Gilfix & La Poll Associates LLP Gilfix & La Poll Associates LLP

Suggested Questions

SUGGESTED QUESTIONS TO ASK THE DOCTOR

The following questions and the answers to them will allow you to make the best
possible decisions for your own health care or for that of your family member or friend. Be
sure, however, to ask these questions as tactfully as possible. Remember that you have
the right and the responsibility to obtain the information that asking them will provide.
Each of us will be confronted with numerous medical decisions during the course
of our lives. Such decisions can be as simple as whether or not to take a particular
medicine for a sore throat, or as serious as whether to terminate life-sustaining treatment.
Treatments have different purposes. Some are intended to restore health, some to slow
the progress of disease, and some to provide comfort. We should evaluate as best as
possible the purpose and benefits of the treatment, how effective it is likely to be, and
weigh these against its risks and side effects. We should also try to find out whether there
are alternatives that could be better for us, including the possibility of no treatment.

TESTS

  1. Why are you doing this test (or tests)? What do you hope to learn? Will a test provide substantially better information than a clinical assessment of my symptoms? – Than a thorough history?
  2. Have I had any tests similar to this that make this test unnecessary (Duplicative testing is too often done.)
  3. How is it done? What do I need to do to prepare f or the test?
  4. What are the risks?
  5. What are the benefits to me? Will the results of the test influence treatment decisions, i. e., will it affect outcome? How?
  6. When will I get results? (Make sure that you find out whom to contact if you
  7. do not receive the results. Follow up. Many test outcomes never find their way to the patient; some never even make it to the ordering physician.)
  8. What if I wait?
  9. It may also be important to know if the ordering doctor has a financial interest in the testing equipment.

The following are to help you evaluate whether to consent to a proposed test or diagnostic procedure:

  1. Is the test technically valid or satisfactory? What will be learned from the test, and how valuable is the information?
  2. How safe is the test?
  3. What is the sensitivity of the test? In other words, how often does the test fail to indicate the presence of what it is designed to test for? For example, how often does an EKG fail to show any heart disease when there actually is heart disease? (This is called the incidence of “false negatives.”)
  4. What is the specificity of the test? In other words, how often does the test indicate that there is or there may be a problem when there actually is none For example, how often does an EKG indicate heart disease when there is actually a healthy heart? (This is called the incidence of “false positives.”)
  5. How accurate is the test overall? The accuracy of a test is determined by adding the true positives (i.e., test findings indicating the existence of a disorder which is actually present) with the true negatives (i.e., findings indicating no disorder is present which is actually the case) and dividing this number by the total number of tests done.
  6. How useful is this test or procedure for patients generally? Does the medical literature indicate that findings from this test or procedure generally contribute to making better treatment decisions for persons with medical problems like mine or my family member’s?
  7. How useful will this test or procedure be specifically for me or my family member? How will its results be used by the physician in managing my condition?

DIAGNOSIS

Once you’ve thoroughly described and explained your symptoms, agreed to and undergone tests, if appropriate, your doctor will use the evidence to arrive at your diagnosis.

  1. What are the diagnoses you considered, but dismissed? Why? The frequency of misdiagnosis and/or failure to diagnose is hard to determine, but experts estimate the rate to be way too high: around 40%1. The doctor must use the clues given by our symptom description, by his observations, and by results of medical tests to figure out what is possibly wrong. He will rule some things out - making what is called a differential diagnosis. It’s important for you to know what those other diagnosis options were and why they were eliminated. Listen carefully as your doctor explains why he rejected each of the other options. It could be that the clues used to discard a diagnosis are wrong. By reviewing the evidence with your doctor, you’ll be verifying that the correct evidence was used to determine your diagnosis. Write down the names of diagnoses your doctor rejected. It may also be helpful to request to see your medical record including the doctor’s notes. A doctor, writing in the Wall Street Journal, told about how he began the practice of dictating his notes in the presence of his patient so that she could verify or correct the information he was relying on.
  2.  What else could it be?
  3. What happens next?
  4.  If s/he needs to refer you for treatment or further tests, ask where s/he would send a loved one.

TREATMENTS - Including surgery, therapy, medication

Once you understand your diagnosis, know why it was determined for you, and are
relatively sure it’s correct, you’ll want to review treatment options with your doctor.
In addition to the questions you should ask about treatment proposals, you can learn
more through research about your diagnosis and treatment options. With your increased
knowledge you’ll be able better to partner with your doctor to choose the best option for
you.

  1. What are the purposes of the treatment that you propose? What can I expect the treatment to achieve?
  2. What are the risks of the treatment?
  3. What are the benefits of the treatment?
  4. What are the alternatives to the treatment and the risks and benefits of each of them – including nontreatment? Can my condition safely be monitored if I don’t get treatment?
  5. How can I maximize the effectiveness/benefits of the proposed treatment?
  6. What will you do if the treatment does not work?
  7. What if I wait? Ask why it is urgent, if the physician indicates that it is. Ask how long you have to safely decide.
  8. What are the best sources for more information?

