Monday, May 7, 2012

How to Talk to Doctors: It Could Save Your Life

My mission in my blog is to expose and explode perpetuated medical mythologies that undermine human health; and to educate people to understand exactly what health is, thus empowering and enabling them to optimize their genetic potential to achieve it.

Reading through my blog one might get the idea that I am anti-medical. That is not true. I am absolutely opposed to the medical disease model as applied to everyday health.

One of the most important advisers you need in your life is a good medical doctor; one that takes time to listen to you and then performs a thorough hands-on physical examination of your chief complaint. Subsequently, he/she explains, to your complete understanding; the diagnosis, the treatment they propose (including the risks versus benefits), your responsibilities now, and ongoing, to safeguard your health.

However, as time is the greatest luxury in today's medical care, you as a patient have some important responsibilities.

Should you need a medical doctor it is imperative that you know how to talk to and question them to elicit the best care from them.

Most importantly, remember that a doctor is not an authority figure. A doctor is a consultant, like a financial consultant; someone whose opinion you can listen to, discuss, dissect, accept, or reject. A doctor's word is not the final word; your word is.

William Osler, the father of modern medicine, once said: “if you listen to the patient, they will tell you what is wrong with them (the diagnosis).” Physical examination findings should then confirm what the history revealed; and any additional or special tests are only needed to confirm a questionable diagnosis and/or aid in further diagnostic and treatment decisions.

Accurate diagnosis is quintessential to proper treatment. Said another way, misdiagnosis creates a dangerous cascade of treatment errors, that all too often are fatal.

Therefore, it is of vital importance that you are a good historian, as aided by your doctor's ability to elicit an accurate history of your chief complaint, including: a detailed description of your symptoms, onset (how and when), progression, aggravating and relieving factors, prior care, tests, pre-existing and/or concurrent complaints, etc.

It is when the doctor gets to the diagnosis and treatment discussions that you really need to be armed and ready with questions, and know how to speak to doctors.

In his book How Doctors Think, Jerome Groopman, MD, states: “no one can expect a physician to be infallible. Every doctor makes mistakes in diagnosis and treatment.” In fact, autopsies reveal that 10 to 15 % of all diagnoses are wrong, and “the majority of errors are due to flaws in physician thinking, not technical mistakes.” Note: misdiagnosis is different from medical mistakes.

Therefore, to reduce the frequency and severity of diagnostic errors there are certain routine questions you as a patient, or your health proxy, should ask.

1.      What else could it be? This question is a key safeguard against several common critical errors in  doctors' thinking.
2.      Is there anything that doesn't fit? “This follow-up should further prompt the physician to pause and let his mind roam more broadly.”
3.      Is it possible I have more than one problem? “this question is another safeguard against one of the most common cognitive traps that all physicians fall into: search satisfaction... This question should trigger your doctor to cast a wider net...”

In addition, simple procedural questions to ask your doctor such as; “Did you wash your hands?” could also save your life.

Today more people die from hospital-acquired infections than die from breast cancer (41,000/year) and automobile accidents (45,000/year) combined. Said another way, (doctors') hand washing might save twice as many lives as would a miracle cure that would completely eliminate breast cancer.”

Prior to any/all treatment, the doctor is required by law to give Informed Consent. This is based on the legal understanding that “every human being has an inalienable right to determine what shall be done with his own body.”

According to the AMA: “Informed Consent is a process of communication between a patient and physician that results in the patient's authorization or agreement to undergo a specific medical intervention.”

Informed consent is an education process during which the doctor must discuss with you, to your full comprehension:
1.      the diagnosis
2.      the nature and purpose of a proposed treatments
3.      the risks versus benefits of the treatments
4.      alternative treatments and their risks vs benefits
5.      the risks vs benefits of doing nothing at all.

If your doctor fails to fulfill this responsibility, you may need a new doctor. At the very least, it is incumbent upon you to discuss all of these things prior to submitting to any treatments.

Knowing how to talk to your doctor can save your life.


kelly Lee said...

Good, useful information that your life could depend on!

kelly Lee said...

If enough patients asked their doctors to wash their hands it could become a habit and they would not need to be asked as often. If doctors stopped wearing neckties lives would also be saved. Especially in hospitals, ties catch and carry infections. Doctors should know this but most I've seen still wear ties.