Taking control of care

Every year in the United States, an estimated 400,000 people die from preventable medical errors.

When Leslie D. Michelson cites that figure, he - like many patient-safety experts - translates it into aviation terms.

"That's the equivalent of two fully loaded jumbo jets crashing every single day with no survivors," he says.

Michelson had an early start in helping prevent medical errors. He was a teenager when his father came home one day and announced his physician had told him he needed open-heart surgery or he would die. The boy couldn't believe it. So he called the only hospital he knew of and asked to speak to the head of cardiology. He made his father an appointment for a second opinion, which turned out to be that the surgery was not necessary.

His father died 40 years later from a completely unrelated cause.

Statistics and incidents like that led Michelson, who lives in Los Angeles, to form Private Health Management, a company aimed at helping patients find the best medical care possible.

To bring the lessons he's learned to a broader audience, Michelson wrote The Patient's Playbook: How to Save Your Life and the Lives of Those You Love, published this month. He'll talk about it with former Gov. Ed Rendell at a public forum at the Free Library of Philadelphia at 7:30 p.m. Thursday.

Recently, he shared a preview with us.

Why did you write this book? What problems are you trying to address?

We live in a perilous and an opportune time if you happen to get sick. It's perilous because few people realize that preventable medical error is the third-leading cause of death in the U.S., right behind heart disease and cancer. The opportune side is that biomedical research is proceeding at a far more rapid pace than anyone has ever thought possible. So for the first time in history, if you're diagnosed with a serious condition, and you can figure out how to keep that condition at bay for a while, there's a reasonable chance that a fundamentally better treatment will be developed. People in Philadelphia are lucky because this is where a great amount of work in developing those new treatments is happening. You have access to world-leading expert physicians at the city's academic medical centers.

The health-care system is under such extraordinary stress right now. Physicians and nurses - all hardworking and dedicated - just don't have the time and resources they'd like to invest in getting patients the best care. It's become so complex. So it's essential to learn how to become a more effective consumer of medical care.

I've seen the difference it can make. First of all, you'll be more confident. You'll learn how to select the right physicians. You'll make better treatment choices. You'll have less ambling around from physician to physician and test to test. You'll get better outcomes. And you'll lead a longer and healthier life.

You say that everything starts with your primary care physician. What makes a good one?

Five things.

The first is that they have to be someone with whom you have a personal relationship. You kind of feel that chemistry where they're listening to you and you're listening to them and there's a sense of trust.

Their office needs to be organized. There's so much information that goes back and forth in a primary care practice, and because of the pressures to do more with less, balls get dropped. Data show that 8 percent of significant medical findings never get reported back to the patient.

Your primary care physician should help you identify specialists if you develop a significant issue.

Your primary care physician should help coordinate across specialists when you have a complex problem. For example, if you have heart disease and you've been diagnosed with breast cancer, there's going to need to be a lot of coordination among your breast cancer surgeon, your radiation oncologist, and your medical oncologist as well as your cardiologist.

Lastly, your physician needs to support your wellness goals. If you're a little prone to high cholesterol or high blood pressure and you want to try and manage those without medication or with a minimum amount of medication, we all know that you can do that with changing your diet and improving your exercise regimen. You want a physician who is going to help guide you to do that.

What's the best way to pick a primary care physician?

Step one is to create a list of things you think are important. Step two, ask friends, family members, and physicians you like who they would suggest and why. Step three, make appointments and interview the physicians. I know that sounds odd. But you would do it in every other important realm of your life - if you need a babysitter, if you're picking a school, a lawyer. I would submit that your physician is arguably the more important professional in your life. If they won't do the interview the way you like, the next time you have a cough or a cold or a rash, you go and incorporate the interview into that appointment.

We often focus on physician mistakes. What are common patient mistakes?

They don't ensure their physicians are fully informed about all of the aspects of their health. For example, if you're taking certain supplements, the doctor needs to know that, because that might influence the way in which you metabolize certain medications.

Another mistake patients make is not going to specialists with deep experience and expertise in exactly what they have. If you have prostate cancer, instead of a urologist who does 10 to 20 surgeries a year, go to someone who in aggregate has done 1,500.

In your book, you name three things someone can do right now to be better prepared if a serious illness should strike. What are they?

First, document your family medical history. We're learning more and more that your inherited genetics are an important determinant of your health status and your health risks. So it's more important than ever to know what diseases your grandparents and aunts and uncles had, and what they died of.

Second, collect your own medical records. Most people, particularly people who are a little on in years, have been to many different physicians. It's really important to have all your medical records compiled in one place and readily available. I have mine in my wallet, on a memory stick that sits on a piece of plastic the size and shape of a credit card. I have it with me all the time because I travel a lot and I want everybody to have my medical records.

Third, create what I call a medical inventory and keep it with you. It should include key things about you: Who are you? Who is the emergency contact? What diagnoses do you have? What medications are you on? List any allergies. List your physicians and include information about your health insurance. So if the God-forbid happens - you fall down the steps, you get hit by a car, you faint, you choke in a restaurant, all that stuff happens - it's so much easier to have all that information available.