Questions for doctors are powerful patient tools

by Toni Bigby

Our Federal Government is investing in a consumer education campaign called, “Questions are the Answer.” The idea is to encourage people to watch out for themselves a little better and be their own advocate by asking their doctors questions like, “Why do I need this surgery?” and “Are there any side effects from this drug?”

Why are we as health care consumers, who collectively spend trillions of dollars each year on health care, likely to ask more questions about a $15 dinner than a doctor’s diagnosis? Why isn’t there a menu listing the costs associated with the services/procedures/drugs that a doctor says we need before we decide whether or not we can actually afford the service?

The way we pay for health care is like we have a high interest credit card with no limit. We buy now and pay later — so much later that our future generations will still be paying because many of us are hesitant to ask: “Do I really need this? Is this my only option? Should I get a second opinion?”

Who is responsible?
Yes, doctors should elicit patient questions and answer them fully. And many doctors –- but not all — even take the opportunity to answer the questions their patients don’t think to ask like, “What are your health care goals?”, “Do you want to live pain free?”, or, “What are the side effects you have experienced from this particular drug or procedure?”

But doctors cannot bear the weight of this burden alone, nor should they. Patients have a responsibility to become informed and to take necessary actions to improve their health. Families ought to help in the decision making process and be supportive. Health plans should have clinicians and medical professionals that proactively help their members understand what options they have.

Patients should ask the obvious questions outlined at the link referenced above. But the historical reluctance to question the health care provider continues to linger on. Don’t get me wrong -– I appreciate the wealth of knowledge that doctors amass. Often times, they know too much which makes it that much harder to communicate to those of us who can’t even remember our own blood type. And besides, it’s hard to ask a question of someone who’s halfway out the door, instructing you to come back for another billable visit and who’s just probably told you something you didn’t necessarily want to hear.

My point is, even if you engage your doctor in meaningful conversation about your diagnosis, the doctor should not be the only one responsible for deciding what is best for you. Each one of us should have an entire team established — the health care consumer, our family, our doctor, and our health plan — all working together in unison.

Why? Because too many of us pay for decisions made simply because the doctor “says so.” We as a country need to decide collectively that we will begin to make informed decisions in the future -– not just the billable ones charged to an unrestricted credit card.

Toni Bigby is Director, Consumer Advocacy at CareSource.

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  • http://www.DNAandYou.org Matt Mealiffe, M.D.

    Great post, Toni. I could not agree more. It’s important for patients and doctors to make decisions collaboratively, and patients can look out for their own best interests by asking savvy key questions hopefully without overburdening MDs by asking too many irrelevant ones.

  • http://www.practicemanagersolutions.com RMore

    Ditto Dr. Mealiffe’s comments. I wonder how second opinions will play into the mix going forward. It is the act of “response ability” on the part of the patient to be communicative with their provider and ask pertinent questions. This also brings up the aspect of providers giving opportunity to patients to ask questions even after the visit, say with secure email, etc. Many times questions pop up after the visit. There are EHR software packages out now that offer that secure communication between practitioner and patient now.

  • Not Savvy

    “It’s important for patients and doctors to make decisions collaboratively, and patients can look out for their own best interests by asking savvy key questions hopefully without overburdening MDs by asking too many irrelevant ones.”

    Sorry, but I don’t have a degree in medicine. If I have to spend hours googling my condition, making sure I understand the risks and benefits of possible treatments, why do I need to see a doctor? Isn’t that what I am paying the doctor for…a diagnosis and a treatment plan? Do I get a discount for doing all the work myself?

    • I’m With You

      Right on! I’m with you, but, do the checking anyway ’cause you may have the pleasure to go to one of these militants/militia doctors who spend their time on hating everyone (including patients) and don’t really have any time left to keep up to date on their job.

  • http://nostrums.blogspot.com Doc D

    I think it was Einstein who said that all important concepts can be explained very simply. If we think in jargon, the challenge is to communicate in language that makes it real for the patients. I’ve found that to be the best antidote to patients’ unfruitful questions. They got it the first time.

  • http://bittersweetmedicine.com DrLemmon

    I like answering questions my patients have. A lot of times I say “I don’t know” and then explain:

    1. Why it does not matter, or.
    2. I will find out, or.
    3. They need a specialist.

    It seems most things are not clear cut if it is not emergency care. A lot of interventions don’t really help that much. Patient’s ask me questions about how much an intervention will help more than anything. I am often ignorant and when I look it up I frequently find it does not help much.

    Once a patient was discharged from the hospital and was in pain from a vertebral fracture. The discharge summary requested I refer the patient for vertebroplasty. The patient inquired. I was writing the referral and then decided to look into it more. I googled it on the spot. Turns out it is a completely worthless procedure, sham procedure just as effective (2 NEJM articles confirm) and worst complication is death. After 8 weeks of Lortab, patient’s pain gone. No vertebroplasty.

    This helps with coding too, charge level 99214, document time counseling.

    Another challenge is colonoscopy versus occult blood testing. Many people know of a loved one who suffered a tragic outcome from a colonoscopy: death and anoxic brain injury come to mind. People like an alternative to colonoscopy (I know I would) and I review USPSTF recommendations on this. Some opt for the colonoscopy, others don’t, but they share in the decision making. Same for mammogram screening.

  • TrenchDoc

    Not Savvy
    You remind me of the patient a few years ago who got offended when I asked him too many questions about his chest pain. He told me that he didn’t understand why I couldn’t just look at him like a Veternarian does his dog and tell him what was wrong. I told him to go see a Veternarian.

    It is your body and ultimately your responsibility.
    We are not Gods!

  • Yious

    But how accepting are doctors to answering questions?

