Navigating the Health Care System
Advice Columns from Dr. Carolyn ClancyFormer AHRQ Director Carolyn Clancy, M.D., prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They address important issues such as how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan.
How to Make an Emergency Department Visit a Safe OneBy Carolyn M. Clancy, M.D.
You hope an accident or illness won't send you to an emergency department (ED). But being prepared for such an event can help you get good, timely, and safe care when the need arises.
Unfortunately, U.S. hospital EDs are severely overcrowded. In 2006, America's emergency rooms cared for 120 million patients, according to data from my agency, the Agency for Healthcare Research and Quality (AHRQ). And—because the Nation's health care system still relies on largely paper-based medical records—chances are, if you land in the ED, the doctors won't have information about your medical history.
ED staff won't know what medicines you take or what medical problems you have unless you are able to tell them. Even if you are alert, you're likely to forget important information about your health, such as medicine allergies or your blood type.
Being prepared for a trip to the ED—whether because of an accident or illness—increases your chances of getting safe, high quality health care. It might even save you money, depending on your health plan's policy for ED visits. Know what your health plan policy is. Some health plans require that you get authorization for emergency care other than for life-threatening emergencies.
That's why it's important to have handy, updated, and thorough information at hand. Keeping your information either on paper or in an electronic form, like on your cell phone, may help you receive better, safer care in a medical emergency.
Here is a basic list of information that you should have available in case you ever need to go to the ED:
- Medical conditions or illnesses you have, such as heart disease or diabetes, and any surgeries or treatments you've recently received.
- Medicines you take, including prescription, over-the-counter, and herbal medications, along with dosage information. Some drug interactions can be deadly, so it is essential for ED staff to know which medicines you take and in what amounts. If you have time, bring your medicines in a bag, or keep in your wallet an updated list of all your medicines and dosages. AHRQ also has a model pill card that can be created on a computer.
- Allergies or known reactions you have to medicines, foods, or latex (a material in many medical supplies, including some types of gloves and adhesive tape).
- Names and contact information of your primary care doctor and any specialists (such as a cardiologist) treating you. Also, have contact information of family members or close friends who may know your medical history in case you are not able to communicate it.
Other important information to have handy includes personal identification (such as a driver's license), insurance information, and an advance directive, if you have one. Advance directives are legal documents that state your wishes about health care, including end-of-life care.
There are several ways you can prepare all of this information before you ever need it. Keep essential information typed or written in your wallet. Emergency doctors recommend that people with cell phones add "ICE'" entries into their cell phone address books. ICE stands for "In Case of Emergency." Medical providers can use it to notify your emergency contacts and to obtain needed medical information if you arrive unconscious or unable to answer questions.
Increasingly, people are creating and maintaining electronic personal health records (PHRs). These can be very useful if they're portable and easy to access. There are several PHR options available for you to choose from. Some of them allow you to keep a copy or summary of your health history, medicines, and allergies in one safe place that you control. Check to see if the PHR you prefer allows you to keep the summary. It can be kept on a secure Web site, or stored on your computer or another electronic device, or on paper.
Regardless of how you keep your vital medical information, it is important to keep it updated. It is also important that your family members know where this information is in case you are unable to do so in an emergency. And when you leave the ED, make sure you understand the instructions given to you by the hospital when they let you go home, called discharge instructions. These can include directions for follow-up visits or changes in medication.
I'm Dr. Carolyn Clancy, and that's my opinion on how to navigate the health care system.
Agency for Healthcare Research and Quality
How To Use Hospital Emergency Rooms Wisely
Advice Column from Dr. Clancy, August 19, 2008
Talking About End-of-life Treatment Decisions
Advice Column from Dr. Clancy, July 7, 2009
Keeping Track of Your Health Information
Advice Column from Dr. Clancy, June 16, 2008
Better Information Helps Patients When They Leave the Hospital
Advice Column from Dr. Clancy, December 16, 2008
American College of Emergency Physicians Foundation