Navigating the Healthcare System

Chapter 24: Navigating the Healthcare System — Your Rights, Your Voice, Your Plan

Chapter Opening — David's Story

David was 63 when his PSA came back at 9.2. His primary care doctor referred him to a urologist, who ordered an MRI and then a biopsy. The biopsy showed Gleason 3+4=7 (Grade Group 2) in 3 of 12 cores. The urologist recommended surgery. David's brother-in-law, a nurse, suggested he get a second opinion. David hesitated — he did not want to offend his urologist, and he was not sure his insurance would cover it.

He got the second opinion anyway. The radiation oncologist at a nearby academic center reviewed his case and offered him two additional options: active surveillance with close monitoring, or radiation therapy. She also recommended genomic testing to better understand his cancer's aggressiveness.

David was overwhelmed. He now had three options from two doctors, a stack of medical records he did not fully understand, a patient portal with lab results that used abbreviations he could not decode, and an insurance company that required prior authorization for the genomic test.

"I felt like I needed a medical degree just to be a patient," David said later.

He did not need a medical degree. What he needed — and what this chapter provides — is a practical guide to navigating the healthcare system: how to get the information you need, communicate with your medical team, understand your rights, and advocate for yourself at every step.

Part 1: Building Your Medical Team

Prostate cancer care involves multiple specialists, and understanding who does what is the first step toward feeling in control.

Your core team may include:

• Urologist — The doctor who typically makes the initial diagnosis through biopsy. Urologists also perform surgery (radical prostatectomy) and manage urinary side effects. Some urologists subspecialize in urologic oncology.
• Radiation oncologist — The doctor who plans and delivers radiation therapy (external beam radiation, brachytherapy, or both). Radiation oncologists also manage radiation-related side effects and often coordinate hormone therapy.
• Medical oncologist — The doctor who manages systemic therapies including hormone therapy, chemotherapy, immunotherapy, targeted therapies, and radiopharmaceuticals. Medical oncologists are typically more involved in advanced or metastatic disease.
• Primary care physician (PCP) — Your general doctor, who coordinates your overall health, manages other medical conditions, and helps with preventive care. Do not neglect your PCP during cancer treatment — your heart, blood pressure, diabetes, and other conditions still need attention.
• Pathologist — The doctor who examines your biopsy and surgical specimens under the microscope and determines the Gleason score, Grade Group, and other critical features. You rarely meet the pathologist in person, but their work is foundational to your diagnosis.
• Radiologist — The doctor who interprets your imaging studies (MRI, CT, PET scans, bone scans). Like the pathologist, you may not meet them directly, but their reports guide treatment decisions.
• Nurse practitioners and physician assistants — Advanced practice providers who work alongside your doctors. They often spend more time with you during visits and are excellent resources for questions about side effects, medications, and daily management.
• Nurses — Your frontline caregivers during treatment. Radiation therapy nurses, infusion nurses, and clinic nurses are often the most accessible members of your team. Do not hesitate to call them with questions.
• Social worker — Helps with emotional support, insurance navigation, financial assistance, transportation, and connecting you with community resources.
• Dietitian/nutritionist — Provides guidance on nutrition during and after treatment.
• Physical therapist — Particularly pelvic floor physical therapists, who help with urinary incontinence and sexual rehabilitation.
• Psychologist or counselor — Provides emotional and psychological support for you and your family.

Navigating between multiple specialists:

One of the most confusing aspects of cancer care is coordinating between multiple doctors who may be in different offices, different health systems, or even different cities. Here are practical tips:

• Ask who is the "quarterback." One doctor should be coordinating your overall cancer care. This is often the urologist early on, but may shift to the radiation oncologist or medical oncologist depending on your treatment path. Ask directly: "Who is leading my care, and who should I call first if I have a problem?"
• Make sure your doctors talk to each other. Ask each specialist: "Have you seen the notes from my other doctors?" If they have not, request that records be shared. Most electronic health record systems can send records between institutions, but it sometimes requires your authorization.
• Keep your PCP in the loop. Cancer specialists focus on your cancer. Your PCP focuses on everything else — and sometimes catches things the specialists miss. Make sure your PCP receives copies of all your cancer-related records.
• Multidisciplinary clinics are ideal. Some cancer centers offer clinics where you see the urologist, radiation oncologist, and medical oncologist in a single visit — or where your case is discussed at a tumor board (a meeting where multiple specialists review your case together and make a joint recommendation). Ask if this is available.¹

Part 2: Getting a Second Opinion

A second opinion is one of the most important things you can do after a cancer diagnosis — and one of the most underutilized.

