"Listen to Me, Doctor" Taking Charge of Your Own Health Care by Marti Ann Schwartz. MacMurray & Beck, Aspen, CO, 172 pages, 1995.

Marti Ann Schwartz, a self-styled "consummate consumer" came by her knowledge and understanding of the health care marketplace the hard way - she was diagnosed with Hodgkinís disease during the fifth month of her first pregnancy. Following her successful management of this personal crisis, her doctor, family and friends urged her to take up consumer advocacy, and since that time she has offered seminars for those seeking guidance in managing their health care.

Her book, doubtless patterned after her successful seminar series, is a practical, plain speaking guide which offers potential patients three simple rules to live by in order to obtain the most and the best for their health care dollar. It is a quick course in assertiveness training for the average adult who is used accepting the arcane ministrations of todayís high tech medical community without question or complaint. (She is obviously opinionated in this matter of fact "how-to" guide, but not hostile or unfair.)

Her rules are these: 1)we are health care consumers; 2) work with the doctor as a team to get the quality care you need; and 3) medicine is a business. She orients the consumer to the medical marketplace - insurance companies, hospitals, drug companies, doctors - and briefly explores the motivations of these very different players in the game, even to the extent of explaining why hospitals charge patients up to ten times what an item costs them. (At this stage, this begins to look like a "must read" book.) Then she gives a run down on how to apply her three rules to every aspect of the health care process.

Her chapter on doctors tells readers more about us than we, as physicians, might know about ourselves and what we are about. She explains how to choose the best doctor and what makes a good doctor. ("Turning pages" now becomes more important than sleeping.) One important "donít": NEVER choose a doctor from the yellow pages. She recommends that if you don't have a good relationship with your doctor, change doctors, and then offers twelve reasons to change doctors: you receive "poor-quality" care; you have a poor relationship with your doctor; your doctor displays a lack of interest, exhibits rude behavior, has a bad attitude, doesn't take enough time with you, is unwilling to discuss the diagnosis fully, ignores your concerns, loses your trust, objects to your seeking a second opinion, leaves practice, or retires. (Ouch! That smarts!)

In succeeding chapters she explores other members of the health care team, saving money (some great little tidbits of advice here - these alone are well worth the price of the book), womenís health care, menís health care, senior health care, and childrenís health care. She adds a chapter of caveats - beware of managed care, self-diagnosis and over the counter remedies, direct mail solicitations, and violations of privacy. And she wraps it up with a quick look at the future of health care.

In all, this is a worthwhile investment of the time you will spend to read it, if for no other reason than to gain insight about how our profession and our market sector is perceived by a savvy consumer. It could certainly empower the average patient, and thatís not necessarily a bad thing. Once patients become active players on the health care team, the insurance industry may eventually be forced to give them the full measure of what they are paying for.