“You were right,” Susan said. “The view’s great from the other side of the road.”

Jimmy Duncan watched her approach, the sun behind her and the wind riffling her hair. She fiddled with her camera a moment, then plopped down beside him on the grassy hillside. To their left, loomed a wall of black forest; jungle birds screamed and chattered in the trees. To the right, beyond the rented Jeep, a line of ragged mountains marched away into the blue distance.

“How do you know this place?” she asked. “You never said anything about all this.”

“I don’t know the whole country. Just this area.”

She grinned. “And I thought you’d told me all your secrets.”

When he didn’t reply, Susan’s voice turned soft. “This has something to do with the accident, doesn’t it?”

“Why do you think that?”

“Because I know you. The look on your face.”

Jimmy sighed. “That was a long time ago.”

“So?”

“Besides”—he plucked a blade of grass, examined it, twirled it between a thumb and forefinger before the wind took it—“I’m not even sure you’d call it an accident.”

“What would you call it?”

…

“A miracle,” the cop said.

Jimmy turned his head toward the voice. Not his eyes, just his head. His eyes were bandaged tight. “What’d you say?”

“I said it was a miracle. That car of yours was squashed so flat we thought you was too. You’re one lucky fool.”

Jimmy groaned. He didn’t feel lucky. He felt blind, and nauseated, and achy. From somewhere down the hall, he heard the sad rattle of a cart as patients were brought their lunch trays.

“The other driver?” Jimmy asked.

“Not even a bruise. Them 18-wheelers are built like tanks.” Jimmy heard a rasping sound, and realized the cop was scratching his chin. “Want some advice, kid? That truck’s company owns a thousand stores, and we got three witnesses say it ran the light. Sue ’em, settle for a couple million, and move to Hawaii. Beaches, sunsets, girls in grass skirts.”

“What if you can’t see them?” Jimmy asked.

“Yeah, well, that could be a problem.” The cop cleared his throat. “Catch you later.”

Which was a lie. The cop didn’t return. The doctor, however, did. Along with a parade of nurses and orderlies and even a few lawyers. But no friends, and no family. Jimmy didn’t have any of those.

He didn’t even have a home. For the past two months, since the layoff from the warehouse in East Texas, he’d been on the road. Footloose, but not fancy-free. His savings were gone now. He’d hoped to sell some of his paintings, but that notion had suffered the same fate as most of his other ideas. In San Francisco he’d heard about an art colony near Vancouver and headed north. Why not? He’d never seen Canada. Then, in Oregon, a truck had failed to stop for a red light. What had stopped was his tour of the Northwest.

Broke, alone, homeless, blind. Even his artwork was gone, destroyed in the crash. He didn’t know what hospital he was in, or who was paying for his treatment. Uncle Sam, probably.

He almost wished he hadn’t been thrown clear, wished he’d been squashed as flat as his 10-year-old Civic. Easier for everybody.

But life went on.

As if proving that, Jimmy soon learned to ID the hospital staff from their voices. He had little choice; his hearing was one of the few senses he had left. He wondered if he’d ever see anything again.

“Pressure on the optic nerve, plus a scratched cornea,” the doc said. “A specialist is coming in. We’ll know more then.”

Three specialists and two surgeries later, Jimmy was told he would regain his sight. Two months from now, maybe less.

His body was another matter. Multiple head and back injuries, partial paralysis. He could move his neck and his left arm, but only slightly. Otherwise, zip. Each day he was lifted into a wheelchair beside his bed, and each day he wondered why the wheelchair. Did they think he was going someplace? He was left to sit there a couple hours, and then they swung him back into his bed, like a sack of feed. Day after day.

And then he met Maria. She came one morning like a fuzzy dream while he was in the chair and whispered in his ear. He turned his head in the direction of her voice. Many people had spoken to him during his stay, but this was the first whisper. It had a Spanish accent.

“The weendow,” she said. “You must make it to the weendow.” And squeezed his hand. Then she was gone.

