Patient Advocacy and Healthcare Choices [Interview] [Transcript]

Dr_Archelle_Georgiou_Patient_Advocacy_and_Healthcare_ChoicesGuest: Dr. Archelle Georgiou
Presenter: Neal Howard
Guest Bio: Archelle Georgiou, MD, is a nationally recognized physician and consumer advocate. As former Chief Medical Officer of UnitedHealthcare, she changed the company’s policies and eliminated the bureaucratic hassles that managed care companies impose on patients and physicians. She uses the media as a vehicle to educate consumers about their health and has a regular health news segment on KSTP-TV in Minneapolis. Archelle is an Executive in Residence at the University of Minnesota Carlson School of Management.

Segment overview: Dr. Archelle Georgiou, MD, talks about her new book, “Healthcare Choices: 5 Steps to Getting the Care You Want and Need”, and discusses how patients can be an advocate in their own care.

Transcription
Health Professional Radio – Patient Advocacy

Neal Howard: Hello. Welcome to the program today. I’m your host Neal Howard here on Health Professional Radio. If a healthcare crisis hits you or your family, are you prepared? Are you ready? Most people aren’t. With your health being the most important thing that you possess, our healthcare system is designed so that truly getting the care that’s right for you is sometimes nearly next to impossible. Our guest today is Dr. Archelle Georgiou, she’s here to talk about her brand new book, “Healthcare Choices: 5 Steps to Getting the Care You Want and Need,” and also to discuss her work as a patient advocate. Welcome to Health Professional Radio, Dr. Georgiou.

Dr. Archelle Georgiou: Thank you.

Neal: Now, you’re a healthcare advocate. You’ve been working extensively nationwide in order to give patients a voice in their own healthcare. It’s not something that is easily gained with most of us thinking about our doctors being way up there and slowly patients sometimes being down here and sickly. Talk about your brand new book, “Healthcare Choices,” and give us a little bit of background about yourself.

Dr. Georgiou: Sure. Well, first of all, I think it’s important to state that I am a physician by training, and I’ve worked in the health insurance industry for over 15 years. Now, I’m more of a patient advocate because in my own experiences, I’ve seen that, in addition to what insurance has to do to finance your care and what your doctors have to do to treat you, patients and consumers, themselves, have to play an important part in getting the care that they want and need. That’s what this book about is about. It’s about healthcare choices. Really, what it does is it tells readers how to make balanced healthcare decisions. By balanced, I mean balancing what you need medically, along with what you want from a personal quality of life, professional, economic perspective. Ultimately, what gives you peace of mind? Your doctor can’t make those decisions for you. Only you can make those decisions for you, with their input about what you need.

Neal: Okay, so we’re going in there to tell our doctors what we need. What about the person who thinks they know what they need, or the doctor who doesn’t want to hear about what you think because he’s or she’s the doctor?

Dr. Georgiou: Well, I hear a lot of concerns from people who say, “But the doctor doesn’t want to talk to me,” or, “They’re not open to hearing what my thinking is.” Studies show that doctors actually prefer to have patients that are educated about their condition, ask questions, and care. Why? Because patients who are engaged in their care, who are active participants in their care, end up taking better care of themselves, and then that’s good for everyone. Its better outcomes for the patient and better statistics for the doctor. I think that what is really important is when you’re interacting with your doctor, to be very prepared in that conversation and to have the confidence that you know best what your preferences are, what your values, what your economic preferences are. I think going in prepared, that means thinking in advance before you go into the doctor’s office, what your symptoms are, what considerations you want to take into account, instead of showing up at doctor’s office and just being a recipient, a passive recipient of information.

Neal: Now, we’re not talking about being arrogant or anything like that. We’re talking about mutual sharing of information, a mutual expression of needs and wants and things, as it pertains to your healthcare, but what about the time that that takes?

Dr. Georgiou: Sure. Time is a challenge. I think that the most current statistics show that an average office visit is about 18 minutes, which doesn’t seem very long. That 18 minutes probably includes things in addition to the face-to-face time with the doctor. Even more reason to be prepared. Let me give you an example. I have a 14-year-old daughter. I am trying to teach her how to advocate for herself. We recently went to the doctor for some ear pain. On the drive there, I made her recite back to me, what her symptoms were, when they started, what made the pain better, what made the pain worse, so that we weren’t wasting time in the doctor’s office for her to think about the answers to those questions. I think that that’s a key part of playing an active role as a patient.

Neal: Now, “Healthcare Choices: 5 Steps to Getting the Care You Want and Need,” your brand new book. I understand why you wrote the book, but what do you say to the people that say, “Well, the insurance company and the physicians or the hospitals, they’re all in it together. They’re not trying to make it easier for us.”

Dr. Georgiou: Well, let me just change the angle on that question a little bit.

Neal: Okay.

Dr. Georgiou: Let’s talk about somebody that has breast cancer, for example. That person, regardless of their insurance, regardless of who their doctor is, is going to get treated. Their doctor, if they have a certain stage of breast cancer is going to usually have two options, right? They’re going to have an option between a lumpectomy and radiation or a mastectomy for that breast cancer. It is up to a patient and the doctor to have the conversation about what the right approach is to treating that cancer. That is important regardless of the insurance you have, the time that you’re in the office. Knowing how to approach that situation, understanding your condition, knowing all your alternatives, respecting your preferences, evaluating your options, and then weighing in to the right decision for you is something that you have to advocate for, regardless of all of those other barriers that are certainly there, but you have to be able to overcome them.

