It starts with telling the doctor what you really think and
want. Don't be a spectator in your own healthcare.
Have you ever left the doctor's office thinking that the doctor
just did not hear your concerns? Or do you remember all the
questions you wanted to ask, but didn't, on the drive home?
You are not alone. Research shows that doctor-patient relations
are not always ideal. But in many cases, the injury is
self-inflicted. "Doctors think that if patients don't speak up,
they don't want a conversation and they want to be told what to
do," says Dr. Michael J. Barry, a clinical professor of medicine
at Harvard Medical School and president of the Informed Medical
It doesn't have to be that way. Here are some simple but
effective tricks to making sure you leave the doctor's office
with what you need.
1 Before the office visit, think
clearly about what is important to you in a treatment
decision. "Ask yourself what you really care
about," says Karen Sepucha, an assistant professor in medicine at
Harvard Medical School and director of the Health Decision
Sciences Center at Massachusetts General Hospital. "How much are
you willing to do to get rid of your symptoms? What are your main
concerns and what are you hoping to achieve with treatment? Make
sure the doctor knows what is important to you—and write things
2 Don't be afraid to speak your
mind. Many people are fearful about appearing to
contradict or disagree with their doctors. "We know from a
lot of research that patients are often afraid about speaking
up," Dr. Barry says, "People are afraid of being labeled a bad
patient by their doctors if they speak up too much or push back."
We go to doctors for their medical opinion and expertise. But the
one thing they don't and can't know on their own is how you feel
about a test or treatment. Most doctors believe in shared
decision making, but may default to "Doctor knows best" if you
don't speak up for yourself. Just say, "Could I take a minute to
tell you what I really think about this?" Saying it in the form
of a question can defuse some of your nervousness.
3 Ask about options. Medical decisions
researchers have identified and tested some simple questions that
can help you to get more out of encounters with doctors. The
following questions have been shown by research to improve the
outcome of decisions between doctors and their patients:
"These questions are good ones and have been tested," Dr. Barry
says. "When people speak up there is a more engaging conversation
about treatment options."
Also, ask for estimates of benefits and harms in the form of
numbers. Out of every hundred people who have a treatment, how
many stand to benefit? And how many could have a serious side
effect? Not all doctors will have these numbers immediately at
hand, but they may be willing to do some homework and get back to
you about it.
4 Pick a doctor who is willing to
share decisions. Expect your doctor to bring you
into the decision. Many experts in healthcare, including Dr.
Barry, feel that shared decision making should be the rule, not
the exception. It requires you to be assertive, but also requires
doctors to be welcoming. A doctor who does not express interest
in what you think might be a bad match. "Both parties have to
agree there is a role in working together to get to the right
decision," Dr. Barry says. "There's time in the visit where we
need to be hearing the patient's agenda instead of just pushing
the doctor's agenda."
5 Ask for a second opinion when it
counts. For many routine decisions, asking for a
second opinion may not be worth the time and money. If the issue
is trust, maybe you need another doctor. But for decisions that
have high-stakes consequences—cancer treatment, for
example—doctors should be comfortable with facilitating second
opinions. "If the stakes are major, and particularly if what the
doctor is suggesting doesn't sit right with you, second opinions
are a good approach," Dr. Barry says. "Seeing different doctors
in different specialties is a good way to get different points of
view, and good doctors aren't offended by that."
6 Bring someone along. Take a spouse,
adult child, or friend with you for support. "They can sometimes
be very effective at making sure certain questions get asked,"
Professor Sepucha says. "Having someone there who can support you
is always going to be a good thing."
But don't bring someone who will try to take over the decision
for you. "Make sure that person is going to support your
preferences rather than replacing his or her preferences for the
doctor's," Dr. Barry says. "You want to go with someone who is at
least sympathetic to your perspective."
7 Take your time. Professor Sepucha
emphasizes that good decisions take time. "Probably one of the
most important tips that I tell people is to take your time," she
says. "Most medical situations, even important ones like a cancer
diagnosis, are not emergencies." You may have several weeks to
absorb information, research options, seek out second opinions,
consult with family and friends, and make a decision.
Ask the doctor, "Does this need to be done right away? How much
time can I safely take to consider my options?" The goal should
not be to procrastinate. But on the other hand, it's good to
remember that you don't have to make the decision in one short
Be part of the decision
As in most aspects of health care today, the success of treatment
depends as much on you as on the doctor. If you often find
yourself leaving encounters with doctors feeling that your
concerns weren't really addressed, don't just go with the flow.
Ask what you—or your doctor—can do to improve the quality of
medical decisions. Your health and possibly your life could
depend on it. To get the best care, you have to be an active
participant in that discussion.
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