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Healthcare Choices
 Healthcare Choices

5 Steps to Getting the Medical Care You Want and

Need

Archelle Georgiou, MD

ROWMAN & LITTLEFIELD

Lanham • Boulder • New York • London
Published by Rowman & Littlefield
A wholly owned subsidiary of The Rowman & Littlefield Publishing Group, Inc.
4501 Forbes Boulevard, Suite 200, Lanham, Maryland 20706
www.rowman.com

Unit A, Whitacre Mews, 26-34 Stannary Street, London SE11 4AB

Copyright © 2017 by Archelle Georgiou

All rights reserved. No part of this book may be reproduced in any form or by any electronic or
mechanical means, including information storage and retrieval systems, without written permission
from the publisher, except by a reviewer who may quote passages in a review.

British Library Cataloguing in Publication Information Available

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ISBN: 978-1-4422-6033-7 (cloth : alk. paper)

ISBN: 978-1-4422-6034-4 (electronic)

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Printed in the United States of America

For my mom—my ongoing source of courage
and determination
 Foreword

Dan Buettner
Not long ago, I returned from Central America with a scorching lung
infection that left me listless and scared. Was it ZIKA virus, tuberculosis, or
just the flu? I pondered a trip to the emergency room, but opted instead to
lean on my many contacts in the healthcare industry to find a good doctor.
One of the country’s most famous cardiologists made a call to the Mayo
Clinic to get me a lung specialist. Mayo’s scheduler called me immediately,
but that call just led to six more phone calls and then a dead end. Another
influential friend connected me with a local specialist who, I discovered
after an hour on the phone, only sees hospitalized patients. Yet another
friend connected me with the University of Minnesota. They assured me
that they could get me an appointment with their top pulmonologist—in
three months.
Finally, after three weeks of failed attempts to get the care I needed
and gasping for breath, I called Dr. Archelle Georgiou. She introduced me
to CARES, the step-by-step formula she has created to help anyone
evaluate their medical options and select the healthcare treatment best for
them.
America’s healthcare system is impossibly complex; it’s based on a
pay-for-services rather than a pay-for-cure model. Thousands of
disconnected providers all vie for their share of the pie. Meanwhile, those
of us who get sick or injured are faced with navigating a Byzantine system
that often favors the bottom line over a patient’s well-being. As the former
CEO of one of the country’s health insurance companies once told me,
“We’re in the business of saying no.”
So our journey to getting better often begins with finding someone to
say yes—and that “yes” has to come from the right provider who knows
how to diagnose and treat your problem and do so effectively. A misstep
along the way can result in no care, insufficient care, or, even worse, care
that leaves you worse off than when you started. And stuck with a huge
bill.
That’s why we need this book.
 Archelle’s CARES model taught me how to take charge of my own
healthcare. Her formula is based on five key steps: Understand Your
Condition, Know Your Alternatives, Respect Your Preferences, Evaluate
Your Options, and Start Taking Action to follow through on your healthcare
decisions. Her book explained exactly how to gather accurate medical
information about my lung condition and how to choose the best doctor
for my care. She directed me to a number of publicly available websites to
find a highly rated doctor who could treat my infection. She reminded me
that you often have to advocate for the care you need. Her CARES formula
ultimately put me on my path to a diagnosis and treatment by starting with
a step I had completely overlooked: to call my primary care physician (who
got me into a specialist the next day).
I cannot think of a more qualified healthcare expert than Archelle.
During the decade that I’ve known her, she has served as the Chief Medical
Officer of one of the nation’s largest healthcare insurers. She has been an
advisor to a prominent U.S. congressman, and literally millions of viewers
know her in her role as the polished, uber-informed medical
correspondent for KSTP-TV Eyewitness News. In 2008, Archelle joined my
National Geographic team to identify and explore one of the world’s
longest-lived areas—the so-called Blue Zone of Ikaria, Greece. There I saw
her put her research, communication, and medical skills to work for a
national audience. When our CNN cameraman lost his footing and
plummeted from a cliff, smashing his head on the rocks below, she coolly
took charge of his care. She administered first aid, oversaw his airlift to
Athens, got him into the right hospital with the right surgeon, and, sixteen
hours later, miraculously got him into the intensive care unit after we were
told there were no available beds. Her efforts saved his life.
Not everyone is as lucky as I am—I have Archelle’s number
programmed into my cell phone when I have a medical question. But you
do have her book. Read it now and keep it on hand. I can assure you that
the time will come when your health, or the health of someone you love,
will take a turn for the worse. When it’s your turn to find your way through
the maze that is our healthcare system, Archelle’s CARES formula is the
guide you’ll use to get to the care you need.
Dan Buettner
 National Geographic Fellow and author of the New York Times
bestsellers The Blue Zones and Blue Zones Solution
 Acknowledgments

