Controlling health care costs

Rising health care and health insurance costs disproportionately affect small business owners, including many veterinarians. In fact, it is estimated that state regulations that restrict access to health care insurance coverage disenfranchise more than 200,000 members of the veterinary community. Veterinarians thus have a special interest in controlling health care costs. One way to accomplish this while still ensuring that one receives the best possible medical care is to be proactive about keeping track of medical records.

"The more information we have, the better," said Marie Savard, MD, an internationally known internist, patient's rights champion, and former associate professor at the Medical College of Pennsylvania-Hahnemann. Dr. Savard spoke at a Personal and Professional Development session at this year's AVMA Annual Convention.

Dr. Savard recommends that individuals carry in their wallet or purse a foldable card containing a summary of their health history. The card should contain a list of their allergies and medical conditions and any medications, vitamins, and supplements they are currently taking. It should also contain the results of routine tests and procedures performed, the dates of any vaccinations and blood tests they have received, and a list of medical conditions in their family. Individuals who have undergone specialized tests, such as electrocardiography, should also carry these results with them. Some people may contend they have all this information in their head, but as Dr. Savard asked, "What good is that information if you are unconscious?"

Dr. Savard also recommends keeping a complete set of detailed medical records, suggesting that keeping thorough medical records will not only save money but also ensure that one receives the best medical care.

Electronic personal health records are in our future, but for the most part, they are not available now. "We need to (manually) carry our physical records to our doctors," Dr. Savard said.

Collecting this information is easy if patients obtain copies of their records after every medical appointment. "If you get your records as you go and you give your doctor a self-addressed, stamped envelope, nobody is going to charge you," Dr. Savard said. You are ethically and legally entitled to the information in your medical records.

Individuals should retain copies of any procedure or pathology reports, and, when hospitalized, discharge summaries. "It's not good enough to know that a test result is OK," said Dr. Savard, recounting the story of a woman who may have saved her husband's life by retaining copies of his medical information. The woman had been collecting records of her husband's prostate-specific antigen test results, and when she noticed a sudden increase in the levels, she encouraged her husband to inquire about them. The test results were still within reference limits, and her husband's doctor, therefore, had not recognized a problem. The increase, however, turned out to be a sign of early prostate disease.

Dr. Savard also related the story of a woman who did not keep track of her medical records and suffered a costly medical error as a result. "She said to me that when she went [to her doctor] this past January, the doctor looked up at her and said, 'Your Pap test was abnormal last year ... didn't you get our letter?'" Dr. Savard said. "He sent a letter saying, 'please call us,' and she didn't get the letter."

As a result, the woman's cervical cancer had progressed, and she had to undergo a hysterectomy. Caught earlier, the cancer would have necessitated only a minor procedure. If the woman had been collecting her records, she likely would have followed up with her doctor and possibly avoided major surgery.

Dr. Savard is also a proponent of bringing a "health buddy" to important doctors' appointments. This person can help take notes and keep track of details that a frazzled patient may miss.

Veterinarians should not only look out for themselves, they should encourage their employees to do the same for their own health. Not only will this help improve employee health, it will help keep health insurance policies affordable.

While Dr. Savard's talk focused on improving health care for humans, she suggested that the same steps could improve the health of pets. Pet owners who keep complete medical records are better able to participate in the health care of their pets, particularly when they go through a major life change, such as moving to a new locale.