Confidence in dealing with your physician and the health care system are prerequisites for receiving "world class care." This book provides insight into the internal workings of the health care system. Patients are encouraged to participate as partners, self advocates, and key members of the health care team in order to achieve and maintain good health.

As medical care becomes more complex, the tendency to overlook screening tests and evaluations aimed at prevention are a growing problem. Managed care in the interest of saving money has added more regulations to an already confusing system. The complexity of the health care system often interferes with physicians' attempts to deliver quality care.

This book outlines recommendations guiding individuals through life stages from pregnancy through childhood, adolescence, mid-life and later life. Awareness of these comprehensive guidelines will assist patients in the prevention and diagnosis of serious diseases and other life challenges.

Philip Caravella, M.D., F.A.A.F.P., was the youngest president of The Cleveland Academy of Family Physicians when elected in 1980. He has been a Fellow of the American Academy of Family Physicians since the early 1980s, and he won the Max Gansloser Award for achievement and research in psychiatry awarded by St. Louis University School of Medicine. He has been a Diplomat of the American Board of Family Practice since 1975.

Dr. Caravella has practiced in many medical arenas, including military medicine, medical education, medical research, medical administration, physician recruitment, solo practice, group practice, and most recently as a full-time family physician with The Cleveland Clinic Foundation, the leading cardiac surgery center in the world.

In 1971, when working at The Cleveland Clinic in the department of hematology-oncology, Dr. Caravella was a member of the team under the direction of Dr. James Hewlitt that performed the first bone marrow transplant in the Midwest.

In his career as a family physician he has treated over 10,000 patients, delivered over 200 babies, assisted over 800 patients in quitting smoking, and is an expert in providing preventive health care services.

Dr. Caravella was at the forefront of family medicine education, becoming the first assistant director of the family medicine residency-training program at Fairview General Hospital in Cleveland, Ohio, during the 1970s. He later directed a family residency program at Riverside Hospital in Toledo, Ohio. He taught for years as an assistant clinical professor both at Case Western Reserve University in Cleveland and at the Medical College of Ohio in Toledo. He is a life member of Who s Who.

Dr. Caravella has experience in providing presentations on a variety of subjects to physicians, medical students, nurses, and the lay public. A local television station also interviewed him in 1998 for the Great American Smoke Out on effective methods of smoking cessation.

In 1980, Dr. Caravella received his favorite honor one given him by his family practice residents at Fairview Hospital. The residents created an award referred to as the Philip Caravella, M.D. Bedside Clinical Excellence Award to be given annually to the most deserving resident in family medicine upon graduation.

Dr. Caravella s publications include an article in The Ohio Family Physicians News and a commentary in Critical Issues in Family Practice.

The following example helps to illustrate some of the most common problems in the delivery of quality health care to patients. At 7:00 a.m. one Saturday morning, Linda Jenkins, suffering from severe abdominal pain and fearing appendicitis, called her childhood family doctor – whom she hadn’t seen in years. He directed her to a local emergency room. Linda, a 31-year-old patient, had been diagnosed six months earlier with a form of arthritis, but she was taking her medication only sporadically. Since she had recently started a new job, she had missed a follow-up office visit with her specialist and had also failed to reschedule the appointment. In addition, Linda had not taken time to familiarize herself with her new company’s health insurance plan.

After being admitted to the emergency room, she was asked to list her medications, but she could not recall any of them. Linda also could not adequately describe her symptoms. Since she was unfamiliar with how to present a medical problem, she could only provide a vague account of her discomfort. She had not seen a physician in years for a PAP test, and she was very uncomfortable with medical care in general. Lacking important information, the emergency room doctor ordered numerous tests and x-rays to assist in his diagnosis. The evaluation required four hours and added up to a tidy sum of money. Fortunately, the emergency room doctor reassured her that she did not have appendicitis. Unfortunately, the cause of her problem remained undiagnosed. Linda was sent home with a recommendation to see her primary care physician within two or three days.

Due to the unfriendliness of our health care system and Linda’s lack of knowledge, she was unwittingly involved in a long list of errors and mishaps that cost her $1,523.50, and to say nothing of the anger and resentment the incident caused her to have for the medical profession and the health care industry. None of this had to happen – not even the abdominal pain.

With foresight and planning, Linda could have avoided the following errors:

Now Linda is faced with the following problems:

Hopefully, after reading this book and following its recommendations, you will not be as likely to fall into the traps and misfortunes that confronted Linda.

