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
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