Ask your doctor smart health questions

Going to the doctor can be confusing.  Doctors make recommendations based on what they know, and patients are conditioned to trust their doctors.  While I think it’s wonderful that patients trust their doctors, there are times when patients want more input into their health care, and if this is the case, then let me make some suggestions as to what might be important questions to ask.  There is nothing specific to psychiatry about my recommendations, so feel free to have these types of discussions with any doctor or prescriber.

If you go to the doctor for a routine visit and it is suggested that you have routine health maintenance tests or treatments and you are fine with that, then there is not much to ask.  If you have a concern about the necessity of a test or procedure, try to figure out what your concern is so you can verbalize it.  One example might be: Will routine vaccinations cause my child to become autistic?

  • Why do I need this test?
  • What is the risk of this procedure?
  • If a medication or supplement is being offered to decrease the risk of a specific illness later, then it’s reasonable to ask if studies show that this treatment is known to be effective.  This may sound silly, but sometimes we just don’t know things: so people took statins to lower their cholesterol, but it was a while before it was clear that they also lowered the risk of heart disease. And now the thinking is that Vitamin D and Calcium supplements may not lower the risk of osteoporosis in post-menopausal women (they may have other benefits however) but they do increase the risk of kidney stones.

More importantly, if you choose not to follow your doctor’s recommendations, ask:

  • What are the risks of not taking this medicine/supplement/having this vaccine?

My favorite personal example.  When one of my children turned three, I took him to a pediatric dentist to start routine care.  The dentist told me it was standard procedure to x-ray a child’s mouth at this age.  I wondered why — if there are no obvious problems, their baby teeth are going to fall out anyway.  I asked and was told that they like to make sure the adult teeth are there.  Hmm, how many people don’t have adult teeth?

I didn’t ask that, what I did ask was, “If you do an x-ray and find that there are no adult teeth, what can you do about this?”

The answer was, “Nothing, we just like to know.”

So I’m no dentist, but my take on this was that the x-ray exposes my little person to radiation, costs money,  and if a problem is discovered, there is nothing to do to address it.  I verbalized this and the dentist was okay with not getting an x-ray.

If you go to the doctor with a specific problem, things are a little different.

  • If the doctor orders a diagnostic test, you may or may not want to ask what he is looking for or trying to “rule out.”  The answer may be something scary that is very unlikely and perhaps you may not want to know to worry about something that’s not likely to be the problem.
  • Is it an option to treat a presumed illness without having a diagnostic test first?  If the treatment is something easy or benign or cheap or a lifestyle change, maybe it would make sense to try that before having an expensive or painful procedure.  If the test is being done to rule out a treatable form of a serious illness, then usually doctors do not like to delay a test.
  • If the doctor recommends a specific treatment, it’s reasonable to ask “How long it will take to work and when do you want to hear from me if things are not better?”  This is important, if you’re supposed to be better in 3 days, you don’t want to come back in 6 weeks saying you’re still sick or hurting or very much worse.  And if the treatment is going to take 6 weeks to work, he doesn’t want to hear that you’re not better in 3 days.
  • If you don’t want the treatment your doctor recommends (or you’re not sure), it’s reasonable to ask: Are there other treatment options available?  What is the expected course of this illness/injury/problem if I don’t have this/any treatment?  Sometimes the doctor won’t know because different people have different courses with an illness and this can be especially true in psychiatry.

Sometimes people go to the doctor because they are worried they have a specific illness and are then disappointed when the doctor does not order a test to look for that illness.  Sometimes the concern is

  • It’s reasonable to say “I am worried that I have X, how can you be sure that I don’t?”
  • You might then ask, “Would it make sense to order X test?”
  • You might also ask, “If I continue to have these symptoms, are there diagnostic tests or treatment options that might be reasonable to try?”  And then ask for a time frame.

The truth is that doctors often don’t have the answers to these questions, but sometimes it’s helpful to hear their rationale for a decision or to let them know your concerns.  They certainly don’t have crystal balls when it comes to issues of preventative care and risk, and often recommendations are made based on presumptions — for example, people with sunburns get skin cancer, sunscreen prevents sunburn, sunscreen will prevent cancer — before we can be absolutely certain that such logic will bear out.  And whether or not sunscreen prevents cancer, it might be nice to not be in blistering pain tonight regardless of long-term risk.

Dinah Miller is a psychiatrist who blogs at Shrink Rap and co-author of Shrink Rap: Three Psychiatrists Explain Their Work.

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  • http://twitter.com/drsharryn dr sharryn

    And as doctors we need to be ready to discuss or justify our choices / suggestions. This kind of dialogue can only be healthy.
    Bring it on!

  • sFord48

    An ideal doctor/patient relationship would involve a doctor who knows my health and my values and makes recommendation based on my needs. I really don’t want a doctor who just throws out standard advice.

    If I have to be savvy enough to question my doctor’s advice, why do I even need that advice in the first place.

    Clearly the dentist used as an example was trying to make a buck on ignorant patients.

  • http://www.twitter.com/alicearobertson Alice Robertson

    I say the only stupid question is the one that isn’t asked. The doctor is there to serve you. I loved when our specialist knew I was nervous that our daughter would die and I would e-mail him my philosophical fear-filled letters. He wrote back calmly….reassured me…told me he would clear his desk at any time just to chat…encouraged me that I must know I can write at any time. Nothing felt too shallow or unimportant not to mention. I took up as little of his time as I could…although by the end we had become friends. How I wish doctors knew how healing that type of *risky behavior* is to a patient (or her mother who felt like she was dying inside).

  • http://www.facebook.com/people/Stan-Racansky/583864826 Stan Racansky

    Excellent story, but I have few points I would like to point out.

    1. Most of the people are not able to formulate even right question.
    2. In many cases the doctors do not know themself to answer correctly. Look your point about statins. Even at last conference of cardiovascular specialists had been shown that twice a year visit to dental hygienist is more effective then statin treatment.
    3. Many doctors have a chip on the shoulder

  • http://twitter.com/shrinkrapdinah dinah

    Stan– I agree that most people can’t formulate the right question, part of why I wrote the article. It’s particularly hard when someone is sick and vulnerable and a lot of information is thrown at them at once. And some things are so ingrained in all of us, that we don’t even think to ask if they make sense. Doctors may not know, but then shouldn’t it be fine to say “I don’t know” or “We don’t know,” or “this is what the studies show” and let the patient decide? Doctors should get rid of those chips.
    Alice, You have a nice doc.
    sFord: the truth is that there are standard protocols all docs use– they don’t let you take you’re baby home from the hospital without a car seat, and your individual circumstance may not matter.
    Dr. Sharryn: I agree!

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