One of the most important lessons I’ve learned during my career is that
accomplishments are never an “I” but a “we.” While this book is authored
under my name, there are countless family members, friends, and
colleagues who inspired me, encouraged me, trusted me, and put up with
me to help me get this book out of my brain and my heart and into print.
I would not have the experience to write this book had it not been for
the people who believed in me early in my career. Dr. Bill McGuire,
Jeannine Rivet, and Dr. Lee Newcomer understood and shared my passion
for making the healthcare system easier for patients to navigate. They gave
me the professional opportunity of a lifetime at UnitedHealth Group.
Thank you for having my back while we led a tumultuous sea change in the
industry.
In my consulting work, I have been privileged to work with executives,
innovators, clinicians, entrepreneurs, and explorers who have expanded
my thinking about how to make health better and healthcare easier. I was
honored to work in the Center for Health Transformation with former
Speaker of the House of Representatives Newt Gingrich. Steve Bonner,
former CEO of Cancer Treatment Centers of America, challenged my
traditional medical mindset and introduced me to the power of evidence-
based complementary and alternative medicine. Roger Holstein, former
CEO of Healthgrades, ignited my deep belief that with the right tools,
consumers can do the research to get to the best specialist.
Once I made a commitment to writing this book, there were very
special individuals who joined the journey with me. Thank you to my
agent, Helen Zimmerman, for reading my sixty-page book proposal cover
to cover before our first conversation. She saw the importance of this book
because she too shares a passion for improving health and healthcare. To
Suzanne Staszak-Silva and Rowman & Littlefield, thank you for giving me a
chance as a first-time author. Marian Deegan, my editor, brilliantly
maintained my voice and intention in the writing but wasn’t shy about
challenging my ideas. Her quiet strength kept me accountable and
confident that I’d get the manuscript done by the deadline. I absolutely
could not have completed this book without her. Finally, Peter Robson gave
me an open invitation to brainstorm with him. His was my right brain in
this writing endeavor.
My husband, David, has been my rock for the last twenty-eight years.
He’s encouraged me to push myself to a level that I never dreamed was
possible. My daughters––Arielle, Athena, and Zoe—gave me the
confidence to write this book. They remind me, as I remind them, that
there’s nothing that I can’t achieve.
Finally, the unsung heroes of this book are the television viewers in
Minneapolis and Saint Paul who chat with me on Facebook after my news
segments. Their weekly questions keep me in touch with the real
challenges that real people face in our healthcare system. Only a fraction
of their questions are included in these pages, but each and every one is
important. They remind me that I am, first and foremost, a doctor.
 Chapter 1
The Journey from Healthcare to Health
If you are reading this book, you are looking for tools to make better
choices for your health. You are not alone. Making healthcare decisions is
hard—even for medical professionals. In an ideal world, you would sit
down with the doctor best qualified to treat your condition and talk about
your concerns, share information, discuss options and preferences, and
agree on a treatment plan designed for you. This shared decision-making
process is the goal of both consumers and healthcare professionals, but it
is challenging to achieve.
The majority of people’s healthcare decisions do not reflect this
collaborative model, and restructuring the complexity of the healthcare
system to achieve this ideal state is beyond the scope of any one person.
However, each of you does have the power to participate in the decision-
making process for your own health. The CARES model is a guided
approach I developed to help my family and friends make medical
decisions that balance the best medical treatments available with their
personal priorities and preferences. This book allows me to share the
model and the tools with you so that you too can get the healthcare you
want, need, and deserve.