A nurse told him later who the woman was. Maria Renaldo, from the fifth floor. A small lady, mid-80s. She loved to talk with patients. No one knew whether her goodwill visits accomplished much, but since she was harmless the hospital allowed her free access.

Fiction: The Outside World The Saturday Evening Post

“I have a few questions,” Susana interjected, stopping the pediatrician in her tracks. “What do I do for her?”

“Give her some Tylenol,” she advised. “She’ll be fine.”

“How much Tylenol do I give her?” the new mother asked.

“What is her body weight?” the doctor said, scanning Sofia’s chart.

“I don’t know—no one in 
your office weighed her or took her temperature,” she replied. “Will you please pay more attention to this situation and tell me what’s wrong with my daughter? I need information.”

Because Susana spoke up, her daughter got the attention she needed, and Susana got the information and guidance that she, as a paying customer and concerned mother, had a right to expect from the doctor. But not everyone feels comfortable doing that, even if they should.

Being wise medical consumers means choosing medical partners we can communicate with effectively and trust. When it comes to protecting our health, we have to be sure that we are getting what we pay for. An engaged, concerned, and skilled doctor is the best health care investment we can hope to find.

Illustrated by Pablo Bernasconi

Let’s Talk

Perhaps the most important step to becoming a smart medical consumer is the process of finding and choosing the right GP or family physician. That person will be your closest medical partner and will play an important role in helping you make other decisions about your health care management and practitioners. If 
you are in the market for a new physician, ask your friends and co-workers for recommendations, and go online to find out what doctors within that specialty are located in your area. When you’ve found one you want to “interview,” call the office and schedule an introductory appointment, so you can go 
in, share your medical history, and get a sense of the doctor’s attitudes and approach to medicine. (Tell the scheduling assistant specifically what 
you want to do during the appointment so you have adequate time.)

As with any interview, little things count: The office workers, nurses, and med techs should be friendly and helpful; the office should be clean; the doctor should be open and willing to talk with you about your concerns and interests. Keep it relatively simple, but use your time to determine how well this physician’s working approach suits your own. Does he or she communicate with patients via e-mail when appropriate? Is this doctor comfortable discussing information you’ve gathered? What hospital affiliations does the practice maintain? What regular screening tests does he recommend for someone of your age group? Talk about your major health concerns and listen closely to the answers you receive. If you’re comfortable with the initial meeting, schedule a full physical and use that experience to cement or break the deal with this doc.

Partner with Your Physician

Doctors are not infallible, nor should we expect them to be. Like the rest of us, they occasionally will be distracted and disengaged, and they won’t always seek our active collaboration in the doctor-patient relationship. It is therefore our responsibility to speak up, ask questions, and insist that our voices are heard when we have concerns about our treatment.

We don’t need a degree in medicine to partner with our doctors. We can start with some very simple steps. First, we should realize that our medical history is our business, not just our doctors’ “property.” Most of us know that we should maintain a list of our medications, including dosages and directions for use, along with any alternative health practices and supplements. In addition, many patient advocates advise that we keep track of our medical records, requesting copies from our doctors for our own safekeeping. That way, we know exactly what information is available to new physicians and consulting specialists—and we have the important information we need if we want to do our own research. Further, with copies of our test results in hand, we can be sure that the correct name appears on them and that there wasn’t a mix-up at the lab.

Be Your Own Records Keeper

Illustrated by Pablo Bernasconi

Every time you visit a new doctor, you’re asked to complete a personal health information form that lists family medical history, your history of diseases, illnesses, injuries, hospitalizations, allergies, and so on. You’re also asked to complete a “release of information” form, which enables your previous doctor to release health records to the new doctor’s office. With all this information floating around, you might wonder why anyone would need to keep his or her own personal health record. But, according to the American Health Information Management Association (AHIMA), everyone should do so. That way, no matter when or where we need health care, the medical provider we consult has access to a full and detailed medical history.

