Navigating the Health Care System

Advice Columns from Dr. Carolyn Clancy

Former AHRQ Director Carolyn Clancy, M.D., prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They address important issues such as how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan.

Today, we know a lot more about what health care quality means than we did just 10 years ago. As our knowledge of health care quality evolves, we are gaining a greater understanding of the types of treatments that work best for you and your family, whether it's for a serious disease, a chronic condition, or a common childhood illness.

But what, exactly, is health care quality? Here's an explanation that I find helpful:

To achieve the best possible results, health care quality is:

  • Doing the right thing (getting the medicines, tests, and counseling you need),
  • Doing it at the right time (when you need them), and
  • Doing it in the right way (with your health care providers using the appropriate test or procedure).

Sounds straightforward, right? But this well-accepted definition of health care quality does not always match the type of care that health care providers give and patients receive.

For example, ear infections are one of the most common reasons parents bring their children to the doctor's office. When their children have ear pain and fever, many parents expect to receive a prescription for an antibiotic.

But we now know that over 80 percent of children with ear infections get better within 3 days without antibiotics. This is largely because most ear infections are caused by germs that do not respond to antibiotics. We also know that prescribing antibiotics too often can make the bacteria that cause some ear infections resistant to these medications. This means the antibiotics can't work effectively.

As a result of these factors, physicians have developed guidelines to limit antibiotic use for ear infections so they are given only when they are most needed. In the majority of cases, treating an ear infection with acetaminophen or ibuprofen treats the symptoms of ear infections while the child's body cures the infection.

Based on this example, it's clear that getting a prescription for an antibiotic to treat an ear infection isn't always the best treatment, even though it seems like it might be.

It also shows that getting high-quality health care depends on striking a balance in the tests and medicines that you receive. Specifically, this means that the services you receive should:

  • Avoid underuse (not receiving screenings that all adults should get, like for high blood pressure).
  • Avoid overuse (getting tests that you don't need or that may cause you harm).
  • Eliminate misuse (making sure that prescribed medications don't have dangerous interactions).

You might wonder how you, as one individual, can ensure that you and your family receive high-quality health care. After all, many of the experiences we have with hospitals and the health care system come at a time when we are most worried about our health or the health of our loved ones. Questions about the quality of the services we're about to receive are generally not what we are concerned about at that moment.

To help you in these situations, the Agency for Healthcare Research and Quality (AHRQ) has developed a tool to help you know what questions to ask the next time you visit your doctor, pharmacy, or hospital.

For example, if you are scheduled to undergo a medical test, here are some of the questions you might ask:

  • What is the test for?
  • How is the test done?
  • What are the benefits and risks of having this test?
  • When will I get the results?
  • What will the results tell me?

Check our Web site: for more information on how to build your own list of questions for your next medical appointment.

We have come a long way in understanding what health care quality is—and what it isn't. Asking questions the next time you visit your doctor, pharmacy, or hospital is an important way to help ensure that you and your family receive high-quality health care.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.

More Information

AHRQ Podcast
How to Spot High Quality Health Care (Transcript)

AHRQ Web Site: Question Builder
Create a personalized list of questions for your next visit with your health care clinician or pharmacist.
http://www.ahrq.gov/questions/qb/

AHRQ Audio Newscast
Listen to an overview of what health care quality is and what you can do to get better care from your doctor.
http://healthcare411.ahrq.gov/radiocastseg.aspx?id=614&type=seg

Current as of October 2007
Internet Citation: Recognizing High-Quality Health Care. October 2007. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/columns/navigating-the-health-care-system/101607.html