Be Intelligent
No one expects you to take a crash medical school course after being diagnosed with an illness. It’s not necessary that you understand anatomy and physiology or cell biology. It is important that you know how your own body works. What are the unique features of your body? What illnesses and injuries have you had? What medications are you allergic to? How do you respond to medication? It’s also important that you have at least a basic understanding of your diagnosis. You should know the actual diagnosis and all its particulars. If your specific disease has stages, phases or degrees, know where you are on the continuum. Do enough research so that you aren’t buried in information on your first doctor’s visit.

Be Curious
Curiosity may have killed the cat, but it could save your life. Today’s healthcare culture is about increasing the numbers of patients seen by doctors while reducing the reimbursement schedules and insurers increasing malpractice insurance premiums. Curiosity allows you to feel prepared for your consults. It shows the doctor that you are part of the team and not simply a bystander or a victim. Curiosity may even get the doctor to think twice about a test, a diagnosis or a treatment. It tells the doctor that you’re not simply a tourist in this process, but you are truly the CEO of your own health. Curiosity also keeps the medical team connected to you even when you’re not present. They will think about questions or research answers about protocols and outcome studies so the next time you come in for a visit they are just as prepared as you.

Be Assertive
Western culture has created a power imbalance between the doctor and patient. It’s not uncommon for doctors to be put on pedestals, unfortunately that means many fall off. When meeting with your healthcare team make clear your expectations. If you feel a particular test needs to be done, don’t take a simple “no” based on the insurance company declining the request. It’s fine to ask the doctor or hospital to appeal the decision and requesting the doctor to provide additional information if necessary to make sure the test is authorized. If you have specific side effects that you don’t feel are being addressed make a firm request of your provider. Suffering should be eliminated at every possible juncture of your treatment process. This is no time to be a wallflower. Your presence is important, so make sure your voice, your concerns and your problems are addressed.

Becoming your own healthcare advocate provides you with a sense of ownership. It gives you the presence of mind to partner with your healthcare team. You’re empowered to ask questions at every step of the process. Your inner strength translates to improved immune function. We all need an advocate so either step up and take that role or team up with someone who has the experience in that position, but don’t be led down a path without having a voice.

Whether you have a loved one living with you full-time or you manage his/her care from 3,000 miles away, chances are you will be called at some point to act as that person’s advocate. So, along with the responsibilities that many of the more than 35 million caregivers in this country face on a daily basis, such as feeding, cooking, bathing or overseeing hired help, you will also need to be a voice for that person if he/she isn’t able to ask crucial questions or find important information.

Physically or mentally impaired older people need advocacy in many areas. Some examples include dealing with housing or transportation offices, the Social Security Administration, and sorting through Medicare and Medicaid. Many seniors are entitled to benefits they are unaware of and need someone to help them find information on vital programs. Some elders are eligible for reduced or frozen rent rates, reduction of transportation costs and/or specialized transportation to help them remain independent. Find your local area agencies on aging at eldercare.gov for more information on what your loved one may qualify for.

Perhaps the most important area for advocacy is the health care system. From prescribed medications to medical testing and hospitalizations, studies show that older Americans must be proactive in understanding the health care they receive to protect themselves from errors and injuries. Those who can’t do so need someone to speak up on their behalf.

Older people need a good advocate within the health care system. There is no doubt that being hospitalized puts older patients at risk for a whole host of problems, including infections, falls, confusion, weakness and bedsores. In addition, a 2006 report by the Institute of Medicine revealed that hospitalized Medicare patients experienced an estimated 400,000 preventable injuries each year from adverse drug reactions. Another 800,000 adverse events were found in nursing homes, plus 530,000 more in outpatient settings.

One of the major recommendations that came from this study was that “patients and their surrogates should in turn take a more active role in the process . . . to keep careful records of all medications.” Patients and caregivers can cut down on the likelihood of injury by creating a simple medical record that is brought to all doctor’s appointments and hospital admissions.

In addition to harm done by medications, what about all of the interventions that are offered to older patients or those with serious illness? We’ve all heard stories about someone who has had the wrong leg amputated or the wrong kidney removed, and are horrified that such things can still happen despite the high level of care available in this country. These are obvious cases in which people received the wrong care-care that only does them harm. In addition, another study showed a 13 percent increase in the number of procedures done on Medicare patients during their final hospital admission that did not result in a corresponding increase in life expectancy. We have more technology to use at the end of life, but it isn’t always the right choice.

Because of this, it is critical that older persons and those with chronic serious illness (and their advocates) become well informed when treatments and procedures are being offered. Some important questions to ask are:

What will be the added benefit of this?
What are the possible side effects?
Will it affect my ability to function independently?
What are the possibilities if I choose not to do this?

Another important step to take is creating advance directives-a living will or health care proxy, depending on which state you live in. Discussing these important issues with your loved one will be immensely helpful should the day come that you must make health care decisions on someone else’s behalf.

Sometimes making big medical decisions can seem overwhelming. One place to turn for support if you are grappling with various treatment choices is your hospital’s palliative care team. This interdisciplinary form of care, now a recognized medical subspecialty for physicians, is focused on relief of suffering for those faced with serious health issues. The services a palliative care team provides are usually covered by Medicare or other types of insurance and are billed just like treatments from any other medical specialist.