Communication, communication and more communication. To me, this is the cornerstone of a functional health care system, in which patient, doctor and insurance companies truly understand the nature of a patient's medical problem.

There must be documented justification and interpretation of each element of the patient's evaluation, and the plan of care must make sense to all involved. Reaching this lofty goal would be true nirvana, but currently we seem as far away from truly communicating as we are from Jupiter and Mars.

Not a day goes by in which I do not interact with a truly baffled family and patient. They tell of admissions to hospitals, multiple tests and numerous contacts with physicians and other health care providers who seem too busy to talk to them, and in the end, the family and patient have no clue as to the nature of the problem, the prognosis or how it should be approached.

And just as common a scenario is a patient whom I have treated for years coming to see me after a hospital stay. He is not sure what tests were done or what the eventual diagnosis was, but he does know that all his medications were changed. "The doctor promised to send all the records to you," I am told. Needless to say, I have no records and no clue what was done, and even more frustrating, the patient did not bring a record of the new medications prescribed and taken.

When doctors get together, they commiserate over the appalling lack of communication, convinced that everyone else contributes to the problem but them. I am sure that on many occasions, my own communication has been below par. I take it for granted that other physicians involved in the patient's care are receiving copies of my records. On occasion, they do, but for many reasons, they frequently do not. And even if the information is sent, it is often too voluminous to make sense or absorb, too difficult to read and not readily incorporated into the patient's record.

The net result of poor communication is duplication, unnecessary tests and procedures, inappropriate referrals to specialists and, sadly, confused and often desperate patients. This is a major cause of poor care.

It has been estimated that half of our yearly $3.2 trillion health care spending is consumed by unnecessary care. By not communicating, we often provide too much care, and if this problem is not corrected soon, our health care system will implode, and the fiscal strength of America will be sapped.

The centerpiece of fluid communication is a universal medical record that is available instantaneously to any appropriate health care provider delivering care to an individual. Fortunately, there is a plan to develop this system, in the Health Information Technology for Economic and Clinical Health, or HITECH, Act of 2009.

More than $29 billion has been assigned for implementation. In a review published by the prestigious New England Journal of Medicine, Dr. David Blumenthal described the daunting nature of this task, opposition to its implementation by many and, sadly, the lack of true consensus by experts in the field. No matter your political persuasion, concerns about privacy and the cost, nothing is more important to the future of our health than a rational and accessible medical record.

In the meantime, all patients must be educated about their health and any medical condition that afflicts them. A study published in the Annals of Internal Medicine showed that most physicians and patients support having an electronic medical record system. Every patient should request copies of his records from each physician visit and take all the information to appointments with other physicians. Most importantly, always carry a list of current medications taken and feel comfortable that the doctor you are seeing has all the necessary information to provide you with the best care possible.

Until such time as the communication problem is solved, trust only yourself and your family in managing your care. Understand and question information in your own medical record, and be assertive in ensuring that your physician has total insight into you as a patient, your problems and how to develop rational solutions.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at:

www.drdavidhealth.com