Healthcare Choices: 5 Steps to Getting the Medical Care You Want and Need

Book Title: Healthcare Choices: 5 Steps to Getting the Medical Care You Want and Need

Book Author: Archelle Georgiou

Publication Information: Lanham, MD, Rowman & Littlefield, 2017, 193 pp., $35, hardcover

Archelle Georgiou, MD’s book is outstanding. Her background as a former chief medical officer for United Healthcare and her mission to educate consumers on health care resulted in the CARES model, which is the framework for Healthcare Choices: 5 Steps to Getting the Medical Care You Want and Need, her first book. CARES translates to: Understand your Condition, know your Alternatives, Respect your preferences, Evaluate your options, and Start taking action. She emphasizes that health care consumers cannot be passive bystanders in their own care—the health care industry is geared to say “no.” Individuals must be prepared to be actively involved in their own care or the care of individuals they are responsible for.

From a lay educator perspective, Dr Georgiou is the on-camera medical expert for KSTP-TV in St Paul, Minnesota, and has an active Facebook page where she answers real-life health-related questions. She uses those roles throughout the book to frame actual consumer questions with the appropriate actions to take using the CARES model. For every chapter and every issue discussed, she hammers home her point using the model to walk consumers through a step-by-step process, making it very easy to follow the logic and rationale for options in simple language. Dr Georgiou’s role as an industry advisor for the Medical Industry Leadership Institute at the University of Minnesota’s Carlson School of Management, where she serves as an executive in residence, gives her credibility with clinicians and university faculty.

The book covers a wide range of topics and practical tips, ranging from how to address your doctor in conversations that establish a level playing field, to recommendations for the best online layperson medical resource for many conditions (mayoclinic.org). A key point is the importance of being objective and learning evidence-based facts instead of allowing decisions to be colored by perception. For example, when discussing options for breast cancer treatment, a patient might choose an option that worked for a friend of theirs because it sounds familiar and makes them feel comfortable, instead of an unfamiliar option that may be a better choice for their individual health condition.

Chapter 6, “Aging With Control” is of particular interest. Utilizing the CARES model, she provides information about dementia and end-of-life care as an example of understanding one’s condition. This includes an interesting discussion of the effects of ageism, beginning with how older adults allow themselves to be negatively addressed, effectively making them unable to express their preferences or have their preferences respected. The passage on understanding the alternatives (p 97) will be an eye opener for many older adults who believe “my family will take care of me” or “I can rely on Medicare or Medicaid for help.” A discussion of residential options, costs, and other pros and cons provides an opening for caregivers and clinicians to initiate conversations with older adults about living arrangements.

Also interesting is chapter 7, “Selecting Your Healthcare A-Team,” which includes a tip for phrasing a request for a second opinion as a desire to obtain a consultation. Consultations are perceived positively by clinicians as consumers seeking information and options. Second opinions are often perceived as unhappy patients possibly seeking to place blame. The key take-home point for this chapter is the importance of patients maintaining their own copies of medical records instead of relying on doctors or organizations sharing information. “The fastest, cheapest, and most efficient way to assure that every doctor has access to all your records is to give them a comprehensive set yourself” (p 132).

Chapter 8, “Powershopping for Health Insurance,” drives home the importance of health care navigators who can help consumers choose the right insurance plan for their needs and budgets. This book was written before the current administration began dismantling Obamacare support services, when health care navigators were available to assist with decision making. For those who have employer-provided insurance with a choice of two plans, or for those who need to purchase their own plan on a health insurance exchange, it can be equally confusing and frustrating. Dr Georgiou cites a 2013 study finding only one in seven Americans understands the basic components of a health insurance plan.¹

Chapter 10 provides a summary of CARES models for a quick reference, but each chapter is a wealth of information, easily read and understood. The framework and tools are practical and easily implemented, but need to be taught to and practiced by individual health care consumers.

As a medical professional with 39 years of experience dealing with multiple family medical issues, I approached this review with a healthy dose of skepticism and doubt that any book intended for the public could actually help navigate the mess that our health care system has become. I was wrong. This book is an easy read for consumers and clinicians, offers excellent advice, and would make a wonderful textbook for an introductory course on effective health care decision making for a wide variety of audiences.