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Agency for Healthcare Research Quality

Getting Involved for Better Health Care

Interview with Carolyn M. Clancy, M.D.

21st Century Health Care Forum

Health care quality is improving in the United States, but there is still a long way to go in reducing medical mistakes. The only person who can really make sure you get good health care is you, according to Carolyn M. Clancy, M.D, Director of the Agency for Healthcare Research and Quality (AHRQ).

This interview highlights tools and information to help consumers be involved, to help them know what questions are good to ask, and to learn more about the ways they can stay healthy. Sky Radio Networks interviewed Dr. Clancy on January 18, 2008.

Select for to Download Audio (MP3 File, 12 MB; Windows Media® File , 3 MB).

Narrator: No matter what solutions are found in fixing America's troubled health care system, there is one key player that will have a central role—and that's the patient. Our next guest is Carolyn Clancy, Director of the Agency for Healthcare Research and Quality under the Department of Health and Human Services. She believes, and has the facts to back up her belief, that patient and consumer involvement is critical to all aspects of our health care system. And she joins us now on Sky Radio to talk about it. Carolyn, welcome aboard.

Dr. Clancy: I'm delighted to be here.

Narrator: We're delighted to have you here. Why must consumers be involved in their health care?

Dr. Clancy: Well, if you think of it this way, most of us wouldn't buy a car, a dishwasher, or a washing machine until we had looked into the safety features, how often it needed to be repaired, other features, how noisy it is, and so forth. And yet, most people walk right into health care settings, whether that's a doctor's office, hospital, or emergency room, and just assume that some guardian angel will take care of all of it for them. If you look at the facts, what we know is that up to 100,000 patients die every year in hospitals from medical mistakes. These are avoidable, and we have no reason to think that that number is decreasing yet. We also know that when patients go to a doctor's office, they get the right care only about half of the time.

Now, we know that quality is improving in recent years—there's a lot more report cards and so forth—but the only person who can really make sure that you get good health care is you. And when consumers ask questions, and when they understand what it is that they need to do to get the best possible care, the system actually begins to respond. So my agency, the Agency for Healthcare Research and Quality, which is a mouthful—shortened to AHRQ—actually actively encourages consumers to be involved in their health care.  So, to that end, we've developed tools and information to help consumers be involved, to help them know what questions are good to ask, and to learn more about the ways they can stay healthy.

Narrator: Well, on the downside, it is a complex task that's being assigned to the health care consumer. It seems like now more than ever there's health care Web sites, there's TV shows, publications on health-related topics. How do consumers make sense of all of it?

Dr. Clancy: You've asked an incredibly important question. There is a lot of information out there on everything from Google™ to YouTube™ to you name it! There's a lot of information, but the information on health care comes in many different forms, and not all of it is good. So having some sense of how to evaluate this information is very important.

The good news is that good health care information is available. There are a number of organizations, for example, who have developed information about medical conditions and about hospital quality. And you want to go to sites from groups that don't gain financially when you make a decision about specific treatment options or choose a particular hospital—for example, Consumer Reports. You can get this information on the Internet, on your home computer, or at the local library. One that's particularly good is called healthfinder®. That's all one word; it's And this is sponsored by the U.S. Department of Health and Human Services for consumers and gives links to about 1,500 health-related organizations.

And on our Web site, that's, we actually have an entire section labeled, "Be an Active Health Care Consumer." So some of the very specific, practical tools you can get there include advice about what to do after a diagnosis. Most people hear the name of the diagnosis, and their mind just goes to Mars right away. So this is very helpful information in terms of followup questions and so forth. We also have information on five steps that everyone can take to make sure that they get the safest health care possible, tips on how to avoid medication errors, and other valuable information about how you can actually be a sort of co-producer in this production.

Narrator: Now, there's another player involved here. You encourage consumers to do their own research, but how do doctors react when a patient brings in information they found, say, on the Internet?  Don't some doctors get annoyed?

Dr. Clancy: Early on, I think some doctors got annoyed. I, for one, as a doctor, would sometimes hear people make jokes about filing these big printouts of material in the circular file. But increasingly, doctors, nurses, and other health professionals really welcome patients who bring information into the office. It gives them an opportunity to work with patients to identify which sources are really good and which are far less good. And oftentimes, they'll be able to point you to other sources of information.

Now, every patient, I think, in the country—and most doctors would agree with them—will tell you they don't have enough time with their doctors. So it's very important to think about this ahead of time. We found that most patients who we've had the opportunity to work with agree that it's very important to ask questions. But if you ask them do they write them down ahead of time, there's like a long pause. And they kind of say, "Well, no." They sort of think that it will all come to them in the waiting room, and what happens is they leave the office and realize, "Whoops, I forgot what happened." So, on our Web site, we actually have a list of questions that people can ask. And it gives you some sense of the types of things that you should be asking. We know that, from our annual report on quality of care, that people aren't asking a lot of questions.

So, for example, the problem of obesity right now is getting a whole lot of attention. Every time we put out a publication or analysis on bariatric surgery, the phone rings off the hook. But the real reason this is important isn't so much the cosmetic or appearance issue, it's because of the link to type 2 diabetes,  to heart disease.