Why get a second opinion?

• Prostate cancer treatment is not one-size-fits-all. Different specialists may recommend different approaches, and all of them may be reasonable.
• Studies show that pathology second opinions change the Gleason score in approximately 25–30% of cases, and some of these changes are clinically significant — meaning they could change the recommended treatment.²
• A second opinion may confirm your current plan, which provides peace of mind and confidence in your decision.
• A second opinion may reveal options you were not offered, including clinical trials, newer technologies, or less invasive approaches.
• Major cancer organizations, including the National Comprehensive Cancer Network (NCCN), encourage second opinions as a standard part of cancer care.¹

How to get a second opinion:

1. Tell your current doctor. Most doctors are not offended by second opinions — they expect them. Simply say: "I'd like to get a second opinion before making a decision. Can you help me with that?" If a doctor discourages you from seeking a second opinion, that itself may be a reason to seek one.
2. Choose where to go. Consider an NCI-designated cancer center or a high-volume prostate cancer program. Academic medical centers often have multidisciplinary teams and access to clinical trials. The NCCN website (nccn.org) lists member institutions.
3. Request your medical records (see Part 3 below). The second-opinion doctor will need your biopsy pathology report, imaging studies (on CD or uploaded digitally), PSA history, and any other relevant records.
4. Send your biopsy slides. This is critical. A second-opinion pathologist will re-examine your actual tissue slides, not just read the original report. Ask your urologist's office or the pathology lab to send the slides to the second-opinion institution.
5. Check your insurance. Most insurance plans cover second opinions for cancer diagnoses. Some plans require them. Call your insurance company and ask: "Is a second opinion covered for a cancer diagnosis?" Get the answer in writing if possible.
6. Virtual second opinions. Many major cancer centers now offer remote second opinions where specialists review your records and provide written recommendations without requiring you to travel. This can be especially valuable if you live far from a major center.

What to bring to a second opinion:

• All pathology reports (biopsy, any prior procedures)
• Biopsy slides (shipped separately to the pathology department)
• All imaging studies (MRI, CT, PET scan, bone scan) — on CD or uploaded
• Complete PSA history with dates
• List of all current medications
• List of other medical conditions
• Any genomic test results (Decipher, Oncotype, Prolaris, etc.)
• A written list of your questions
• A companion to take notes

Part 3: Requesting and Understanding Your Medical Records

You have a legal right to your medical records. Under the Health Insurance Portability and Accountability Act (HIPAA), healthcare providers must give you access to your records, usually within 30 days of your request.³

How to request records:

• In person or by phone: Contact the medical records department of each facility where you have received care. You will typically need to fill out an authorization form specifying what records you want and where to send them.
• Through the patient portal: Many health systems allow you to download lab results, imaging reports, clinic notes, and pathology reports directly from your online patient portal.
• For imaging studies: Request a CD or digital upload of the actual images (not just the written report). The radiology department handles this separately from medical records.
• For pathology slides: Contact the pathology lab directly. Slides are physical objects and must be shipped. There may be a small fee. Request that they be sent to the second-opinion institution's pathology department.
• For records from another health system: If your doctors are at different hospitals, you may need to request records from each one separately. Some systems participate in health information exchanges that allow automatic sharing, but do not assume this is happening.

What you are entitled to receive:

• Clinic visit notes (also called progress notes or office notes)
• Operative reports (surgical notes)
• Pathology reports
• Laboratory results (PSA, blood work)
• Imaging reports and images
• Treatment summaries
• Medication lists
• Discharge summaries (if hospitalized)

Tips:

• Keep a personal health folder — either physical or digital — with copies of all your important records. This is invaluable when seeing new doctors, getting second opinions, or in emergencies.
• You may request records in electronic format. Under the 21st Century Cures Act, healthcare providers are required to provide electronic access to your health information and are prohibited from "information blocking."⁴
• There should be no charge for electronic copies of your records, though providers may charge a reasonable fee for paper copies.