Neal: Okay, learn to basically navigate around them in order to get exactly what you need in a timely manner.

Dr. Georgiou: Absolutely.
Neal: Now, you’re a former chief medical officer of United Healthcare, a huge organization. You made some far-reaching changes while there. We’ve talked about some of the time factors involved in getting a good quality visit with your physician. Talk about the apprehension on the part of the patient to take that responsibility.

Dr. Georgiou: I think that one of first steps is knowing what your go-to resources are to be able to do the research, so that you have the confidence to have that conversation. We hear from many, many people, do not go to Dr. Google. I completely support that. It probably creates more anxiety than it helps when people are dealing with a symptom or a condition, but that doesn’t mean don’t do your research. In fact, I think it’s really important to do your research before you go into the doctor’s office, so that you have that confidence, but knowing what is a credible resource, knowing how to navigate that resource. I don’t get paid by any of these companies at all, but I frankly use mayoclinic.org to guide how I look up conditions and to guide the research that I do. What I do in the book is I list out all of the websites that I personally use to guide the care for me and my family and my friends and others that come to me for help. That’s one way to start having that confidence, to start the conversation is to do your research beforehand, but just make sure you do good research.

Neal: Do you offer any suggestions as to how to alter your approach based on the experience of your physician?

Dr. Georgiou: There’s a whole chapter in the book that talks about how to find the best physician for you. Sometimes, we just get recommendations from our neighbors and even from our primary care physicians about what specialist to see. Those are good recommendations to take into consideration but not the only thing that you should take into consideration. The book lays out a process that allows you to get the recommendations from people you trust, but also allows you to see what kind of training does that physician have? Are they board certified? Are they an expert in the specific condition and symptoms that you have? We know from a lot of data that the more patient’s doctors have treated that are just like you, the more likely they are to have a good outcome when they are treating you. The book really lays out how to very systematically identify a group of physicians that might be right for you and then begin to narrow the playing field to ultimately select the one that’s right for you. That takes into consideration everything from their training to the insurance that they accept because affordability is important to other patients’ experience with that same doctor.

Neal: We’ve talked about resources. What if one of your resources happens to be some information that you gain from another physician?

Dr. Georgiou: Well, I think that when your physician gives you information, hopefully, it’s accurate and credible. If you have a question about it, you should research. If you don’t trust it, you should look that up. I think maybe what you’re trying to get to is: what if you feel like you need a second opinion? I very much recommend that people get second opinions, but here’s the caveat on that. I wouldn’t call it a second opinion. Here’s why. When you get a recommendation from one physician, usually it’s about surgery, and you go to another physician, and you tell them that you want a second opinion. That translates to, “Could you please tell me if my first doctor was right?” The second opinion doctor is immediately biased by the original diagnosis, which means they’re not evaluating your symptoms with a fresh set of eyes. Instead, I recommend getting a second opinion but calling it a consultation, which translate to, “Please tell me what’s wrong and the best way to treat it.” That language really asks that physician to feel responsible for offering a completely independent expert assessment of your medical condition. He may consider what your other physician may have diagnosed, but otherwise, they start with a fresh clean slate, and offer their best thinking with unfiltered recommendations. That’s really what you want from that second opinion, which you should call a consultation.

Neal: There are some changes that are going to be made, it seems, one way or another with our current Affordable Care Act. Talk about what we, as patients, and you, as physicians, are looking out for the most? What should we be on the lookout for?

Dr. Georgiou: I think that there’s two things that we are going to see regardless of the direction that the new Administration is taking. One is that I think we’re going to see even more high deductible plans. That means that people are going to be bearing even more of their own medical expense, which makes it that much more important to be an active participant in your care, to use the care’s model, and to make the choices that are right for you because it not only affects your health, but it affects your checkbook. That’s number one. Number two is that I think that we’re going to continue seeing narrower networks of providers. That means fewer doctors and hospitals to choose from that are covered by our insurance. We know from large insurers, United Healthcare, Aetna and many others, that they do cost 10-14% less than having big, broad networks. If you’re signing up for an insurance that has a narrow network, make sure that your doctors and the best hospitals in your area are included. Don’t wait until you have a significant medical need to find out that the doctor you need to see are not part of your insurance network. Those are the two things I would watch out for.

Neal: Where can our listeners get a copy of your book, “Healthcare Choices: 5 Steps to Getting the Care You Want and Need?”

Dr. Georgiou: They can get it on amazon.com as well as barnesandnoble.com.

Neal: Great. Great. Well, I thank you for the information and coming and speaking with us, Dr. Georgiou.

Dr. Georgiou: Thank you so much.

Neal: You’ve been listening to Health Professional Radio. I’m your host Neal Howard. Thank you for joining us today. Transcripts and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm. You can subscribe to this podcast on iTunes and listen in and download on SoundCloud.