Sunday, June 17, 2012

How to Ask Your Doctor Intelligent Health Care Questions



Going to the doctor can be confusing.  Doctors make recommendations based on what they know, and patients are conditioned to trust their doctors.  While I think it's wonderful that patients trust their doctors, there are times when patients want more input into their health care, and if this is the case, then let me make some suggestions as to what might be important questions to ask.  There is nothing specific to psychiatry about my recommendations, so feel free to have these types of discussions with any doctor or prescriber.


If you go to the doctor for a routine visit and it is suggested that you have routine health maintenance tests or treatments and you are fine with that, then there is not much to ask.  If you have a concern about the necessity of a test or procedure, try to figure out what your concern is so you can verbalize it.  One example might be: Will routine vaccinations cause my child to become autistic?
  • Why do I need this test?
  • What is the risk of this procedure? 
  • If a medication or supplement is being offered to decrease the risk of a specific illness later, then it's reasonable to ask if studies show that this treatment is known to be effective.  This may sound silly, but sometimes we just don't know things: so people took statins to lower their cholesterol, but it was a while before it was clear that they also lowered the risk of heart disease. And now the thinking is that Vitamin D and Calcium supplements may not lower the risk of osteoporosis in post-menopausal women (they may have other benefits however) but they do increase the risk of kidney stones. 
More importantly, if you choose not to follow your doctor's recommendations, ask:
  • What are the risks of not taking this medicine/supplement/having this vaccine?
My favorite personal example-- when one of my children turned three, I took him to a pediatric dentist to start routine care.  The dentist told me it was standard procedure to x-ray a child's mouth at this age.  I wondered why-- if there are no obvious problems, their baby teeth are going to fall out anyway.  I asked and was told that they like to make sure the adult teeth are there.  Hmmm, how many people don't have adult teeth?  I didn't ask that, what I did ask was, "If you do an x-ray and find that there are no adult teeth, what can you do about this?"  The answer was, "Nothing, we just like to know."  So I'm no dentist, but my take on this was that the x-ray exposes my little person to radiation, costs money,  and if a problem is discovered, there is nothing to do to address it.  I verbalized this and the dentist was okay with not getting an x-ray.   


If you go to the doctor with a specific problem, things are a little different.  
  • If the doctor orders a diagnostic test, you may or may not want to ask what he is looking for or trying to "rule out."  The answer may be something scary that is very unlikely and perhaps you may not want to know to worry about something that's not likely to be the problem.  
  • Is it an option to treat a presumed illness without having a diagnostic test first?  If the treatment is something easy or benign or cheap or a lifestyle change, maybe it would make sense to try that before having an expensive or painful procedure.  If the test is being done to rule out a treatable form of a serious illness, then usually doctors do not like to delay a test.
  • If the doctor recommends a specific treatment, it's reasonable to ask "How long it will take to work and when do you want to hear from me if things are not better?"  This is important, if you're supposed to be better in 3 days, you don't want to come back in 6 weeks saying you're still sick or hurting or very much worse.  And if the treatment is going to take 6 weeks to work, he doesn't want to hear that you're not better in 3 days.
  • If you don't want the treatment your doctor recommends (or you're not sure), it's reasonable to ask: Are there other treatment options available?  What is the expected course of this illness/injury/problem if I don't have this/any treatment?  Sometimes the doctor won't know because different people have different courses with an illness and this can be especially true in psychiatry.
 Sometimes people go to the doctor because they are worried they have a specific illness and are then disappointed when the doctor does not order a test to look for that illness.  Sometimes the concern is 
  • It's reasonable to say "I am worried that I have X, how can you be sure that I don't?"
  • You might then ask, "Would it make sense to order X test?"  
  • You might also ask, "If I continue to have these symptoms, are there diagnostic tests or treatment options that might be reasonable to try?"  And then ask for a time frame.
The truth is that doctors often don't have the answers to these questions, but sometimes it's helpful to hear their rationale for a decision or to let them know your concerns.  They certainly don't have crystal balls when it comes to issues of preventative care and risk, and often recommendations are made based on presumptions -- for example, people with sunburns get skin cancer, sunscreen prevents sunburn, sunscreen will prevent cancer-- before we can be absolutely certain that such logic will bear out.  And whether or not sunscreen prevents cancer, it might be nice to not be in blistering pain tonight regardless of long-term risk.