In
a medical system where
doctors are strapped for
time—and patients shrink
from engaging their
providers as equals—it's
easy to feel like a
faceless customer on the
examining table. But by
becoming a more educated
and active participant in
your own medical
treatment, you can break
free from the standard
protocol. Expecting better
treatment ultimately means
becoming a better patient.
The
first step in shifting the
power dynamic is finding
the right doctor. Ask
people you know for
recommendations and speak
with previous patients and
nurses. Treat your first
visit as a test run.
But
before you make that first
visit, sit down and think
about your health, your
life, and your values. If
you're not sure where to
start, Rita Charon,
director of the Program in
Narrative Medicine at
Columbia University,
suggests you "know
your three 'must airs.'
What would you feel bad
about leaving the office
without having said?"
Free-association and
taking notes beforehand
can be helpful, Charon
says. Bring your list with
you.
Not
all patients want the same
thing from a doctor's
appointment. According to
Debra Roter, a professor
of public health at Johns
Hopkins University, there
are three common types of
patient. Are you the type
who wants to be in your
doctor's hands, completely
trusting her to know how
to treat you? Do you
prefer to discuss options
and make decisions
together? Or do you want
your doctor to give you
recommendations and then
respect your decisions?
Know which one you
are—and discuss with
your doctor whether you're
compatible.
Traditionally,
"the medical
encounter has quite a
predictable script,"
Roter says. The doctor
prescribes and the patient
complies. But the old
script, Roter says,
"can be changed by
becoming aware of the
reciprocities of
communication."
"You
want to make sure that you
can tell your whole
story," says Jerome
Groopman, author of How
Doctors Think,
"because you and the
doctor may not know which
of the symptoms you're
feeling is the key to the
underlying problem."
Getting the whole story
out may take
persistence—a 1984 study
showed that most doctors
will interrupt a patient
after only 18 seconds to
make a diagnosis. Taking
shortcuts, Groopman
contends, contributes to
medicine's alarming rate
of misdiagnosis: 15 to 20
percent.
If
your doctor makes an
assessment that sounds off
to you, it's wise to
prompt a re-examination of
the facts, according to
Groopman, a professor at
Harvard Medical School.
You can ask, "What
else could it be?"
Or, "Could two things
be going on
simultaneously?"
Inquire whether there's
anything in your history
or tests that doesn't
match the diagnosis.
Patients
often refrain from
challenging doctors or
asking necessary
questions, because they
don't want to be seen as
difficult or disruptive,
says Marsha Hurst,
director of the health
advocacy graduate program
at Sarah Lawrence College.
"I think people fear
creating antagonism more
than it actually
occurs."
If
faced with a serious
condition, you should
always bring somebody with
you to appointments, Hurst
says. When you are afraid
or in pain you may have
difficulty concentrating.
And ask your doctor to
give you a copy of his
notes on your visits,
which will spur him to use
language you understand
and will let you know
whether you've been
understood.
Once
you have a clear
diagnosis, you have a
little work to do if you
want to be an effective
participant in your
treatment. Doing your
homework does not mean
downloading reams of
information you don't
understand and presenting
it to your doctor in a
panic. Web sites like
WebMD can provide helpful
overviews of conditions.
Or you can go online to
the National Library of
Medicine to find a
consumer health library
near you.
Lucy
Thomas, a medical
librarian and coauthor
of Making Informed
Medical Decisions: Where
to Look and How to Use
What You Find,
remembers a patient who
came to her library with
a pinched nerve and
whose HMO had prescribed
removing a rib. With
Thomas' help, she
determined that her
problem could be solved
with a few months of
physical therapy.
"Someone in the
bean counting department
figured out it would be
cheaper to throw her on
the surgical
table," Thomas
recalls. Because the
patient had done her
research, she was able
to argue her case with
confidence and talked
the HMO into shelling
out for therapy.
Thomas
also suggests gathering
info by contacting
doctors who've written
about your health
situation. Many of them
are semiretired,
extremely knowledgeable,
and less beholden to
insurance companies.
From them you can find
out what the "gold
standard" is for
treating your illness
and go to bat with your
own doctor to make sure
you get it.
Online
forums are often the
first place people turn,
but Groopman warns
patients to be wary.
There is the risk of
misinformation, plus one
person "might
dominate the forum with
all sorts of horror
stories that may not
apply."
When
it comes to treatment,
remember that
"complementary"
medicine is just that,
different from but
compatible with
traditional practices.
Groopman finds that
patients often seek an
unconventional approach
just "to have a
more positive emotional
interaction"—something
they may find lacking in
traditional care. But
there are dangers.
"The
flip side is that people
are at risk for seeing
charlatans,"
Groopman says. In most
cases, you can rely on a
trusted physician to
help you navigate your
medical options.
"Allow yourself to
engage with the doctor
there to help you—he
is after all a
person."--Hadara
Graubart
Meet
Dr. Do-Little
5
cues to press for better
care
- Snap
Judgments.
"Physicians are
thinking with a lot
of data under
tremendous
pressure,"
Groopman says. This
may cause them to
grab on to the first
symptom you offer.
If you think your
doc's ignoring an
important piece of
information, place
more emphasis on it.
- Too
much self-disclosure.
A recent study shows
that 34 percent of
doctors discuss
themselves with new
patients in a way
that has no positive
effects on
treatment. You get
an average of 15
minutes during an
office visit. It
should be about you.
- Excess
empathy.
Sometimes doctors
become so close to
their patients,
Groopman says, that
they subconsciously
refrain from putting
them through
uncomfortable tests
and end up
misdiagnosing them.
- Lack
of eye contact.
There are medical
professionals Charon
calls "flagrant
inattenders, who
spend their whole
time with their back
to you writing on a
computer." Get
their attention.
Snap, snap! I'm over
here!
- Stagnation.
If your problem
isn't improving, the
physician should
consider starting
over, Groopman says.
"If he doesn't
probe more deeply
but stays stuck with
the initial
assumption, that's a
red flag."
Press for another
analysis.
If
you want better health
care, become a better
patient.