LESSONS FROM IKARIA

In 2009, my career reflected a breadth of medical, insurance, and media
experience as a healthcare advocate. I’d been a practicing physician, the
chief medical officer for the country’s largest health insurer, a consultant to
healthcare businesses, a member of the media reporting on health issues,
and, last (but certainly not least), the mother of three young women and
the wife of an actively practicing gastroenterologist.
However, the passion and defining experiences captured in this book
unfolded on the tiny island of Ikaria. On this windswept, ninety-eight-
square-mile Greek refuge in the northern Aegean Sea, a population of
about 8,500 inhabitants live in homes camouflaged to protect them from
the pirates of days gone by. Over the centuries, Ikarians had mysteriously
developed a lifestyle that protected them from the ravages of old age as
well as rapacious raids by buccaneers. In April 2009, explorer and
bestselling author Dan Buettner, with funding from the National
Geographic Expeditions Council and the National Institute on Aging, asked
me to join him on an international research trip to identify “Blue Zones,”
small pockets of communities populated with an exceptionally high
percentage of people living to one hundred years of age or more. Dan had
already explored four other Blue Zones; Ikaria was the final stop. I was
intrigued. My Greek heritage and my passion for improving healthcare
could not resist an opportunity to explore clues to longevity in a country
that I considered a second home.
In Ikaria, we joked that “people forget to die.” The islanders live into
their nineties at several times the rate of Americans. Ikarians had
significantly lower instances of cancer, cardiovascular disease, and diabetes
—during our trip, we met only one individual with even a hint of dementia.
[1]
The lifestyle findings we identified in Ikaria were fascinating, and
consistent with Dan’s observations in Okinawa, Japan; Sardinia, Italy;
Nicoya, Costa Rica; and Loma Linda, California. Ikarians eat a plant-based
diet, and virtually everything served at their tables comes from their own
garden because importing food to this outlying island is expensive and
unpredictable. They also “move naturally,” as Dan says. Ikarians don’t go to
the gym; they get a good workout simply by walking the rugged terrain
during their daily activities. However, their longevity secret goes beyond
diet and exercise. Ikarians maintain a sense of purpose. They don’t retire—
they rewire and maintain responsibilities on their family farms well into old
age. Finally, these generous hospitable islanders remain actively connected
to friends and family.
For a Johns Hopkins–trained physician, these observations alone
would have been enough to open my eyes to a broader definition of what
it means to be healthy. But a specific and dramatic event brought my
Ikarian experience into focus and shaped my current view about the
difference between health and healthcare. During our two-week stay, our
activities were being filmed for a series of live satellite interviews with
CNN’s Anderson Cooper. Our Greek videographer, Emmanuel Tambakakis,
was superb, and had earned an international reputation for doing
whatever it took to get the perfect shot. One of our last shoots took place
in thermal waters at the base of a steep rocky cliff. Emmanuel found his
perfect shot looking down from the edge of the cliff. While setting up the
camera and satellite cables, the ground beneath his feet crumbled. He lost
his balance and fell, smashing against boulders and tumbling fifty feet to
the middle of the cliff face. From the beach, I heard screams for help from
Dan and our satellite technician and sprinted up the precipice to reach
Emmanuel. He was unconscious when I reached him. His face was smeared
with blood and rocks; his eyelids were blue and swollen. As I carefully
checked to see whether he had a pulse and was breathing, I noticed a
trickle of clear fluid from his left ear. This was a telltale sign of an epidural
hematoma—an accumulation of blood between the brain and the skull
caused by a ruptured artery. To survive, Emmanuel needed emergency
treatment within hours.
Ikaria had no hospital or emergency room. The most advanced
technology on the island was an x-ray machine. For emergencies like this,
people are transported via helicopter to Samos, the neighboring island,
and then flown to Athens for hospital care. It was dusk, and too dark to
safely make the thirty-minute jump to Samos. The Greek medical
evacuation system was paralyzed by its own bureaucracy, and there were
no commercial flights to Athens until morning. Emmanuel was dying.
Fortunately for Emmanuel, he had a resource that Ikarians do not: the
power and international influence of CNN. Our contacts at the network’s
Atlanta-based office responded to our call, communicating and
coordinating Emmanuel’s care nonstop for thirty-six hours. As I sat on the
hillside beside my unconscious friend, our producer handed me the phone
and I found myself talking to one of the top neurosurgeons in the United
States who coached me through the steps I needed to take to stabilize
Emmanuel. CNN convinced the Greek government to send a jet to Ikaria
and a C-27J Spartan military plane arrived two hours later. Emmanuel
underwent life-saving emergency neurosurgery in Athens that night.
Thanks to the heroic efforts and persuasive global connections of our CNN
team, Emmanuel made a full recovery.
In the weeks and months following, I found myself replaying the
accident and my own emotional reactions to it. I was frightened—and
confused. What would happen if an Ikarian fell from that cliff, without
access to CNN resources? Death was almost a foregone conclusion. How
did the Ikarians have such extraordinary health, as evidenced by their
longevity, in the absence of a sophisticated healthcare system? The island
had probably lost a good number of people to traumatic injuries, yet the
island’s overall health statistics far exceeded those of Americans with
access to the most advanced medical resources. For the first time in my
career, I realized that health and healthcare are not synonymous.
This insight took me beyond Dan’s published findings that diet,
exercise, purpose, and family/social connections can stretch one’s years. As
a physician steeped in my Greek heritage, I came to my own hypothesis
about Ikarian longevity: Ikarians have health without advanced healthcare
because they have been forced to be self-reliant and look first to
themselves—not a doctor—for care. When they have a twinge of pain or a
bothersome symptom, Ikarians’ first instinct is to patiently trust their
body’s self-healing ability. A common expression on the island is “tha
perasi” or “it will pass.” When ailments persist, they try “indigenous” home
remedies. Skin rash? Take a dip in the sea. Stomachache? Drink an herbal
tea. Knee pain? Apply warm towels and avoid walking uphill.
Worrisome or persistent symptoms typically prompt Ikarians to pop in
and visit the local pharmacist for advice before they consult a doctor—a
clinic visit with the area’s sole primary care doctor can be a daylong ordeal.
[2]
Ikarians’ self-reliance continues even while they are under the doctor’s
care. The primary care physician currently assigned to western Ikaria told
me that Ikarians adhere to their treatment plan and are 90 to 100 percent
compliant with their prescription medications. Their motivation? Avoiding
a trip to Athens for more advanced care. When Ikarians face a decision
about treatment for a serious illness, they discuss and weigh all their
options—they know that surgery or other advanced care will require
significant time, cost, and complex logistics. Geographic isolation has
forced Ikarians to actively participate in decisions regarding their health.
I am struck by the contrast between the Ikarian approach to
healthcare and the culture of care in the United States. Americans, in
general, are far from self-reliant when it comes to their health. I will boldly
go further and describe our nation’s approach to care as passively
dependent. When Americans experience something that just “doesn’t feel
right,” the reflex behavior is to see a doctor who can “find it and fix it.”
According to a 2012 survey by the Centers for Disease Control, there were
almost one billon physician office visits in the United States in a single year.
[3]
The most common reason for an office visit? Cough. When I’ve asked
people why they sought medical advice for common cold symptoms, the
usual response is, “I just wanted to make sure that I wasn’t missing
anything since I’m not a doctor.” Ikarians do not presume to have the
knowledge of a physician, but they do have the self-confidence to make
choices about when to get care, where to get care, and what care they
prefer. Americans, on the other hand, tend to lack this self-confidence.
They depend on medical professionals, passively ceding control of their
healthcare decisions to doctors, insurers, hospitals, and other authorities
within the system.
My observations in Ikaria brought me to the belief that there is a
better way to achieve health in America—without moving to a remote
island, living a rustic lifestyle, and growing your own food. You can achieve
better health by replacing passive “fix me” behaviors with self-reliant ones
—new habits that keep you actively involved in your own care. New habits
require new tools.
I am encouraging you to make a significant change in the way you
approach your own health and healthcare. I realize that cultivating new
habits is no easy task, and committing to change is not easy. This is why I
would like to share with you my own journey through change that starts
with the stories of my immigrant family’s determination to make a better
life. Their courage inspired me, as I hope it will inspire you.