It turns out, though, that only about 50 percent of obese adults are actually given any advice by health care professionals about diet. I think that this is a direct reflection of limited time together. But you can imagine the scenario and interaction is much different when people go in and say, "This is what I need. I want to lose weight. You're right. I need some specific advice or some specific places to go to." 

You know, another example is colon cancer. Every year, about a 150,000 new cases are diagnosed. The only way colon cancer is cured is if we find it early. Anything else, and we're just going to be treating symptoms. And yet, just over half of patients actually get the screening test that's recommended every year. Asthma is another problem, and the list goes on and on.

So, the take-home message is it really helps if you think about going in to see a physician or other health care professional in the same way you'd go in to see your child's teacher or anyone else—with a list of questions and issues that you want to cover.

Narrator: Now, is this an issue that affects everyone equally?

Dr. Clancy: Overall, for all of Americans, we know that we have big quality problems. And it turns out that it doesn't matter where you live. Virtually every community, every institution, every office practice has got issues. There's a gap between best possible care and the care that people routinely receive.

We also know, though, that Blacks, Hispanics, and lower-income people are likely to get even worse care, according the annual report that my agency does on health care disparities. So, for example, among people who are older than 65, Blacks, Hispanics, and the poor are much less likely to receive a very straight-forward vaccine to help prevent the most common kinds of pneumonia. We also know that different types of care vary from State to State.

So, again, it really pays to pay attention to these issues and to make sure that you know what conditions you are at risk for, what you should be getting information about.

Narrator:  Where do you see the quality of the U.S. health care system heading?

Dr. Clancy: Well, the really good news is, based on the data that we organize every year in this annual report to the U.S. Congress, we know that the quality of health care in this country is improving—that's the good news. The slightly less good news is that it's at a pretty slow pace. So, it's about 3 percent a year across all settings and people of all ages. So, the trend is in the right direction, and that's been steady for the last few years. But it's pretty clear that we need to accelerate the pace of that change.

All of us like to think that the quality of our health care is the best in the world. You hear people say that all the time. "Well, you know where they come when they've got a life-threatening disease," and so forth. And we all want to believe that if we're sick or one of our loved ones has a life-threatening illness that our doctors and hospitals are the very best at what they do. But, for all of the miracle stories and the great results that we hear about on TV and other sources, there are too many examples where we drop the ball; where patients simply don't get good care, even when it's fairly routine. And, in fact, sometimes the care they get makes their conditions worse because of avoidable mistakes. So we've had to face some pretty tough facts about the quality of health care in this country that you, as an involved consumer, ought to know about.

We are working very actively right now with people who lead health care organizations, with physicians, with nurses, and others to try to identify and put in place solutions that actually make health care safer and make the right thing to do the easy thing to do. But we can't wait until all of that work is perfected. We really need consumers to be involved.

Narrator: Over the next 5 years, what changes do you see the U.S. health care system that will improve the quality of care?

Dr. Clancy: Right now, there's a lot of effort by the Department of Health and Human Services working in close collaboration with many in the private sector to try to actually have a health care system. Right now, we have a sector. You know, for cell phones, if you have T-Mobile® and I have Verizon, we can talk to each other. The way it works in health care, that's not how it works, right? One doctor doesn't necessarily have easy, rapid communication with the hospital; doesn't necessarily send the right information to the nursing home or rehab facility; and so forth. So we're going to continue to do the work that we are, supporting the adoption of health information technology, which means electronic medical records... it means order entry…so that if a physician  prescribes a drug for you which is likely to have a serious adverse interaction with one you're already taking, they know about it right then. And the response of most doctors who use these systems now is: "Thank you. Thank you for letting me know and helping me prevent a mistake." We have to do a lot to make sure that more doctors find it easy to do that. We're also going to be seeing more reporting systems for medical errors.

Right now, a lot of the public is very concerned, as they should be, about the potential for getting infections in hospitals, for example. So that's a big focus for us this year, as we try to understand how it is that we can reduce those infections to a minimum. One very large statewide project that we funded in Michigan actually found that with fairly straightforward interventions, you can reduce the rates of serious infections in intensive care units to almost zero and keep them that low. That's the kind of work that we need to keep doing.

We're also going to be seeing that, in the next few years, the information that's available to consumers and that is customized to them is only going to get better. So, for example, as a consumer you'll be able to log on to a site and say that I want information about, say, breast cancer, and then you'll be asked if there's more recent and updated information, do you want us to send that to send that to you. And I think we're going to be seeing more and more of that in the future. So all of these advances are incredibly promising, and if it all pulls together so that in health care we have the equivalent of T-Mobile being able to talk to Verizon and being able to talk to Sprint and so forth, that'll be wonderful. But between here and the next few years, when we're hoping all of this begins to gel, it's very important that consumers stay on alert and make sure that they've got the right information for themselves.

Narrator: Carolyn Clancy, thank you so much for joining us here on Sky Radio. Wonderful information.

Dr. Clancy: A pleasure to be here. Thank you.

Narrator: Our guest has been Carolyn Clancy, Director of the Agency for Healthcare Research and Quality under the Department of Health and Human Services. We reached her at the Agency's offices in Rockville, Maryland. The Agency and a great deal of very useful information can be found on the Web at

Current as of April 2008

Internet Citation:

Getting Involved for Better Health Care. Interview With Carolyn M. Clancy, January 2008. Audio transcript. Agency for Healthcare Research and Quality, Rockville, MD.


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