We live in an era of medicine in America in which patients want to be involved in their healthcare. This is very satisfying to physicians like me, who prefer to educate and engage patients rather than just telling them what to do. Granted, there are some instances when a patient does need to be told what to do (ex: “You have appendicitis. You need surgery.”)
However, when faced with a tough choice in treatment, it is often difficult to know what questions to ask your doctor. Sometimes, a diagnosis -cancer, in particular – can leave you dumbfounded and unable to absorb any further information.
I recently found out an elderly loved one was diagnosed with cancer. She comes from a generation that let the doctors run the show (paternalistic healthcare). Her son has been very involved and, faced with a decision to undergo chemo or not, they were both unsure of what the appropriate next step would be.
Because I am not a family member and I live far from her, I wanted to help her and her son with upcoming doctor appointments. I compiled a list of questions to ask the oncologist (cancer doctor). Really, though, this set of questions can apply to many situations where you have a difficult treatment decision to make.
- What would happen if I did nothing?
- What is/are the worst case scenario/side effects of the treatment you are recommending?
- What is the likelihood the treatment will work?
- If it doesn’t work, what next?
- Is it possible to “watch and wait?” Perhaps re-evaluate the issue in a few months by re-imaging. (This may help avoid unnecessary treatments).
- How soon do I have to make a decision?
- What do you think about getting a second opinion? *
*(I personally do not take offense to this question, so don’t feel shy about it if you feel very unsure about what is being recommended. However, it is generally not a good idea to “doctor-shop” or try to find someone who will recommend what you specifically want. While there can be varying ways of treating the same thing, two opinions generally should suffice. There are always exceptions, but your healthcare can get more convoluted and expensive the more opinions you get. Often physicians will order redundant tests if they do not have easy access to the first set of data).
And, most importantly, try to convey to the doctor what your overall goals are. Is it independence? Is it living as long as possible? It might be staying healthy enough for a particular event (like a grandson’s wedding, or a child’s graduation). I knew a patient who preferred to be in pain from poor circulation rather than undergo leg amputation. Perhaps in your own belief system, you want to do everything possible to stay alive, whether or not it means losing independence. There are myriads of views on personal healthcare and it is often difficult for doctors to know what your personal goals are.
One last tip, when you think you might be faced with a difficult diagnosis or discussion with your doctor, bring one friend or family member with you to be an extra pair of ears for you.
Linda Pourmassina is an internal medicine physician who blogs at Pulsus.
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