It wasn’t long ago that the punditry in Washington, D.C., was declaring that you, the frustrated health-care consumer, were in control of the nation’s political future. Polls showed you were demanding legislation to protect against the worst instincts of money-hungry HMOs. And the talking heads were all predicting that the patients’ rights issue might decide many congressional races in this fall’s elections.
      After all that buildup, it must be disappointing to learn that Congress does not, in fact, consider you a potent political force. Not as compelling, it appears, as a certain political sex scandal. So the patients' rights bills that were supposed to bolster consumer power in the chaotic health-care system have dropped out of sight. Members of Congress dumped the issue and ran home to defend their seats.
       Where does that leave the consumer? On your own, at least until next year. But there's no sense waiting for Congress to act. The best strategy to avoid unpleasant run-ins with a system that isn't exactly user-friendly is to arm yourself with information and assertiveness.
       In fact, researchers are finding that patients have a lot more control than they think in encounters with doctors, hospitals and insurers. It's easy to subscribe to the traditional idea that medical professionals are authority figures who must not be questioned, and that insurers are impenetrable bureaucracies beyond our understanding and control. But neither of those ideas is really accurate. Doctors aren't paternalistic figures anymore, they are professionals whom we pay to provide a service for us, like lawyers or plumbers. And if you understand who's ultimately in charge of paying the bills, you can save a lot of time fighting with insurers and hone in on who's really calling the shots. If you get insurance from your employer, the buck ends at the personnel department. It's also possible that the physican group you see takes financial responsibility for patients and is making many of the decisions about what treatment it can afford to mete out under your health plan.
        Here are eight ways to keep on top of the system rather than having it land on you.

1.  Find a main health-care provider you like and trust.

Think about your main provider of health care, whether that's your primary care doctor, a nurse-practitioner or somebody else who regularly follows your care. Do they listen? Do they provide reliable advice and let you play a role in making treatment decisions? Can you get in to see them on short notice? If not, reconsider.           

2.  Know what kind of health plan you have.

Never mind the fancy initials. Does your doctor or health plan take on the financial responsibility for you staying healthy, and if so, do they seem to make decisions based on cost rather than quality?

3.  Plan ahead for doctor visits.

Before you see a doctor, write down your questions. Bring them to the examining room and make sure you get the answers you want — even if that means taking notes while you're wearing nothing but a paper gown. Share with your doctor what you have already done at home to treat the problem, if anything.

4.  Read your medical records.

Ask to see your medical charts occasionally, and especially before an operation or after a major medical event. Make sure the notes are accurate and that they don't mischaracterize what you've told the doctor. Remember that this is a document that will be shared with other medical professionals, and that's how they'll learn about you and your medical problems. And keep your own records at home of medical problems, doctor visits, prescriptions and other medical information.

5.  Take any medications as prescribed.

This is particularly true of antibiotics. If you have an unpleasant side effect that makes you want to stop, tell your doctor or pharmacist first.

6.  Give feedback to whomever is paying the insurance bill.

If you get insurance coverage from your employer, keep the human resources department apprised of your experiences with the health plan, both positive and negative. That's the best way to get the benefits and health plan that you want. If you have a gripe or a request for a new benefit, get together with colleagues at work and ask collectively.

7.  Don’t be gullible.

Just because some test or treatment is advertised in a magazine or discussed in an Internet chat room, don't believe everything you hear. Check it out with a few other sources. Ask your doctor, look at medical books in the library, search some of the reliable Web sites that rely on scientific study of medical care. And if you do try an alternative treatment, be sure to mention it to your doctor.

8.  Take care of yourself.

Prevention is usually easier and more pleasant than treating health problems.

                                         
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