Part 4: Understanding Your Rights as a Patient

As a patient, you have fundamental rights that are protected by law and by medical ethics. Understanding these rights empowers you to be an active participant in your care.

Informed consent:

Before any procedure, surgery, or treatment, your doctor must explain:

• What the procedure is and why it is recommended
• The expected benefits
• The risks and possible complications
• Alternative options (including doing nothing)
• What to expect during recovery

You have the right to ask questions, take time to decide, and refuse any treatment. Signing a consent form does not mean you cannot change your mind — you can withdraw consent at any time before the procedure.

HIPAA and privacy:

• Your medical information is protected by federal law. Healthcare providers cannot share your health information without your written authorization, except for purposes of treatment, payment, and healthcare operations.³
• You have the right to know who has accessed your records.
• You have the right to request corrections to your medical records if you believe there is an error.
• You can request restrictions on who receives your information (for example, you may not want certain family members to have access).

The right to a second opinion: As discussed above, you have the right to seek a second opinion at any time, and your doctor is expected to facilitate this by providing records and referrals.

The right to refuse treatment: You are never obligated to accept a recommended treatment. Your doctor should respect your decision, even if they disagree, as long as you understand the potential consequences.

The right to an interpreter: If English is not your primary language, you have the right to a qualified medical interpreter at no cost. Healthcare facilities that receive federal funding are required to provide language access services under Title VI of the Civil Rights Act.⁵ Family members — especially children — should not serve as interpreters for medical conversations, as this can lead to errors and places an unfair burden on the family member.

Advance directives: These are legal documents that specify your wishes for medical care if you become unable to make decisions for yourself. The two most common types are:

• Living will — States what treatments you do or do not want (for example, mechanical ventilation, feeding tubes, resuscitation).
• Healthcare power of attorney (healthcare proxy) — Designates a person to make medical decisions on your behalf if you cannot.

These documents are important for all adults, not just those with cancer. Discuss your wishes with your family and your doctor, and make sure copies are in your medical record.

Part 5: Communicating Effectively with Your Medical Team

Good communication with your doctors is not a luxury — it is a medical necessity. Research shows that patients who communicate effectively with their healthcare team have better outcomes, greater satisfaction, and less anxiety.⁶

Before your appointment:

• Write down your questions in advance. Prioritize them — put the most important questions first, in case time runs short. Aim for 3–5 focused questions per visit.
• Bring a companion. A spouse, family member, or friend can take notes, ask questions you might forget, and help you remember what was said. Studies show that patients forget up to 40–80% of medical information provided during visits.⁷
• Bring a notebook or use your phone to take notes. Ask permission to record the conversation if that would help you review it later.
• Bring your medication list. Include all prescription medications, over-the-counter drugs, vitamins, and supplements — with doses.
• Bring your symptom diary. If you have been tracking symptoms (urinary, bowel, sexual, pain, fatigue), bring the record.
• Bring your insurance card and any referral paperwork.

During your appointment:

• Start with your most important concern. Do not save the big question for the end when time is running out.
• Ask for clarification. If you do not understand something, say so. Phrases like "Can you explain that in simpler terms?" or "Can you draw that for me?" are perfectly appropriate.
• Repeat back what you heard. This technique, called "teach-back," helps confirm understanding: "So what you're saying is that my cancer is Grade Group 2, and my options are surveillance, surgery, or radiation — is that right?"
• Ask about next steps. Before you leave, make sure you know: What happens next? When is my next appointment? Are there tests I need? Who do I call if I have a problem?
• Ask about clinical trials. If you are interested in participating in research, ask: "Are there any clinical trials that might be appropriate for me?"

After your appointment:

• Review your notes with your companion while the information is fresh.
• Check the patient portal for visit summaries, lab results, and messages from your doctor.
• Call with follow-up questions. Do not wait until your next appointment if something is bothering you. Most offices have a nurse line for non-urgent questions.
• Keep a running list of questions that come up between appointments.

Difficult conversations:

Sometimes you need to have conversations that feel uncomfortable:

• "I'd like a second opinion" — This is your right. A good doctor will support it.
• "I don't agree with this recommendation" — Express your concerns. Ask about alternatives.
• "I'm not comfortable with this" — Whether it is a procedure, a medication, or a communication style, you have the right to speak up.
• "I need more time to decide" — Unless there is a true medical emergency, most prostate cancer decisions can wait days to weeks. Do not let anyone pressure you into a decision you are not ready to make.
• "I want to include my partner in this conversation" — Your support person is welcome at most appointments. If a provider resists, ask why.