    I have been to doctors that don’t want to spend more than 1-2 minutes listening to or answering questions. It can be quite annoying

    Some feel that what they say is LAW and if anything is even remotely questioned or asked about, the patient is fighting them

    • Consumer

      It depends on your insurance. They already pre-screen everyone and assign you how much time they will spend with you based on your payment not so much on your condition (this takes place before your visit).

      • JustADoc

        Hmm, no.
        At my clinic new patients get 30 minutes, established get 15, physicals get 30, and there are a couple of other categories as well. That is true if you have private insurance, Medicare, Medicaid, Tricare, or no insurance. In most cases I don’t know what insurance you have and don’t look until I am deciding how to bill(can’t bill Medicare a physical for example) or what meds to prescribe(some insurers like one ARB, others like another and if it doesn’t make any real clinical difference, who cares). And if you are self pay I am free to charge reasonably and document only that which actually matters.

    • http://somebodyhealme.dianalee.net Diana Lee

      One way to deal w/ this is to state up front that you have three questions and that you understand he/she is extremely busy so you don’t intend to waste his/her time. This can help grease the wheels when a doctor is confronted by strict time constraints.

  • http://somebodyhealme.dianalee.net Diana Lee

    Awesome post! Asking questions and learning as much as you can is the key to becoming an empowered patient.

  • Dr Synonymous

    The patient should remember that the physician is a medical “coach” with a lot of specialized knowledge. That knowledge can best serve the patient in the context of the patient’s life. “Will I be well enough to fly to Florida next Tuesday?” “What can be done to make sure I can walk down the aisle to give my daughter away at her wedding in two weeks?” “I have a high deductible HSA, what’s the lowest cost for a medium quality gallbladder removal?”

    As the patient gets more personalized with their questions, the physician can get better connected to their values, their humanity and their uniqueness and give personalized answers. The human connection of patient and physician provides a good base of respect for later medical clarification. The consumer in the patient may connect to the consumer in the physician to clarify some cost/quality aspects of the decisions at hand, while the steward of scarce resources in the patient may relate to the physicians desire to be cost effective with scarce, valuable resources.
    The relationship between patient and physician ultimately anchors the dyad in a trusting or disrespectful attitude. That relationship is more critical than many of the questions asked for the wrong reasons, allowing both patient and physician to give their perspective about the issues at hand.

  • Outrider

    >>You remind me of the patient a few years ago who got offended when I asked him too many questions about his chest pain. He told me that he didn’t understand why I couldn’t just look at him like a Veternarian does his dog and tell him what was wrong. I told him to go see a Veternarian.>>

    No, you should have told him to go see HIS veterinarian, as his veterinarian is obviously psychic, though most of us are not.

    Obviously, I don’t ask my patients questions, as they can’t answer for themselves. But I do ask the owners the same basic list of questions a pediatrician might ask a parent. Then I perform a good physical exam.

  • Not Savvy

    It’s interesting how doctors on this blog can be rude to patients are censored. Why am I not able to respond?

    • http://www.kevinmd.com Kevin

      All comments must have a respectful tone. Keep in mind that I have removed plenty of comments from physicians as well.

      A reminder that I reserve the right to delete any comment for any reason at any time. I do not have to disclose or explain my reasons.

      I moderate about 200+ comments per day in addition to my normal activities. I apologize in advance if some offending comments inadvertently get through, or if I accidentally delete legitimate comments.

      Best,
      Kevin

  • TrenchDoc

    Kevin
    I apologize if other bloggers are offended with what I have written. The same issues happen in the office. If you don’t like the answers then don’t ask the questions. Patients have a duty and an obligation to educate themselves about their health concerns. I always try to provide honest answers and list all of the treatment options for the patient. Give and take and an exchange of opposing views is always good. Don’t get mad at your doctor if he doesn’t answer questions you don’t ask . The Mayo Clinic has a patient educational booklet titled “Ask Questions, Leave With Answers”.

    • Not Savvy

      “Patients have a duty and an obligation to educate themselves about their health concerns.”

      My grandfather with an 8th grade education who doesn’t even own a computer is going to get inferior care because he doesn’t have the skills to “educate” himself.

      And I consider myself “educated.” When I walk in the doctor’s office, I already know the possible diagnoses, the possible treatment plans, their side effects, tests needed, etc… I often sit there politely and listen to it all again. Many times information is missing or inaccurate. The only reason I go is because I don’t have the authority to order tests or prescribe my own drugs. Thank God for Dr. Mercola, Dr. Weil, Dr. Chopra….

  • TrenchDoc

    It is all about communication. You don’t have to be educated to ask the basic questions:
    1. What is wrong with me?
    2. What is the best treatment?
    3. Will I get well?
    4. Do I have cancer.
    In fact I have found may times the more educated a patient is the more difficult it is to communicated with them. To communicate there has to be a connection between the patient and the doctor. It takes equal effort. So if you are a patient and not getting the answers maybe it is YOU who is not communicating. Don’t assume it is always the doctors fault.

  • TrenchDoc

    You “educate” yourself by asking questions.
    Otherwise we were all stupid before the internet. We are really talking about communication. Many times I have found that the “educated” patient has already made the diagnosis of their condiotion before they are every examined by me. I would certainly consider giving them a discount if they were correct in their diagnosis which they rarely are. “It is hard to fill a cup that is already full.”
    Let me give you some 8th grade education questions I frequently get:
    1. What is wrong with me?
    2. How do I get well?
    3.When will I feel better?
    4. Do I have cancer?
    Do you need to know anything else?
    So the next time you go to the doctor, empty your cup and write down those 4 questions.

  • TrenchDoc

    “Thank God for Dr. Mercola, Dr. Weil, Dr. Chopra….”

    What do they all have in commom?
    They are all good communicators.