These records can be in written or electronic form, stored in a file folder, on a computer hard drive or disk, on a portable USB removable flash drive, or through an online service. The AHIMA maintains a Web site (My Personal Health Record, myphr.com) that offers full information about the benefits of maintaining a personal health record, along with free downloadable electronic forms for compiling one. The site has a search feature to find forms, tools, and software for storing records. Online services typically have access codes and other measures devised to keep information secure and accessible only by those you’ve authorized. Some online storage services are free, while others charge a monthly fee; check each service carefully when making your choice.

Asking Questions, Getting Answers

At some point, most of us will need a medical advocate—a friend or relative who can accompany us to our appointment or examination to help take notes, ask questions, and listen to information. If 
our doctor wants to send us on our way with a prescription, we first should ask for the drug’s name, its purpose, side effects, potential negative interaction, and so on. Then, when we fill the prescription, we need to check its accuracy before we leave the pharmacy. And we should always feel free to ask “why”: Why do I need this drug, treatment, or surgery? How else could we tackle this problem? What benefits will I get 
from this treatment plan, and what risks am I taking?

Some doctors can be prickly when they sense that their authority is 
being challenged. So how do we help make sure that our physician isn’t misdiagnosing our condition? Jerome Groopman, M.D., recommends that patients or their advocates describe to their doctors exactly what worries them most about their symptoms or condition. And ask early—don’t leave important details until the doctor is leaving the room. Groopman also suggests that patients ask questions 
to make their doctors think more deeply about their diagnosis, such as “What else could this be?”

We shouldn’t hesitate to speak up about sloppy practices, either. We can—and need to—ask whether all medical instruments, including stethoscopes and blood pressure armbands, 
have been sterilized, 
and whether we should be started on antibiotics before surgery, to help ward off post-surgical infections.

Illustrated by Pablo Bernasconi

Patient-Physician Compatibility?

Through the years, my expectations for physicians have changed. If you’re going to need ongoing service, such 
as from a cardiologist, dermatologist, internist, or gynecologist, then compatibility is much more important. On the other hand, if you’re seeing a specialist for a (hopefully) one-time treatment, such as an oncologist or surgeon, personality is not as important. What you really want to know is, “How good is the doctor for this type of treatment?” A good question to ask in the first meeting is, “What is your success rate?”

I firmly believe it’s important for patients to be accountable for their bodies and health. We are in a professional relationship with our physicians. We may form close bonds with the health care teams that tend to us or our loved ones, but we can’t afford to overlook potential warning signs simply because we like and trust them. Mistakes happen all the time. Better that we ask why an order has been changed, why a vital sign has been altered, why a medication has been dropped or started, than to have a simple slip-up go unchecked and develop into a fatal error.

Primary Concerns The Saturday Evening Post

As uninsured ranks grow and insured employees cope with complex health plans with varying copays and coverage options, people struggle with understanding their bills and detecting potential errors. But help is available from a growing cottage industry of health advocates and firms specializing in reviewing medical bills; discovering mistakes; and negotiating with health care providers, insurers, and collection agencies, reports Barb Berggoetz in her Sep/Oct 2010 Saturday Evening Post article “Decoding Your Medical Bills.”

Here’s how to contact the medical billing companies mentioned in her article and take control of your health care costs:

1. Medical Billing Advocates of America

PO Box 1705
Salem, Virginia 24153
billadvocates.com
540-387-5870

2. MedReview Solutions, Inc.

4840 Willow Ridge Court
Zionsville, Indiana 46077
medreviewsolutions.com
317-873-4872

3. Chapman Consulting and Hospital Bill Review

14604 Mansfield Dam Ct Unit #1
Austin, Texas 78734
hospitalbillreview.com
800-906-8085

4. Health Advocate, Inc.

3043 Walton Road, Suite 150
Plymouth Meeting, Pennsylvania 19462
healthadvocate.com
610-825-1222

Decoding Your Medical Bills The Saturday Evening Post