The Patient as Advocate for Himself : Better Health Turns on How, When Medical Aid Sought

Everybody talks about what doctors should do for us. But there are things we should do for ourselves, too.

As a doctor told me some years ago, “The patient is his own best advocate.”

“Patienthood” is the fine art of learning how and when to seek medical care.

Dr. Eugene D. Robin of Stanford University--in a provocative new book, “Matters of Life and Death” (W. H. Freeman: $21.95; paperback, $11.95)--sums it up this way: “Your rights as a patient are inseparable from your responsibilities as a patient. . . . Learn to make an informed choice from among the alternatives available.”

Honest Answers And he tells a story.

A woman of 44 was dying of heart failure caused by pulmonary hypertension. Her doctors wanted to open the affected lung to find the precise problem. Her husband asked: Would the operation be painful? Could she die? Could it help her get well?

The answers, after some equivocation, were honest. Yes, she would suffer. She might die. No, the result could not help her. The husband and wife said no to the operation.

“It is not that the doctors were badly trained,” Robin explains. “They were highly motivated, good humans. But they . . . watched her dying day by day and wanted to do something, however ill-conceived.”

Healthy Assertiveness The lesson, he says, is that patients have “both the right and responsibility” to ask: Why are you doing this? What are the risks? The benefits? How safe is it? If a test is involved, how accurate is it? Can the result help me?

By learning more about doctors and medicine, he says, “you run the risk of feeling insecure in dealing with doctors. . . . You may find yourself less ready to accept medical advice, but some degree of reservation is often warranted.”

Questioning doctors takes a healthy degree of assertiveness. Dr. Marvin Belsky, a New York internist, says: “Doctors need to stop playing God, but that’s not enough. You’ve got to get up off your knees. But that alone is still not enough. You’ve got to begin to share responsibility for your health.”

If you want more information, Robin says, ask. If you disagree, say so--”Any doctor worth his fee welcomes an informed patient.” If you are confused about what course to take, “Ask your doctor where he would go or whom he would consult were he in your situation. Don’t be satisfied by partial or evasive answers.”

Assertiveness need not mean belligerence. At some point we must decide whether to trust or distrust our doctors, and if trust is our choice, we have other important obligations as sensible patients:

--Openness. A patient once told Belsky that “a good patient is a patient who tells his doctor everything and doesn’t hide anything. Every patient usually hides a little something.” “Why?” Belsky asked. “Because we don’t want to know the truth.”

--Completeness. Don’t assume some symptom or other is due to aging or stress or the weather. Let the doctor decide.

--Cooperation. Various studies show that between 20% and 80% of all patients fail to follow their doctors’ advice. One study found that only 22% of prescriptions were being taken according to directions; 31% were under- or over-used in ways that threatened health.

--Self-education. We can learn to look after our own minor ailments and attempt to learn which are minor and which major--requiring a doctor. An excellent book on this subject: “Take Care of Yourself: A Consumer’s Guide to Medical Care” by Drs. Donald Vickery and James Fries (Addison Wesley). We can learn about medications by asking questions of doctors and pharmacists, by reading the inserts that come with some drugs and by reading the same sources doctors rely on: the “Physicians’ Desk Reference” or other books found in most libraries.

--Self-care. We all need exercise, proper nutrition, proper rest and relaxation.

--Humanity. Assertiveness need not mean arrogance or lack of regard for doctors as human beings. Doctors should indeed be human, but can only be human. No one can be in good humor or possess saintly patience always.

With understanding, we can help our doctors and help ourselves.