinion often experience some change in their diagnosis. So my question is, is it a positive change, or a negative change and I'll take my answer off line.

CONAN: Ok, Andrew, thank you.

ANDREW: Ok.

Dr. OZ (Co-author, You the Smart Patient: An Insider's Handbook for Getting the Best Treatment): Well, the change isn't necessarily a positive or negative. A second opinion may not be the right opinion for you but it opens up an array of possibilities so at least you think about them. Whenever a patient sees me in my office I'm very clear in my belief that if they get an extra opinion they're actually helping me. Because they may find out something from another doctor that may help me learn more about their problem as well. So I can spread that same knowledge to future patients coming down the road of me.

And by the same token, hopefully that other physician will either agree with me, which validates what I'm doing or if they're incorrect I may have helped them. So it works in all ways and that's what a smart patient does. You get multiple people giving you advice so you can be the judge. You don't have to just take the word from the gospel once.

CONAN: Here's an email question from Tonya Watt. I've just made an appointment with a new ob/gin and I would really appreciate any suggestions about how to best prepare for the appointment, to illustrate the seriousness of my concerns and get the most out of my appointment.

Dr. OZ: Well, right off the bat, do not walk into the office without having a few bits of homework done. And we have this in the book in the first chapter. You need your health profile. What does that mean? Is there anybody in your family younger than the age of 65 who has died? And if so, what caused their death, because those are often genetic markers, warning signals to your doctor. Number two, are there any illnesses that tend to run in your family, whether they cause death or not? Share those. Third, are there vices? Don't be embarrassed. The one time where you should tell the truth is with your physician.

In my business when people don't tell the truth patients die. So come clean on some of these concerns that you may have and right off the bat create a timeline. I have, you know, 65 seconds worth of stuff to tell you. Can you just bear with me? I'm going to get through it really quickly. And when you go to your doctor's office go with a tape recorder or go with an advocate--someone else that you trust as a friend of yours so you can both pay attention to what the doctor's telling you.

One of the most frustrating things as a physician is when you tell a patient something as clearly as you can and they don't get the message. And it turns out when we do surveys that 50 percent, half the people walking out of their doctor's office, do not really understand what the doctor told them. That's a problem on both sides. It's not just a physician's problem.

It's also because sometimes the pupils aren't prepared. The patients haven't read up on their illness and aren't really comfortable even beginning a discussion. So you know what ends up happening Neal? You practice veterinary medicine. The patient comes in, right, you ask a question, they don't know, you ask another question, they ask their wife, the women are better at this by the way, women are much better patients than men are.

And then at the end of the third question, you say you know what, they don't really know anything about what's going on with them, I'll order five tests. And that's not an efficient way to run healthcare in this country.

CONAN: You say confess your vices, here's a question from Nate on email. My insurance recently kicked in. I'm seeking treatment for a condition that I've had since before becoming insured. If I tell anybody about this my insurance could be void. If I don't I misinform my doctor. What do I do?

Dr. OZ: We need religious scholars involved in that question. That's unfortunately an issue of honesty versus health and I'll always pick the health. It is possible that your insurance company may give you a hard time about it, but if you're going to risk your life to gain that benefit I think you're defeating the whole purpose of having insurance.

CONAN: Mehmet Oz is co-author of You the Smart Patient: An Insider's Handbook for Getting the Best Treatment. And you're listening to TALK OF THE NATION from NPR News.

And another caller. This is Bob. Bob's calling from San Francisco.

BOB (Caller): Hi. Thank you for taking my call. I appreciate it.

CONAN: Sure.

BOB: I am really interested in this discussion. I'm a full-time physician and a part-time patient kind of voluntarily. I recently had a brain tumor, which, you know, I haven't read your book, but I assume that I did many of the things that you advocate, which is I researched very thoroughly which physician, which center--I got a number, not just two opinions but actually four opinions from different neurosurgeons, found an excellent neurosurgeon with an excellent record who had experience dealing with the type of tumor that I had, had it taken out, and the surgery, while it was more extensive than initially thought, went well.

I was taken out of the surgery unit into a, you know, postoperative care unit feeling reasonably ok with controlled pain and in the middle of the night developed a ten out of ten headache with an associated stiff neck. The nurse who was taking care of me ignored that, documented it in the chart, and basically thought I was asking for more pain medicine which she didn't feel authorized to give. Did not call the physician and it wasn't until the physician arrived in the morning that it was discovered that I had had a postoperative intracranial bleed.

In layman's terms the tumor was out but there was bleeding at the sight where the tumor had been. Which fortunately for me was not a lethal condition, but it was a serious condition which required evaluation and treatment. And it was completely missed, not by the physician who was taking care of me, but by the nurse who was taking care of me. And the reason for that I believe is staffing ratios. She had four other patients, or she had three other patients, I was one of them.

So, I hear what you're saying and I agree with what you're saying about the smart patient idea, however, we need a smart system. We need a system where the resources are there to support good providers of medical care to do what they do best and we don't have that system in this country unfortunately. We have the resources to do it, but we don't spend them, you know, we'd rather do other things with our resources. I won't get into that.

CONAN: Mm hmm.

BOB: But I called because I have some very specific advice, which was given to me by a senior physician...

CONAN: And if you can get it out quickly Bob because we're running out of time.

BOB: Very quickly, here it is. Don't leave anyone you care about alone in a hospital. Have your family there with you. Make sure they ask what's going on. Because if anybody could have recognized that I was in agony...

CONAN: Next point Bob, we're running out of time.

BOB: Bad.

CONAN: Ok, Dr. Oz.

Dr. OZ: So, I'll address that.

CONAN: Yeah.

Dr. OZ: It's a point we make in the book as well. It is an interesting phenomenon that in the United States, because it's not true in most countries, we actively prohibit patient's families from spending time with them. We have things called visiting hours. In my hospital, New York Presbyterian, I've done everything I can to abolish these. And many progressive hospitals around the country are revisiting this whole concept.

I absolutely agree with the caller. If you have someone you care about in a hospital stay with them. Create a call system. There is no easy fix to the problem unless you have someone with you who can take care of you in your time of need.

And I always tell families when they're waiting outside in the waiting room during surgery, you're doing this for you. I don't need you in the waiting room when I'm operating on your loved one. When I do need you is tonight and tomorrow and the day after tomorrow when they're on the floor and sudden symptoms develop and there's nobody there. That's when I need you.

CONAN: Hmm. Bob, I hope there's been progress and good luck with your condition.

BOB: Thank you. And I really appreciate that answer the physician gives. I'm actually fine. Thank you. Bye-bye.

CONAN: Oh, good. Glad to hear it Bob. And Dr. Oz thank you very much for being with us today.

Dr. OZ: Neal, it's been a great honor, love the show.

CONAN: Ok. I appreciate it. Along with Michael Roizen, M.D., Mehmet Oz, M.D. is author of the book, You the Smart Patient: An Insider's Handbook for Getting the Best Treatment. The book was written in cooperation with the Joint Commission which describes itself as the patient's safety champion. When we come back from a short break the mistakes the government made in the sentence trial of Zacarias Moussaoui. A memorable performance in recollection from Joshua Foer and your letters. It's the TALK OF THE NATION from NPR News. I'm Neal Conan.

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