Our Bodies, Ourselves (144 page)
Read Our Bodies, Ourselves Online
Authors: Boston Women's Health Book Collective
When these attitudes exist, you may feel intimidated and fail to ask questions or request a clearer explanation. However, it is important that you have the opportunity to both understand and question your own care.
If necessary, bring along an advocate who can ensure your questions are answered and help assess your care and treatment (see
“Making the Most
of Your Health Care Visit”).
If you consistently feel that your concerns aren't heard or your participation in your own health care isn't respected, find a new health care provider, if possible. If the problem is really significant, you may want to submit a formal complaint (see
“Voicing Our Complaints”
).
COMPLEMENTARY AND ALTERNATIVE THERAPIES
Women have long used massage, herbal medicine, and other methods to heal ourselves, soothe members of our families, assist birth, and tend the ill. Many women continue to use traditional healing methods, which range from ginger tea for a cold to entire medical systemsâsuch as traditional Chinese medicine and ayurvedic medicineâthat have their own diagnostic techniques and treatments. These healing methods are diverse, yet most are rooted in the following principles:
⢠Health is not merely the absence of disease but a state of well-being in which the body, mind, and spirit are balanced.
⢠Disease and treatment affect the whole body, not just one part.
⢠Human energy flow (variously called chi or qi, prana, life force, or vital energy) can be affected by disease or treatment.
⢠Each person has a great capacity for self-healing.
In North America, these diverse health care practices are sometimes called complementary and alternative medicine, often referred to as CAM. CAM health practices include both practitioner-administered therapies such as acupuncture, chiropractic, and massage, and self-care practices such as meditation and visualization. Integrative medicine is the practice of combining both Western and CAM approaches to care.
People may explore alternative therapies because they seem safer than conventional medical or surgical approaches, appeal to the desire to use natural methods to manage health, align with cultural values, or counteract side effects of other treatments.
Until recently, there was little scientific evidence about the safety and effectiveness of many complementary health practices. In recent years this has begun to change, and agencies such as the U.S. National Institutes of Health's national Center for Complementary and alternative Medicine (nccam.nih.gov) now provide research-based information on treatments such as acupuncture, yoga, herbs, and dietary supplements. As more and better research is done, we will have a clearer idea of what complementary therapies are helpful and safe to use. In the meantime, it is important to remember that a therapy described as “natural” or “herbal” is not necessarily safe or effective, and may have adverse effects or interactions with medications or other treatments.
Complementary health practitioners work in a range of settings, including clinics, private offices, health spas, and homes. To find a practitioner, ask for referrals from a health care provider, friends, or family, or seek local referrals from national organizations.
Alternative modes of healing may seem to promise a richer way of practicing health care than the standard drugs and surgery used in conventional Western medicine. However, holistic practices and practitioners can have some of the
same weaknesses, as well as additional problems of their own.
The tips below can help you choose and evaluate a provider or treatment.
Check your state department of health website for licensure information:
Many states require licenses for practitioners of acupuncture, chiropractic, massage, reflexology, or other therapies. While a license does not guarantee safety or efficacy, it is a good first step in evaluating a provider.
Competence matters:
National Certification exams exist for some complementary therapies; however, no piece of paper guarantees a person's ability to heal (nor does the lack of a recognized credential mean that a person isn't skillful or knowledgeable). Expect practitioners to be able to describe their training and experience in relation to the treatment they provide and ask about their experience in cases similar to yours. Be wary of practitioners who have no indicators of their qualifications.
Seek practitioners who listen carefully
and are willing to try different approaches and teach you skills to improve your health. Ask for personal referrals, interview several practitioners, and trust your intuition. If you are not comfortable with a practitioner for any reason, or a practitioner is willing to consider only one specific kind of treatment, go to someone else.
Look for practitioners who are willing to be part of a team of providers:
Avoid those who insist that any other therapy will undermine treatment.
Clarify how many appointments you will need:
Be wary of providers who try to get you to commit to a long series of treatments before you begin.
If a treatment isn't helping after a reasonable time, do not continue it:
Most CAM methods should lead to benefits within a month or two, or after three or four treatments.
Avoid practitioners who ask you to purchase expensive equipment or remedies
, especially if they sell these from their office.
Beware of miracle cures:
Don't trust sweeping claims about curing cancer, AIDS, or other serious diseases.
Ask about the cost of treatment:
If you have health insurance, check to see whether the treatment is covered. If you are unable to pay the full rate, ask the provider if she or he will accept a reduced payment.
Beware of alternative diagnostics:
This includes iridology (which claims to diagnose disease through examination of the iris), muscle testing, and machines that purport to detect energy fields. Alternative laboratory tests are almost always a waste of money and generally are not regulated by the federal government.
Explore the politics of the method you want to use:
Ask yourself, “Who profits from this mode of healing?” Complementary and alternative healers can also be profiteers or use shamanic, Native American, and other traditional practices in exploitive ways, for example to add a veneer of mysticism to what they do.
Avoid practitioners who seem to blame you for your health problems:
Trusting
our capacity for self-healing is not the same thing as blaming ourselves for illness. Some alternative practitioners may suggest that wrong thinking, lack of will, a driven or meek personality, or insufficient faith in the practitioner is the real root of illness. This blame-the-victim mentality is both cruel and inappropriate.