Part 6: Patient Portals and Electronic Health Records

Most healthcare systems now offer patient portals — secure websites or apps where you can access your health information online. These are powerful tools when used effectively.

What you can typically do through a patient portal:

• View lab results (including PSA values) — often available before your doctor calls
• Read clinic visit notes and imaging reports
• Send secure messages to your medical team
• Request prescription refills
• Schedule or reschedule appointments
• View your medication list and allergy list
• Access educational materials
• Complete pre-visit questionnaires
• View billing statements and make payments

Tips for using patient portals effectively:

• Check results, but do not panic. Lab results and imaging reports often appear in the portal before your doctor has had a chance to review and explain them. Medical reports use technical language that can be alarming out of context. If you see something concerning, write down your questions and contact your doctor's office — do not spend hours searching the internet for worst-case scenarios.
• Use secure messaging wisely. Patient portal messages are good for non-urgent questions, medication refill requests, and appointment scheduling. They are not appropriate for emergencies or urgent symptoms. If you are experiencing a medical emergency, call 911 or go to the emergency room.
• Download and save important documents. Keep digital copies of key reports (pathology, imaging, PSA history) in a personal health folder. This makes it easy to share with new doctors or second-opinion consultations.
• Grant proxy access to a caregiver. Most portals allow you to designate a family member or caregiver who can access your health information. This can be helpful if your partner manages appointments or medications.

Understanding the 21st Century Cures Act:

This federal law, fully implemented in 2021, requires healthcare providers to give patients electronic access to their health information without unnecessary delay. Providers cannot engage in "information blocking" — meaning they cannot withhold your records or make it unreasonably difficult to access them.⁴ If you are having trouble accessing your records electronically, you can file a complaint with the Office of the National Coordinator for Health Information Technology (ONC).

Part 7: Preparing for Specific Types of Appointments

Different appointments require different preparation:

Initial consultation (new diagnosis):

• Bring all records: PSA history, biopsy pathology report, imaging studies (on CD or uploaded), list of medications, list of other medical conditions
• Bring a companion to take notes
• Write down your top 5 questions
• Be prepared to discuss your baseline urinary, sexual, and bowel function — the doctor may ask you to complete questionnaires (EPIC-26, IPSS, SHIM)
• Ask about the doctor's experience and volume with the treatment they are recommending

Pre-treatment planning (simulation for radiation, pre-operative visit for surgery):

• Ask what to expect on the day of the procedure
• Ask about dietary restrictions (bowel and bladder preparation for radiation; fasting for surgery)
• Ask which medications to stop (blood thinners, NSAIDs, GLP-1 agonists) and when
• Ask about recovery time and when you can return to work and normal activities
• Arrange transportation — you may not be able to drive after certain procedures

Follow-up visits (after treatment):

• Bring your PSA results (or have them drawn before the visit)
• Bring your symptom diary — track urinary, bowel, and sexual function between visits
• Report any new symptoms, even if you think they are unrelated to cancer
• Ask: "What is my PSA doing? Is it where you expect it to be?"
• Ask: "When is my next PSA check and next appointment?"

Visits for side effect management:

• Be specific about your symptoms: when they started, how severe they are, what makes them better or worse, and how they affect your daily life
• Bring a list of everything you have tried (medications, exercises, dietary changes)
• Do not minimize your symptoms. Doctors cannot help with problems they do not know about
• Ask about referrals to specialists (pelvic floor PT, sex therapist, dietitian) if your current management is not working

Part 8: Medical Interpreters and Language Access

If English is not your primary language — or if you are more comfortable discussing complex medical information in another language — you have the right to a qualified medical interpreter.

