Ask Me Three and Getting Answers

Many medical librarians and health care providers are familiar with the AMA’s Ask Me Three program (http://www.npsf.org/askme3/) :

• What is my main problem?
• What do I need to do?
• Why is it important for me to do this?

There have been a couple of studies demonstrating that doctors had better be asked, because they will neglect to tell you!

“The Quality of Ambulatory Care Delivered to Children in the United States” NEJM 11 Oct 2007; 357(15):151-1523.  http://content.nejm.org/cgi/content/abstract/357/15/1515

“The Quality of Health Care Delivered to Adults in the United States” NEJM 26 Jun 2003;348(26):2635-2645.  http://content.nejm.org/cgi/content/abstract/348/26/2635

 This reflects my own experience.  If I present with a problem (which doctors are trained to characterize as a “chief complaint” thereby branding the patient as the “complainer”) I can expect the doctor to order lots of tests, and perhaps tell me the results of the tests, but not to tell me what those results mean for me as an individual and certainly not what I can do for my problem.  I have friends who have dutifully gone to doctors, only to ultimately develop their own treatment plans for restless legs, or back pain, or asthma, because the doctors seemed to lose interest before telling the patient what to do.  They came to the library or the Internet or other friends and worked it out themselves.  I am challenging myself to always ask these three questions and not to leave the exam room until the doctor gives me some kind of an answer.  How about you?

Navigating the health care system

Have you ever wondered how people with language and literacy barriers, time management problems, or a lack of sheer determination ever manage to make appointments and follow doctors’ instructions?  I was recently referred to a specialist, whose office sent me a hefty package of information and “chores” to perform in advance of the appointment.  One of the chores was to bring copies of any lab tests, x-rays, etc. that had been done in the previous year.  Is this a simple request?  Apparently not.  In our fragmented health care system, one is sent all over the place to separate offices for each annual screening exam, for lab tests, etc.  You can try to track down the phone numbers of the various places you have been, and then you can work your way through the automated phone tree (“press one if you wish you could speak to an actual person”).  Then you ask for copies of your own medical records, which you should be able to access.  You have to appear at a particular place between the hours of 9 AM and 5 PM (when you are at work) to sign a form, or perhaps you will be allowed to fax in your request, or perhaps they will insist that your referring doctor must request the records to be sent directly to your specialist because they would rather you didn’t handle your own records yourself.  Every office has a different story. 

How many doctors have told patients to go get some sort of screening exam without writing down the name of the exam or telling the patient where they have to get the exam or reminding the patient to call first and find out if they take his or her insurance?  As a consumer health librarian, I can help someone understand what a mammogram or a colonoscopy is, and I can help the patient locate providers in the area who provide that exam, but so many people have no clue, and they don’t ask the librarian, either.  I suspect that oftentimes, they just don’t know how to proceed, so they don’t get the exam.