November 8 has always been a special day. It was my father’s

nameday, and in Greek families, namedays are more important than
birthdays. In our very traditional home, this meant an annual open house
for my dad, complete with mountains of stuffed grape leaves, platters of
triangle-shaped cheese pies, and trays of honey-drenched baklava. The
party was also an opportunity for my dad, a master tailor, to take a short
break from his seventy-hour work week. He owned a dry cleaners in
downtown Baltimore, and for the forty-plus years that he was in business,
his primary goal was earning enough to pay for our college educations—in
cash.
 November 8 was also the day my mother arrived in the Port of New
York in 1951. She left Greece as a young woman of nineteen, wearing
white ankle socks and a dress sewn from a potato sack. Seven years of
hardship and hunger—four years during World War II and three more years
during the Greek Civil War—gave my mother the courage to leave her
parents and six siblings to build a new life in the United States under the
auspices of President Truman’s Displaced Persons Act of 1948. Each year,
on the anniversary of her arrival, my mom retells the story of her journey.
Determined to find the U.S. sponsor she needed to sign her visa
application, she found her way to Athens. A hotel lobby was her home for
two nights until she secured a sponsor and her visa. She negotiated a loan
for the eight hundred dollars she needed to pay for her boat ticket, proudly
reminding us that she paid back every penny, just as she promised she
would.
Each year, my parents’ stories rekindle my admiration for their
conviction that they could and would find a new and better way to live
their lives. As my family gathered to celebrate my graduation from The
John Hopkins University School of Medicine in 1986, my medical degree
opened the door to my new life as a physician. In ways I didn’t realize at
the time, their vision of a brighter future would continue to inspire my
professional journey.
For five years, I practiced internal medicine in San Ramon, a suburb in
the San Francisco Bay Area. This affluent community was home to the
corporate headquarters of Chevron, 24-Hour Fitness, General Electric’s
global software center, and the West Coast office of AT&T. With a median
family income of about $100,000, my patients were primarily middle-aged,
well-educated women with the intention and the resources to take care of
their health.
My practice grew and flourished. I shared idyllic office space with my
husband’s gastroenterology practice. Our daughters visited often, watching
Looney Tunes videos on the procedure room monitors when David wasn’t
doing a sigmoidoscopy. I was elected chairman of the Department of
Internal Medicine. On the surface, my career seemed perfect.
Nevertheless, over time, a math equation had taken shape in my mind. If I
followed the traditional path, seeing fifteen patients each day, every day,
for the next thirty years, I’d have a medical impact on about 100,000