When you’re in the grip of a medical concern, whether it’s chronic or sudden, it can be difficult to remember how to be the best consumer of medical care. But that’s not only financially smart, it helps you get the best care.
For a general review, see the chapter in my book, "The Life You Save: Nine Steps to Finding the Best Medical Care -- and Avoiding the Worst," that discusses all the questions you should ask if you’re shopping for a top primary care doctor. And here are some guidelines for more specific, common situations.
Writing on KevinMD.com, Alex Lickerman, who practices internal medicine, understands that although common, paternalism has never been the best practice in medicine. Here are five questions he says any patient should ask when his or her doctor suggests a treatment for anything from a cough to breast cancer. The point is not only to get concrete information, but to encourage the doctor to see you as a full participant in the management of your care.
1. What’s the likelihood it will help me?
For many treatments, this answer is known, but that doesn’t mean your doctor will know it. Not every question has been studied, but if it has, the doctor should know. Ask specifically where his or her answer comes from. If it’s from a study, ask if you are similar to the study’s subjects in terms of age, gender, ethnicity, degree of disease, etc. If they were different from you, ask how confident the doctor is generalizing the results of the study to you.
2. If it does help, how much will it help?
Some treatments can make you better but that’s not necessarily a compelling reason to have them. What if the improvement is small, temporary or doesn’t restore you to full or acceptable function? What if the side effects are intolerable?
3. What is the likelihood it will harm me?
“No intervention—absolutely none—is without risk,” Lickerman writes. But some are small, such as a blood draw, and others aren’t, such as open-heart surgery. Knowing the range of risks is essential to enable you to weigh the value of the benefits from the answers to No. 1 and No. 2.
4. If it harms me, how much will it harm me? And how bad can it be?
If there’s a 1 percent chance the intervention will harm you, but that harm is death, as opposed to paralysis or post-operative pain, wouldn’t you want to know?
5. What’s likely to happen if I don’t do it?
Never forget that doctors are trained to solve a problem, and solve it with all the tools at their disposal. Most don’t ask themselves, “Must I do anything at all?” But some problems resolve on their own. The good doctors know which ones don’t, or at least the likelihood of that happening. And if they’ve taken a thorough medical history, which is your responsibility to know, they will know what those chances are with someone like you. So for some people, it makes sense simply to monitor a breast lump, while others should have it biopsied.
Because medical outcomes can be uncertain, determining the course is a matter of risk management. As Lickerman says, “If you and your doctor thought through all the risks and benefits, you can content yourself you made the best decision with the data you had available at the time.”
Drugs, whether procured over the counter or with a doctor’s prescription, are a specific kind of medical intervention careful patients should investigate. Pharmacist Carlene Oleksyn, also writing on KevinMd.com, has five questions you should ask your doctor when he or she suggests you take a certain medication. Your pharmacist is also a good resource for information about drugs and drug interactions. Here, too, familiarity with your medical history is critical.
1. What is this medication for?
Oleksyn is amazed at how many patients for whom she fills prescriptions are unaware of why their doctors prescribed the medication. “When someone doesn’t know what a medication is for,” she notes, “there is little motivation to take it correctly or even at all. Most drugs have more than one indicated use. Know what yours are being used for.”
2. What will happen if I don’t take this medication?
More than half of all prescribed medications are taken incorrectly or not at all. If you fail to take your high blood pressure pills, your chances of having a heart attack or damaging your kidneys increase. If you fail to take an antibiotic for a nasty cold, not much happens because antibiotics don’t address colds and, in fact, can be worse for you in the long run because they make microbes more resistant. Many prescriptions are unnecessary, and some prescriptions can be deadly if you do not take them exactly as prescribed.
3. When can I expect this medication to work for me?
The effects of some medication are felt in hours, some in weeks. Knowing what to expect is essential in order to remain compliant with the directions for its use. Depression meds might not start to work for as long as six weeks. But someone in acute pain deserves a medication that starts working in an hour or so; if it doesn’t, maybe the dose is incorrect. If you’re taking an antibiotic for a skin infection that keeps spreading after three days, you’re not supposed to wait for the 10-day course to be completed—you should be reassessed immediately.
4. What do I do if I have a problem with this medication?
Some problems and side effects can be addressed with minor changes in dose, timing, formulation or how you take the medication. Sometimes changing the medication is necessary.
5. Can I take this medication with all my other medications?
Don’t forget to include nonprescription meds and dietary/herbal supplements that you take. Many vitamins and so-called “natural” products can interact with prescription medications. (See our August newsletter, "Eat, Drink and Be Wary: The Truth about Diet Supplements and Sports Drinks.")
Choosing a psychological therapist, we reminded readers in a blog post a few months ago, is no different from choosing other medical provider when it comes to asking pertinent questions. Link here to learn what to ask of potential counselors.
The popular media can be an excellent or terrible source of information about health and medicine. Consumers can navigate through the sloppy to the superior with the help of HealthNewsReview.org, a website that reviews and rates the quality of stories you see and read about. See our story, “Hype Busters: Helping You Get Better Care,” to learn more.
Our newsletter, “When the Doctor Isn’t Sure What You Can Do,” has more good questions for patients seeking information from their doctors.