Key points:

• It is free. Healthcare facilities that receive federal funding (which includes most hospitals and clinics) are required to provide interpreter services at no cost to the patient.⁵
• Request an interpreter in advance. When scheduling your appointment, tell the office what language you need. This allows them to arrange an in-person interpreter or a phone/video interpreter.
• In-person interpreters are ideal for complex conversations (treatment decisions, consent discussions, bad news). Phone and video interpreters are acceptable for routine visits.
• Do not rely on family members as interpreters. While it may seem convenient, using family members — especially children — as interpreters can lead to errors, omissions, and emotional burden. Medical interpreters are trained in medical terminology and confidentiality.
• Translated materials. Ask if patient education materials, consent forms, and instructions are available in your language. Many cancer centers provide materials in multiple languages.
• Cultural considerations. A good interpreter does more than translate words — they help bridge cultural differences in how health information is understood and discussed. If you feel that cultural factors are affecting your care, speak up or ask for a patient advocate.

Part 9: Dealing with Insurance and Prior Authorizations

Insurance can be one of the most frustrating aspects of cancer care. Understanding the basics can save time, money, and stress. (Financial aspects are covered in more detail in Chapter 20, but the practical navigation tips belong here.)

Key insurance concepts:

• In-network vs. out-of-network: In-network providers have agreements with your insurance company and cost less. Out-of-network providers may cost significantly more. Before seeing a new doctor or getting a second opinion, check whether they are in your network.
• Prior authorization (pre-approval): Some tests, procedures, and medications require your insurance company's approval before they will be covered. Common items requiring prior authorization in prostate cancer include: PET scans (especially PSMA PET), MRI, genomic tests (Decipher, Oncotype, Prolaris), certain medications (novel hormonal agents, PARP inhibitors), and proton beam therapy.
• If authorization is denied: You have the right to appeal. Ask your doctor's office to submit a peer-to-peer review (where your doctor speaks directly with the insurance company's medical reviewer). Many denials are overturned on appeal.
• Referrals: Some insurance plans (especially HMOs) require a referral from your PCP before you can see a specialist. Make sure this is in place before your appointment.
• Explanation of Benefits (EOB): This is not a bill — it is a statement from your insurance company showing what was billed, what they paid, and what you may owe. Review it carefully and compare it to any bills you receive.

Practical tips:

• Keep a log of every call you make to your insurance company: date, time, name of representative, reference number, and what was discussed.
• Get important decisions in writing. If an insurance representative tells you something is covered, ask for written confirmation.
• Ask about financial assistance. If you are struggling with costs, ask your cancer center's social worker or financial counselor about assistance programs, co-pay assistance, and charity care (see Chapter 20).
• Know your out-of-pocket maximum. This is the most you will pay in a calendar year. Once you reach it, your insurance covers 100% of covered services. Cancer treatment often reaches this maximum early in the year.

Part 10: Advocating for Yourself

Being your own advocate — or having someone advocate on you behalf — is one of the most important skills in cancer care.

What self-advocacy looks like:

• Asking questions until you understand. There is no such thing as a stupid question in cancer care.
• Seeking a second opinion when you are unsure about a recommendation.
• Requesting records and keeping your own copies.
• Speaking up about side effects rather than suffering in silence.
• Saying no when something does not feel right.
• Bringing a companion to appointments for support and note-taking.
• Reporting concerns about your care. Every hospital has a patient advocate or ombudsman whose job is to address patient concerns.
• Participating in shared decision-making. Your doctor provides medical expertise; you provide knowledge of your own values, preferences, and priorities. The best decisions are made together.¹

If you feel your concerns are not being heard:

• Ask to speak with the charge nurse, patient advocate, or department manager.
• Put your concerns in writing (a patient portal message or letter creates a record).
• Consider changing providers if the relationship is not working. You have the right to choose your doctor.
• Contact your insurance company's member services if you are having difficulty accessing care.

Patient advocacy organizations can also help:

• Patient Advocate Foundation — patientadvocate.org — Free case management for insurance and access issues.
• Cancer Legal Resource Center — thedrlc.org/cancer — Free legal information for cancer patients.

Questions to Ask Your Doctor

1. "Who is coordinating my overall cancer care — who is the 'quarterback' of my team?"
2. "Can you help me get a second opinion? Where would you recommend I go?"
3. "How do I get copies of my pathology report, imaging studies, and medical records?"
4. "Is there a multidisciplinary clinic or tumor board where my case can be discussed by multiple specialists?"
5. "What should I do if I have questions or concerns between appointments — who do I call?"
6. "Are there clinical trials that might be appropriate for me?"
7. "Can you explain my diagnosis and treatment options in simpler terms?"
8. "Does this test/procedure require prior authorization from my insurance?"
9. "Is there a social worker or financial counselor who can help me navigate insurance and costs?"
10. "Can I have an interpreter for my appointments?"