IF MEDICATIONS ARE PRESCRIBED:

The above questions about treatments apply, but more specifically, you should ask
the following. Make sure you provide current information on all medications and nutritional
supplements you are taking.

  1. How does the medication help?
  2. What are possible side effects?
  3. What interactions, if any, with other medications, foods?
  4. How and when should I take this medication to make sure it is as helpful as possible?
  5. Ask for written information about the medication and clear written instructions for how to take it.
  6. How and how soon will I be able to tell if it’s working?

IF SURGERY IS RECOMMENDED:

See above, and also consider the following.

  1. Compare surgery with other approaches. Often, surgey should be a lastresort.
  2. Can it be done on an outpatient basis? Can it be m inimally invasive?
  3. What are the risks of waiting? Can my condition be safely monitored if I donot have surgery?
  4. How often is surgery successful in treating the problem? How successful? Ask for information about how others who have had this procedure are doing. Any I can talk to?
  5. Will I need general or local anesthesia?
  6. Can I prepare for a better outcome by following dietary and/or exercise recommendations prior to surgery?
  7. How long do I have to be in the hospital?
  8. How long does it usually take to recover from this surgery?
  9. Ask the surgeon how many such surgeries s/he’s done.
  10. Ask which hospital is the best for this particular surgery.
  11. What is the hospital’s infection rate?
  12. Do surgical teams use a checklist for each surgery? (Ask to see it.)
  13. What steps should I take to enhance or speed up my recovery?

QUESTIONS TO CONSIDER ON BEHALF OF A MENTALLY INCAPACITATED PATIENT

  1. Is the incapacity likely to be permanent, according to best medical judgment
  2. How certain is the diagnosis?
  3. Are any new treatments on the horizon that might help this patient?
  4. Will the treatment provide comfort and minimize pain? For example: Will the use of antibiotics be more likely to keep the patient from pain (e.g., painful bacterial infection, painful cough) or prolong what would otherwise be a relatively quick and painless death? Evaluate in light of the patient’s wishes, values, and medical condition.

GENERALLY, you should ask for the diagnosis and what any other possible
diagnoses are.

Ask what to expect in the short term (over the next few days/weeks) and over the
long term. Make sure you understand any unfamiliar terms, and that you understand what
your care provider has told you. Re-stating in your own words what you have been told will
help to clear up any confusion or misunderstandings.

REALIZE that physicians do not always agree on the best approach or course of
treatment for a given health problem. Find out as much as you can before making
important health care decisions for yourself or on behalf of a loved one.

Only the patient, not the physician, is the ultimate source of decision-making
authority for the patient. If the patient is incapacitated and cannot make his own decisions,
legal authority rests with a surrogate who acts according to the patient’s previously
expressed wishes (e.g., as provided in an Advance Health Care Directive) or who uses
“substituted judgment” to interpret what the patient is likely to want, or who decides
according to his own judgment about what is in the patient’s best interests.

Deal with physicians as valued and respected consultants or partners in evaluating
the patient’s needs. Remember that stress, fear, intimidation, and unfamiliarity with
medical settings and jargon can easily impede communication.

Be sure to seek accurate and complete information. Request a private place to talk;
avoid rushing into decisions in hectic places such as hallways. Be aware that health care
personnel are also under stress – tact is important. But keep asking until you understand.
Repeat to the doctor your understanding of what she has said, so she can correct any
misinterpretations.
 

NOTES:

  1. DIAGNOSIS: The reality is that doctors will often form a diagnosis within 30 seconds of hearing your complaint – and stick with it even if subsequent information doesn’t fit. So,
    1. Tell all of your complaints/symptoms – even those that seem minor or unconnected.
    2. Put symptoms into chronological order; knowing what came first can be critical.
    3. Don’t dismiss a symptom or guess what it means - the doctor may agree with your assessment that it was “just gas” even though you may be worried about ovarian cancer;
    4. Bring a list and a companion to help you remember and get your questions answered.
    5. You may want to do some research – either on your symptoms prior to your appointment (so that you can hone your questions to the doctor) or after – when you have a diagnosis. There is a handout in your folder on Internet Medical Research. It’s very basic, but if you haven’t done this before, it will get you started.

I also want to give you a couple of other practical tools that are very specific and helpful for every one of us.

TO: HAND HYGIENE

Most of this is self-explanatory, but I want to note a particular example of when “doing
nothing” or “monitoring” the condition may be the better choice. [See p. 3 #4] Recently I
read about a large review of Medicare records (more than 7,000 patients) that found that
older people with small kidney tumors were much less likely to die over the next five years
if doctors monitored them instead of operating right away. Even though almost all of the
tumors turned out to BE cancer, they rarely proved fatal. And surgery roughly doubled
patients’ risk of developing heart problems or dying of other causes. After 5 years, 24% of
those who had surgery had died, compared to only 13% of those who chose to be
monitored. Only 3% of EACH group died of kidney cancer. (The study only involved people
age 66+, but ½ of all kidney cancers occur in this age group.) Surgery is the STANDARD
treatment now – but in order for people – at least of this age–to make a decision, this
information is certainly material.

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