The Affordable Care Act comes with the promise of a dramatic overhaul in what many see as a broken health care system. It promotes the potential for “better all around” – better care, easier access to hospitals, and affordable treatment. It also comes with a price. For one reason or another, the turbulence within the American health care system is causing doctors to shut down, downsizing or sell their practices – keeping fewer nurses and support staff on payroll. With fewer people to help you, your care will likely deteriorate.

When doctors sell their practices to hospitals or networks, the practices are typically restructured. When they restructure, the new arrangement can put the doctor under more pressure to treat you (the patient) more “economically,” so as to generate more income. This can mean ordering tests or prescribing medicines that you may or may not need – things that are more for “let’s just be safe” and would be avoided in a private practice.

What does this all mean for you as a patient? Other than potentially higher medical costs, possible deterioration in treatment, and a lack of personal attention as a person, it boils down simply to a conflict of interest. In other words, there is greater potential for disagreement regarding what is in your best interest according to convention and how the doctor or hospital treats you.

It may not seem like there is much you can do in situations such as these. After all, you want to trust your doctor and not put yourself at risk. That being said, there are some simple steps you can take to make sure you’re getting the best care possible without compromising your health.

• First, when your doctor is recommending tests or treatments or hospitalization for you, take the time to ask if you really the treatments – ask if the doctor would do the same for a family member
• Second, ask for a second opinion to determine if you need the recommended care – this should be your standard reaction when tests are ordered
• Third, ask the office manager and doctor is there is a performance requirement in the practice to generate more tests, treatments or admissions – these “goals” could be influencing the doctor’s decisions regarding your treatment
• Fourth, take notes and record conversations with the doctor (on a smart phone or small tape recorder); doctors will be very honest when answering direct questions
• Fifth, ask the doctor if the recommended treatment complies with national guidelines, or if it is different and why. Don’t know the guidelines? Take some time to research them before committing to any treatment
• Finally, if you suspect your doctor has a conflict of interest, always get another opinion and if necessary, find another doctor in whom you have complete confidence. There are multiple online databases and forums where patients comment and critique different doctors, facilities and treatment courses – take advantage of the experiences of others

It’s important to keep in mind that above everyone else, you are the one in charge of your care and doctors certainly aren’t out to harm you. To ensure you get the best care at all times, come having researched your condition, prepared to ask questions, and willing to fight for what you need.

Cary Presant is a hematology-oncology physician and the author of Surviving American Medicine: How to Get the Right Doctor, Right Hospital and Right Treatment with Today’s Health Care.