Find out how the practice or clinic works:
Know the hours of operation, evening and weekend coverage, what to do in an emergency, and numbers to call for appointments, prescriptions, and referrals. Ask what hospitals the practice uses and who will care for you if you need to be in the hospital.
Bring someone you trust with you:
It is often helpful to have another pair of eyes and ears to “record” what happens at appointments. (See
“Patient Advocates”
). If you do not have a friend or relative to accompany you, ask your doctor if you can record the visit so that you can review important conversations and instructions when these are needed.
Track your health information, and bring it with you to visits:
Practitioners often do not recall the details of your specific case, so they will benefit from this important information about your previous experience. Keeping a journal of symptoms and other issues related to your condition can help your provider better understand what you are experiencing (see
“Tracking Your Own Health”
). If possible, research relevant issues before your visit, and discuss your findings with your health care provider.
List all your questions and make sure that they are addressed:
Take into account that providers typically spend only relatively short amounts of time with each patient, so it helps to be prepared before your visit.
Bring any medicines, herbal preparations, or over-the-counter preparations you are taking to avoid receiving duplicate medications or medications that interact poorly:
If needed, ask your provider for detailed instructions for taking new medications or making changes in your existing medications.
Ask your provider for an explanation of anything you do not understand:
If necessary, ask for images or diagrams that explain your condition or materials in your language or at your literacy level. Ask for a written statement of the treatment plan in order to monitor your care or in case you choose to seek a second opinion later. When no medical emergency exists, take as much time as you need to think about any decisions.
Confirm how the practice uses email or digital communication tools:
Can you submit questions about treatment or routine matters such as scheduling and prescription renewal via email or online? Can you sign up to get a text message reminding you when your next appointment is?
If you need more time for the visit, ask for another appointment:
You can also ask to schedule longer visits, though this is not always possible.
If you have tests, make sure you get test results
, an explanation of any abnormal findings, and recommendations for follow-up. Request a
printed or electronic copy of the results, since it may show additional helpful information. Find out exactly when you can expect the results and who will contact you. If notification occurs only when there is a problem with the results, ask to be contacted regardless.
The more complicated your symptoms or diagnosis, the more you will want to bring someone to your health care appointments who can help you keep track of the details and advocate on your behalf.
Doctors, nurses, and other health care professionals are required, according to the federal law called the Health Insurance Portability and Accountability Act of 1996 (HIPAA), to keep your information private. You'll want to have a conversation with your advocate, regardless of whether that person is related to you, about keeping your information private, too. You'll also want to make sure her or his presence doesn't prevent you from bringing up important but sensitive topics such as domestic abuse or sexual history. Choose someone whose presence does not prevent you from being completely honest about these issues, or ask your advocate to leave the room for part of your visit when you discuss those issues with your provider.
RIGHTS REGARDING MEDICAL RECORDS
You have a legal right to view, obtain, or even correct your hospital and medical records. Since 2003, this right has been backed by federal law, the Health Insurance Portability and accountability act (HIPAA) legislation and regulations. A written statement of your rights is provided when you see a health care provider or are admitted to the hospital. These rights include all hospital and individual provider records about you, except, in some cases, psychotherapy notes.
The time frame for making records available to you varies by state, and providers are allowed to charge per printed page. If you request your records at each appointment, test, or hospital visit, those charges may be waived, since their purpose is to cover the cost of records retrieval. If you obtain health care through the Department of veterans Affairs (VA) you can download certain health data directly from the VA website (myhealth.va.gov) by clicking the “download my data” blue button, a feature that Medicare beneficiaries may soon be able to access as well.
Regulations and standards affecting patient access to medical records are very likely to change as the federal government offers incentives for hospitals and health care providers to increase their use of electronic medical records. A robust advocacy movement is also afoot to remove barriers to patient medical record access. For up-to-date information about your rights under HIPAA and state laws, visit the Center on Medical Record rights and Privacy at Georgetown university (medicalrecordrights.georgetown.edu).
Before your visit, discuss with your advocate what you want and expect to happen. Make sure you both understand the kinds of diagnostic tests, treatments, or surgical procedures proposed. Ask your advocate to keep a record of events that occur. Anticipate situations that may make you feel powerless or inadequately informed and make a list of your questions. No good hospital (or individual provider) should object to patients having an advocate, and many actively encourage it.
Large hospitals and health plans may employ patient advocates or representatives who can help cut through red tape. Yet because they represent the hospital, these people may not be free to represent your interests if they conflict with the interests of the hospital or provider. Even so, many patient advocates do an excellent job.
FINANCIAL BARRIERS
The high cost of health care creates particular hardships for women because, on average, women use health care services, especially reproductive health care services, more than men. We typically have more provider visits, fill more prescriptions, purchase more over-the-counter medications, and make greater use of complementary and alternative medicine. As a result, even those of us who have health care insurance often find that we cannot afford the health care that we need.
The up-front cost of insurance premiums represents only one part of our actual health care expenses. In order to use our health care insurance, we typically have to pay a co-pay (a fixed sum per visit, procedure, or medication) or coinsurance (a percentage of the visit or procedure). In addition, many insurance plans require an annual deductible of anywhere from several hundreds to several thousands paid out-of-pocket before the insurance kicks inâmaking insurance essentially unusable for people who lack sufficient funds to cover this initial payout. Annual deductibles are particularly problematic for pregnant women, who are likely to carry a pregnancy over two different years and thus would need to reach the annual deductible twice before insurance pays for their maternity care.