BODY WATCH : It’s a Control Thing : Most of us are a little in awe of doctors. But by asking a few well-informed questions, we don’t have to feel that we’re at their mercy.
You pride yourself on being an intelligent, educated and assertive person who takes control of situations that affect you. You wheel and deal to get the best insurance policies, the best benefit package in that new job and the best vacation itinerary.
But chances are when it comes to your most precious asset--your health--even you are reduced to a mute or blithering fool who mindlessly accepts everything your doctor does and says.
You’re not alone: Most people respond to pain and illness with vulnerable confusion and to the title M.D. with irrational deference. But this is just the time that you need to make decisions that could affect the rest of your life.
There are many things you can do to take back some control over your medical fate. They include talking to your friends; reading health magazines, scientific journals and other periodicals; searching health databases in cyberspace; buying a copy of the Physician’s Desk Reference, which lists all drugs and their side effects, or reading any number of medical books and encyclopedias written for consumers.
But the most immediate way is to ask your doctor. And one book to help you start asking the right questions is “Smart Questions to Ask Your Doctor” (HarperPaperbacks) by Dorothy Leeds with Jon M. Strauss, M.D. The 178-page book lists more than 300 specific questions in more than 10 broad medical categories, including selecting a doctor, tests and examinations, diagnoses, specialists, surgery and traveling.
“Questions are not only to get important information,” Leeds says. “They also put you on a more equal footing with your physician.”
Leeds, a communications and consumer consultant in New York, says one of several incidents that prompted her to write the book was the time a nurse was about to give her a shot of penicillin, a drug to which her chart clearly noted she is allergic.
“If I hadn’t said ‘What is that?’ I’d be dead,” Leeds recalls.
Questions to Ask When Choosing a Doctor
* What is your degree?
Don’t assume that just because people call themselves doctors, they have a medical degree. Chiropractors and osteopaths are called doctors and some alternative-care practitioners--such as allopaths or naturopaths--refer to themselves as doctors, even though they may not have medical degrees.
And there are even cases where people have simply set themselves up as doctors with no degrees whatsoever, Leeds says. To be sure, call your state medical licensing board.
* Where did you do your training?
You may not care whether or not your doctor has a degree from Harvard or from Hank’s Medical College (the “best” schools don’t necessarily produce the best doctors, Leeds stresses), but asking this question can give you a better picture of a doctor’s history. Writes Leeds: “Knowing some of the personal details of (a doctor’s) life can help you see the doctor as a mere mortal rather than as an intimidating authority figure.”
* Are you a board-certified specialist?
If a physician is board-certified, you automatically know two things: He or she was rigorously trained and exposed to all areas of his or her specialty (for family practice this effectively means all areas of medicine, Leeds writes), and that they were willing to put up with at least two years of extra hard work and study. Says Leeds: “There is no guarantee that a board-certified specialist is a better doctor . . . but asking a question like this can give you a good idea of the doctor’s overall attitude toward answering your questions.”
* How long have you been practicing in this area?
Leeds says that statistically, doctors move around a lot, but that is most often in the first years of their practices. Because you may become attached to your physician, it can be comforting to know that a doctor has been around for a while and has many ties to your community.
* How many patients do you book in a hour and how long do patients usually have to wait before they are seen?
Leeds says some physicians, like airlines, deliberately overbook. That can leave little time for you, plus cause frustratingly long waits. “Some doctors’ offices, and many clinics, run on a first-come, first-served basis,” Leeds writes. “This is like lining up for tickets at Madison Square Garden hours or days before a game or sellout concert.”
Questions to Ask About Tests and Examinations
* What is the name of the test that’s being done, how is it spelled and why are you doing it?
When your doctor recommends a test or procedure, write the name down immediately. You may want to research it, or discuss it with another doctor, your family or with the lab technician. Asking the questions gives you answers and makes the doctor think more clearly about those answers, thereby developing between the two of you a feeling of joint participation.
* How much will they cost and who do I pay?
If you have limited resources, you should know that some of these tests could deplete your bank account. A CTscan is very expensive, for example, and that’s not including the cost of the radiologist who will read the reports. Also, some labs require payment at the time of the test, while others will bill you or your insurance. Find out ahead of time.
* Are there risks involved?
Your doctor may not volunteer any if you don’t ask, but the fact is there are risks involved with virtually everything. Some may be relatively benign or obscure; others may be life-threatening. For example, if you are allergic to iodine or any of the components of dyes sometimes used in X-rays, you could have a severe or even fatal reaction.
* How do I find out the results of these tests?
Never assume the doctor will contact you, Leeds stresses, because even if it’s the doctor’s policy to contact the patient, lab results can get lost and a year later your abnormal Pap smear might be found somewhere at the back of a drawer. If the doctor says he or she will call, find out when. If they don’t, you call.
* Can I have a copy of my lab results?
You might want to keep test results in your personal file in case you want to refer to them if you switch doctors or go to a consulting doctor. Also, keeping your own records can be helpful if your problem is one that runs in families: such data can be very helpful in diagnosing and treating other family members.
Questions to Ask About Treatments and Medication
* Is medication the best way to treat this problem?
In our immediate gratification society, both doctors and patients often use medication as the first response to solving a problem, Leeds writes, even if it’s not the best solution. That’s why it’s so important to thoroughly question all medications you are prescribed.
* Are there any alternative treatments available?
If you are extremely resistant to the form of treatment your doctor recommends, it probably won’t help you get better. While in some cases there’s only one course of action to follow, most of the time there are choices, Leeds says. For example, alcoholism can be treated with medication, support groups or “natural” treatments that involve strict diet and exercise.
* What are the contraindications to taking this medication?
There are some medications that some people cannot under any circumstances take. For example, if you are allergic to penicillin, then you should never take it. Other drugs have “relative contraindications,” which means that you may take them under some circumstances but not others. For instance, a drug may be relatively harmless under normal conditions but cause severe adverse reactions when taken by a person with a high level of alcohol.
* What are the possible adverse reactions to or side effects of taking this drug?
If you look at the “Physician’s Desk Reference,” a book available to the general public, you will see that for any given drug, there is anywhere from half a page to two pages listing precautions and adverse reactions. The latter range from anxiety and insomnia to teratogenicity, the harming of a fetus during pregnancy.
* What is the likelihood that I will experience side effects from this drug?
If the side effect of a drug is known to be a low-grade headache, does that means you should expect to get a headache? Does it mean that most people get headaches? Or that .01% of the people who take that drug will get headaches? Once you know the answer, you can decide if the benefit is worth the risk.
Remember, you don’t have to take the doctor’s word for anything just because he or she is a doctor or nod yes if you don’t understand. And you don’t have to leave the office without satisfactory answers.
“You have the right to ask questions and the right to get answers,” Leeds says. “If your doctor won’t answer your questions, get one who will.”