Four Questions Every Patient Should Ask

When I asked my doctor what he would do with the results of the test he was ordering for a painful but minor disorder, he said it wouldn’t change the course of treatment any. I then asked why perform the test if the results had no bearing on the treatment now or in the future. He grew exasperated, as if to say, “Why are you giving me a hard time? If you’re so smart, why aren’t you the doctor?”

It is obvious to some that the more you know the better off you are. But this isn’t always the case. Detecting a small abnormality may only indicate the truism that no body is perfect. Aging leaves its marks on everyone but not all peculiarities matter to our health. The oddity detected may be benign. Of course, it may also be the precursor of something serious, in which case it needs attention.

In my instance, he was certain he knew the nature of my malady. Nothing more was to be done, he said. But he just wanted the test to make absolutely sure. However, if the test came back positive, that wouldn’t mean much since there are false positives. So another test would have to follow, just to rule out a remote possibility that his first diagnosis was incorrect.

The problem is that the testing itself presents a risk. In my case, the doctor said that if the symptoms presented themselves again, he would have to do a test at that time.  

The answer to whether to test should be left in the hands of the patient, but often it is not. Instead, the response by physicians often resembles that of my own doctor: more knowledge is good knowledge and you better have the test done or else you are risking your health.

I was in no mood to get into an argument that day, so I consented.  

To my chagrin, I had deferred to authority, even though my reason told me that undergoing the test was pointless. However, I was a bit worried and in a vulnerable emotional state. Thinking takes a back seat to anxiety; a professional demeanor trumps a lay person’s anxiety.

I don’t know if the physician’s desire for the test was a genuine concern for my health, a desire to collect data for a journal article, or because he feared receiving a bad online review. Perhaps there was a pecuniary interest.

All I know is that I don’t want to be cowed again. I needed to have a better way of dealing with a doctor the next time tests are ordered. I need my reason to remain steady in the face of anxiety, a very difficult task.

So it was with some relief that I read in the NY Times “Are Good Doctors Bad for Your Health,” by noted oncologist Ezekiel Emanuel. Emanuel article is about overmedication but what he suggests is applicable to many doctor-patient interactions. He writes that one “thing patients can do is ask four simple questions when doctors are proposing an intervention” . . .” http://www.nytimes.com/2015/11/22/opinion/sunday/are-good-doctors-bad-fo...

The first question to ask is, “What difference will it make?”

This is followed with, “How much improvement will it lead to?”

Next ask, “How likely and how severe are the side effects?”

Finally, if the intervention is to take place in a hospital, you should ask, “Is it a teaching hospital?” This is important since outcomes are better overall in teaching hospitals.

The last question was irrelevant for my situation but the first three would have been useful. They focus what I was trying to get at but didn’t have the wherewithal to ask.

Emanuel writes how “surprising it is how uncomfortable some physicians are when you ask these questions. No one likes to be second-guessed.” Discomfort aside, these are questions that all patients should carry with them. In stressful situations, as a visit to a doctor inevitably is, it is easy to not think clearly and defer to those in authority. Having the questions at hand helps to focus the discussion and make it easier to decide whether to undergo the suggested procedure.

When your physician recommends a test or procedure, bring out the four questions you have brought with you and go through them one by one until you are assured that all are addressed to your satisfaction. This isn’t a challenge to a physician’s expertise but rather an invitation to collaborative care.

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