Have you ever left a physician’s office thinking the doctor just didn’t hear your concerns? Or do you remember all the questions you wanted to ask on the way home? You’re 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,” said Dr. Michael J. Barry, a clinical professor of medicine at Harvard Medical School and president of the Informed Medical Decisions Foundation.
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. Know what’s important: Before the office visit, think clearly about what’s important to you in a treatment decision. “Ask yourself what you really care about,” said Karen Sepucha, 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 down.”
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,” Barry said. “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:
• What are my options?
• What are the possible benefits and harms of those options?
• How likely are the benefits and harms of each option to occur?
“These questions are good ones and have been tested,” Barry said. “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 100 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.
4. Pick a doctor who’s willing to share decisions: Expect your doctor to bring you into the decision. Many experts in health care, including 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,” Barry said. “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,” Barry said. “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,” Sepucha said. “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,” Barry said. “You want to go with someone who is at least sympathetic to your perspective.”
7. Take your time: “Probably one of the most important tips that I tell people is to take your time,” Sepucha said. “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 visit.”
YOUR THOUGHTS COUNT
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.