There comes a time when some issues vital to the public interest have been ignored for so long that they beg to be addressed. The doctor-patient relationship, as well as the patient-insurance company-doctor triad, are two neglected areas that have demanded attention for a long time. It is intended that this book speak to a large group of people – to provide insight and data regarding health care relationships that all of us will sooner or later experience. An attempt is made to look at problems from a patient’s perspective, and to provide methods to address confusing or irritating issues that confront individuals when dealing with the health care system. The book will discuss common problems that occur repeatedly – albeit unintentionally – yet never seem to be resolved.

Several categories of patients will especially benefit from this book’s insight and methods. After reading this text, those of you who have rarely entered the health care system will be much better prepared to do so. Women, especially mothers and their children, will be aided with advice about how to work effectively with their physician. The elderly, too, will be more able to cope with the complexities of every day medical care. Those of you who are tired of sitting in waiting rooms and exam rooms will be given ideas about how to solve vexing issues of this sort. The confusion and issues revolving around generic drugs versus name brand drugs will be clarified. The selection of a first-class physician will be explored. Ways to effectively prepare for your office visit will be thoroughly detailed. We will look at the important difference between an allergic drug reaction versus a side effect. Confusion between these two different problems may result in success or failure in the management of your medical problem and could even mean the difference between life and death. Your medical record and how to reveal its secrets will also be explored. These are only a few carefully covered topics in this book. Answers to these and many other thought-provoking questions will provide comfort and security for those who will inevitably deal with the health care system.

Are you prepared to help your physician help you? If so, this book will be a valuable guide and reference book for any patient hoping to achieve high-quality health care without skipping a beat. When it comes to working with the health care industry nearly every patient struggles. This struggle is based partially on fear of the unknown, and partially on a lack of understanding of how the health care industry operates. Complicating the problem is the fact that some physicians lack the people skills necessary to deal effectively with their patients; they may consider themselves primarily scientists or researchers. Some physicians lack the social graces and warmth that typify professionals in the social services and religious ministries. As a result, they may appear cold, indifferent, aloof, or uncaring. In addition, many physicians are poor businessmen, unable to efficiently operate a medical office. This lack of sophistication sometimes shows itself by the employment of office personnel who are deficient in appropriate phone skills and people skills.

To further aggravate the situation, the managed care industry has reduced per-visit reimbursement and has instituted complex rules and regulations associated with prescription medications, referrals, and testing. To cover increasing costs, physicians have been forced to see more patients, shuffle more paperwork, and deal with many more business-related problems than ever before. This has led to crowded office schedules, long waits, and often dissatisfaction for patients well before they even see their physician.

Managed care programs usually require physicians on their panel to accept new patients who have chosen them – even when their practices are full or overloaded. This overflow can reach epic proportions during the winter months, when the flu season and infectious diseases are rampant. Patients often fail to visit with their new physician under serene circumstances; instead, they procrastinate until a crisis and then hope to be served by an already busy medical practice. When a new patient calls his or her physician’s office for the first time – hoping to be seen that day for treatment of an acute problem – they may be disappointed. Often they will be told that their doctor’s first available new patient appointment is one or two months down the road. Unfortunately, after hearing that troubling response, they have already gotten off on the wrong foot long before meeting their new primary care physician.

This is only the beginning of many problems that can and will occur if you are not prepared to deal with the complexities of receiving medical care. People expect their medical institutions to provide excellent care. A large multi-specialty health care center like The Cleveland Clinic Foundation, for instance, is proud of its role in providing the best of care to its diverse international patient population. With an emphasis on the latest in research and technology, The Cleveland Clinic provides "world class care" to its patients. Yet due to the complexities and nature of the business, such quality care does not happen by chance. The good news, however, is that world-class medical care is available to all who learn what is necessary to receive it. If you diligently follow the guidelines in this book, you will be in a better position to receive good, comprehensive health care.

This may sound like wishful thinking, but it is not. Like everything else in life, those who are well-prepared and well-organized will be successful in reaching their goals despite the disorganization inherent in the world around them. Being a good patient is an art form. You must attempt to understand the health care industry in order to be better prepared to work with your physician, to solve problems, and to receive good results. Few books describe the pitfalls of the health care system, and even fewer demonstrate how to fix the problems and successfully traverse the obstacle course of managed care. As you read, you will be provided with insight, methods and answers that will help you to receive the world-class health care you deserve.