As a third-year medical student at the University of Tennessee at Memphis Health Science Center in 1991, Dr. Maria Hester witnessed something in a clinic that changed her life.

She was helping a breast cancer patient with an oozing tennis ball-sized tumor and immediately knew that the woman was going to die.

Hester remembers thinking that had the woman gotten an earlier mammogram she likely would have lived longer.

"We're all going to die, but unnecessary suffering and death is ludicrous," said Hester, who is now 46 and lives in Columbia. "We have the resources to prevent that, and we need to be more serious about doing that."

Since then, Hester, who is an internal medicine specialist at the Baltimore Washington Medical Center in Glen Burnie, has been on a mission to educate patients about healthy living and how to communicate with doctors and nurses.

Her latest attempt is through her Web site, PatientSchool.net, which she created in 2005 and recently updated in May.

The site provides links to government health care sites and news articles about diseases, along with information for the uninsured, including a link to a site that allows uninsured people to search for doctors in their area who offer discounts.

A forum on the site allows users to communicate with others about medical issues, and a video library provides short informational movie clips about diabetes, cholesterol and other issues.

Because Hester believes it is critical for patients to provide their doctors with detailed yet concise information about their medical condition, her site also includes a printable health record guide. The guide directs patients to write down important information, such as medications, family history, medical problems, allergies and the names of a personal doctor and pharmacy.

People who learn to take better care of themselves -- and are prepared to accurately and clearly communicate their problems to doctors, thereby leading to quick and accurate diagnoses -- save themselves time, money and suffering, Hester said.

"What I'm trying to do is to help people understand the tremendous role they can play in their health care," she said, adding that while doctors have medical school to learn how to identify diseases from symptoms, patients have never been taught what to look for and track when they're sick in order to best help the doctor diagnose an illness.

Bridging communication gap

This gap in communication between patients and doctors has been around a long time, said Dr. Gail Gazelle, assistant clinical professor of medicine at Harvard Medical School.

"Patients need help and coaching to know what it is that doctors are trying to find out," Gazelle said. "We need to enter into partnership."

Web sites, such as Hester's, form partnerships by bringing patients to the same playing field as doctors, Gazelle said. In medical school, doctors study a large amount of medical information, but are never taught how to teach patients their knowledge. While doctors should move toward patients by speaking in plain English, rather than medical terminology, Web sites that educate and instruct patients can bring patients to a skill level that would allow them to meet the doctors halfway, she said.

Dr. Bob Sheff, a physician adviser at Howard County General Hospital, also believes in partnership between patients and their doctors, he said.

Until about 25 years ago, a paternalistic style of medical help was dominant in the field. Under this style, a patient addressed his needs to the doctor, the doctor told him what to do and the patient did it.

Starting in the 1980s, patients began demanding more autonomy in their health care. A balance between the two approaches will benefit patients most, Sheff said.

"We need an in-between ground where the patient learns to express his wants and desires but also wants to hear what the doctor recommends," Sheff said, adding that while it's important for patients to become more knowledgeable about their health, it's also crucial to allow doctors, who have been trained, to offer their professional advice.

This partnership between doctors and patients also can benefit patients when dealing with insurance companies because doctors can lobby insurance companies to cover a procedure or medication that they otherwise wouldn't cover, Sheff said.

While patients pay insurance companies to cover medical help, the doctors and the patients -- not insurance companies -- should ultimately decide the best course of action, he added.

In regards to health Web sites, such as Hester's, Sheff said the sites can be a useful tool for building partnerships because doctors can educate patients about the medical field and how best to take care of themselves. But patients should always be cautious and should talk with their doctors before changing habits in their lifestyles, he said.

Hester's site and others encourage patient empowerment and show the movement away from the paternalistic style of medical help, Sheff said. While he said the middle ground between paternalism and complete autonomy is ideal, some doctors continue to cling to the old style of help, Hester said.

"Some doctors want to be in complete control. They don't want patients to be empowered," Hester said. "If something happens, it's the patient's life, not the doctor's. ... For a doctor to not want patients to take part in their health care, something's wrong with that. That's old school. We can't afford that anymore."

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