How to Be a Smarter Patient
A Good Appointment
Surprise: The amount of time primary care docs spend with their patients is actually growing. Between 1997 and 2005, the average length of a visit increased from 18 to 21 minutes. Many doctors say they wish they could talk with patients more, but you can do a number of things to maximize the limited time you get.Bring a Friend or Family Member with You
While you'd probably think to do this if you were getting the results of a biopsy or a diagnosis, our experts recommend bringing someone along for any major informational visit, whether it's a pregnancy checkup or to discuss how to get your diabetes under control. Not only will your companion come up with questions you might not think to ask, he'll also keep you honest and may be able to help you nail down specifics with greater accuracy. "I'll ask a patient how long she's had a certain spot on her skin, and she'll say, 'Oh, probably a month,' and the husband will say, 'It's more like a year,'" says Dr. Kriegel. That could make a difference in whether the doctor decides to do a biopsy or just watch it for a few months.Retain the Information
Even if you have a backup with you, one of you should be taking notes or even recording the conversation (be sure to ask first). "Studies suggest that 85 percent of what patients hear is forgotten by the time they get to the reception desk," says William N. Levine, MD, director of sports medicine at Columbia University Medical Center. Before you leave, find out the preferred way to have your follow-up questions answered. A call to the nurse or physician assistant might be your best bet, but some offices let patients use e-mail for simple questions.Get Reassurance
Doctors assume, logically, that you go to see them to find out what you have and how to fix it. But sometimes what you really want to know is what you don't have. You want reassurance that persistent bloating isn't ovarian cancer or that an endless cold hasn't turned into a sinus infection. Once you know that, you may be comfortable with waiting it out. If that's your situation, speak up. "Doctors may order tests or prescribe drugs when they think the patient expects them to do something," says Dr. Chutkan. "Watchful waiting is not in vogue, but it's a useful tool." Every time your doctor suggests a drug or test, be sure to ask: What will happen if I don't do this? Are there any alternatives? What are the risks?Talk About Side Effects
Sometimes your doctor will prescribe a newly approved drug or offer free samples of it. "But we may not have much information about the long-term effects," says Dr. Fugh-Berman. If you have the option, especially if it's for a long-term, chronic condition, it's generally better to use an older drug. "And generic medicines are not only cheaper, they've usually been on the market at least seven years, so we know a lot more about them." While doctors should always tell you about any potential adverse effects, they may not know as much about the medication as you'd like. It's worth talking to your pharmacist or looking up the drug yourself (try FDA.gov or Drugs.com).Get a Second Opinion
Yes, you've heard it before, but our advisory board says most people still skip this step, perhaps because they assume they already have the right diagnosis and treatment plan. That's not a safe assumption. "In a series of studies, the diagnosis or the treatment changed 30 percent of the time with a second opinion. And they weren't minor changes," says Michael Roizen, MD, chief wellness officer at the Cleveland Clinic and coauthor of You: The Smart Patient. A great doctor not only expects you to double-check his work with a colleague but hopes you will because it adds a second viewpoint to the problem being evaluated. After all, your physician has the same goal you do: to keep you alive and well.
Many doctors say you should get a second opinion any time you're contemplating nonemergency surgery, coping with a life-threatening or chronic condition, or taking long-term medication, such as antidepressants or statins (to be sure you need it and that it's the best drug for you). You should also seek a second opinion if you can't get a diagnosis, if you're not getting better, or if you don't believe your doctor is taking your symptoms seriously.
Denise Cohen was glad she did it. The 50-year-old was initially diagnosed with stage III breast cancer in Colorado Springs, where doctors recommended that she start chemotherapy immediately, followed by a mastectomy and radiation. She decided to get a second opinion at Memorial Sloan-Kettering Cancer Center in New York City, where doctors urged her to have the surgery first. "It turned out that I was actually high stage I or low stage II. So instead of the heavy chemotherapy regimen my first doctors recommended I was able to participate in a clinical trial with a much smaller dose of chemo and I didn't need radiation at all," says Cohen.
Don't let cost stop you. Insurance typically covers fees and some plans require you to get a second opinion. Options to help with travel expenses exist. Cohen was able to stay for free at the American Cancer Society's Hope Lodge in New York (she learned about it through social networking) and also got several free flights through the Corporate Angel Network.Can't Get an Appointment?
"The receptionist should become your new best friend," says Dr. Streicher. "I can't tell you how many times my receptionist has said to me, 'You don't have any openings, but I've been talking to this very nice woman and she really needs to see you. Is there anything you can do to make time for her?'" If you can't charm your way in, ask another doctor, such as your internist or gynecologist, to call the office on your behalf. "Unless the doctor's going to Zimbabwe for three months, there's almost always a way to get in if you really need to," Dr. Streicher says.
Also consider seeing a nurse-practitioner or physician assistant. With more education than a typical nurse but less than an MD, these professionals can be a great resource for general care or straightforward problems.When You're in the Hospital
Appoint a friend or family member to be your advocate. "Your job is to heal, so it's important to enlist someone else to take the job of asking questions," says Shmuel Shoham, MD, infectious disease specialist at Johns Hopkins University School of Medicine. "It's always good to get a general idea of the plan for the day and then keep asking questions: What is this fluid? What is this pill? What are the most common side effects of that?" Also: Do you have a checklist for this procedure? More and more hospitals are using step-by-step checklists for everything from inserting IVs to delivering babies and this simple innovation has been shown to reduce medical errors and complications.
Dangerous antibiotic-resistant infections are on the rise in many hospitals. So your advocate should also politely request that your health care providers wash up if they didn't do it when they entered your room. While hands are the most obvious germ carriers, studies have also shown that doctors' neckties, white coats, pens, and stethoscopes can all harbor infectious bacteria. So it might also be worth asking your doc if he will tuck in his tie and clean his stethoscope with an antiseptic wipe.
On a more personal note, Dr. Shoham suggests that you bring a framed photo of yourself to the hospital. He says, "I've seen patients do that, and it's a reminder that you're a person, not just a patient. It's a wake-up call that pushes me to be a better doctor."
Originally published in Ladies' Home Journal, August 2011.