I was contemplating Independence Day and concluded that the concept of freedom means two things to me: having choices and reducing unnecessary uncertainty. Having choices is already a familiar concept, so consider the second of these ideas.

Living here, I am reasonably certain that I will wake up most days to find that I have electricity and running water, that the mountain bike I lock up by the side of a path will still be there when I get back, that the price of apples won't quadruple overnight, and so forth. I don't have to spend a lot of energy dealing with uncertainties in these areas.

Health care is different.

One health policy expert, Harry Cayton, commented in an interview in the newsletter Scrip, "Health care systems have always transferred uncertainty and risk to the patient. Managers, doctors and nurses are in control; they have certainty. It is the patient who usually does not know what is going to happen, or when or why. The risk is taken by the patient rather than the doctor."

A study by the health care research organization Press Ganey discovered that 97 percent of emergency room patients who said that they were kept well-informed about delays gave the hospital high marks for their care, even when they had to wait for more than four hours before being seen.

In contrast, fewer than 43 percent of the patients who waited less than an hour were satisfied with their care if they felt that communication about the wait was very poor. That is, not knowing how long they would have to wait was more upsetting to people than actually waiting four times as long but knowing what to expect.

Have you ever called a customer service phone line and gotten a message that tells you how long you will have to wait? It might say something like, "Your call will be answered in approximately 12 minutes."

Have you noticed that you are much more relaxed waiting for help on calls like that than you are when you have no idea how long it will be before you reach a live person, even if the actual wait time in the second case is shorter? It's the freedom from uncertainty that makes the difference. Many people find that the health care system routinely leaves them uncertain for extended periods of time about a wide variety of topics directly related to their care.

For example, if you are in the hospital:

  • Do you know how long it should take for someone to come help you when you hit the call button?  
  • Do you know the name and job title of the person in charge of your care on each shift?  
  • Do you know when your doctor will come to see you next?  
  • Do you know who all the people are who come into your room and what their jobs are?

An article in the New York Times about women being tested for breast cancer discussed another kind of uncertainty in health care. It was titled "Study Equates Stress of Cancer and of Wait for Biopsy Results." Fifty-eight percent of the women were still waiting for their test results after five days. They had blood levels of a stress hormone, cortisol, identical to those of women who had learned that they had cancer.

In other words, women experienced as much stress by not knowing if they had cancer or not as they did when they found out that they had cancer. Research shows that stress can easily harm people's health, contributing to everything from heart disease to obesity.

Harvard professor and researcher Daniel Gilbert explains his own research findings in an essay in the New York Times: "Not knowing is making us sick. ... People feel worse when something bad might occur than when something bad will occur. ... Human beings find uncertainty more painful than the things they're uncertain about ... We can't come to terms with circumstances whose terms we don't yet know."

What can you do to gain the freedom from worry that comes with having a reasonable degree of certainty about what is happening to you when you receive health care?

Ask questions.

The easiest way to reduce the stress and anxiety associated with not knowing "what is going to happen, or when or why," is to find out.

Sometimes people feel that the doctor or nurse is too busy, and that they shouldn't bother them with questions. But they are there to help you get the best results possible from health care, and you won't get those results if you are distressed and worried because you are uncertain about any aspect of your care.