Myth vs. Fact

Myth: "Getting a second opinion means I don't trust my doctor."

Fact: Second opinions are a standard and expected part of cancer care. Most doctors welcome them. A second opinion may confirm your plan (giving you confidence) or reveal additional options. Major cancer organizations encourage second opinions for all cancer diagnoses.¹ ²

Myth: "My doctor will be offended if I ask too many questions."

Fact: Good doctors want informed patients. Asking questions shows engagement in your care and leads to better outcomes. If a doctor is consistently dismissive of your questions, consider finding a doctor who communicates in a way that works for you.⁶

Myth: "I have to accept whatever treatment my doctor recommends."

Fact: You have the right to refuse any treatment, seek alternatives, and take time to decide. Informed consent means you understand the options and make the choice that aligns with your values.

Myth: "My medical records belong to my doctor."

Fact: Your medical records belong to you. Federal law (HIPAA and the 21st Century Cures Act) guarantees your right to access your health information.³ ⁴

Myth: "Using a family member as an interpreter is just as good as a professional interpreter."

Fact: Professional medical interpreters are trained in medical terminology, accuracy, and confidentiality. Family members may omit, simplify, or misinterpret information — and the emotional burden on them is unfair, especially for children.⁵

Myth: "If my insurance denies something, there's nothing I can do."

Fact: You have the right to appeal any insurance denial. Many denials are overturned on appeal, especially with a peer-to-peer review from your doctor. Ask your doctor's office and the cancer center's financial counselor for help.

Key Takeaways

1. Build your team and know who is leading your care. Prostate cancer involves multiple specialists — ask who is the "quarterback" and make sure your doctors communicate with each other.¹
2. Get a second opinion — it is your right and it is expected. Pathology second opinions change the Gleason score in about 25–30% of cases. A second clinical opinion may reveal options you were not offered.² ¹
3. Your medical records belong to you. Federal law guarantees your right to access them. Keep a personal health folder with copies of all important documents.³ ⁴
4. Prepare for every appointment. Write down questions, bring a companion, bring your records, and do not leave until you understand the plan.⁶ ⁷
5. Advocate for yourself. Ask questions, speak up about side effects, request interpreters if needed, and appeal insurance denials. You are the most important member of your healthcare team.

Support Resources

• NCCN Patient Guidelines — Prostate Cancer — nccn.org/patients — Free, patient-friendly versions of the clinical guidelines.
• Patient Advocate Foundation — patientadvocate.org — Free case management for insurance, access, and financial issues. Helpline: 1-800-532-5274.
• Cancer Legal Resource Center — thedrlc.org/cancer — Free legal information and referrals for cancer patients.
• National Cancer Institute Cancer Information Service — cancer.gov or 1-800-4-CANCER — Information about cancer, treatment options, clinical trials, and local resources.
• American Cancer Society — cancer.org or 1-800-227-2345 — 24/7 helpline for information, support, and referrals.
• CancerCare — cancercare.org — Free professional counseling, support groups, and financial assistance.
• HIPAA Information — hhs.gov/hipaa — Information about your privacy rights under federal law.
• 21st Century Cures Act — Patient Access — healthit.gov — Information about your right to electronic health records.

References

1. 1. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer, Version 4.2025.
2. 2. Epstein JI, Feng Z, Trock BJ, et al. Upgrading and downgrading of prostate needle biopsy diagnoses at expert second opinion. Am J Surg Pathol 2012;36(3):325–332.
3. 3. U.S. Department of Health and Human Services. Health Insurance Portability and Accountability Act of 1996 (HIPAA). hhs.gov/hipaa.
4. 4. 21st Century Cures Act, Public Law 114-255. U.S. Congress, 2016. Information blocking provisions implemented 2021.
5. 5. U.S. Department of Health and Human Services. Title VI of the Civil Rights Act of 1964 — Language Access. hhs.gov/civil-rights.
6. 6. Epstein RM, Street RL Jr. Patient-centered communication in cancer care: promoting healing and reducing suffering. NIH Publication No. 07-6225. National Cancer Institute, 2007.
7. 7. Kessels RP. Patients' memory for medical information. J R Soc Med 2003;96(5):219–222.