Sunday, October 16, 2011

Ten Questions to Ask Your Doctor?

The blog, Shots, posted a question primer to prepare patients for medical office visits with their doctors. A reaction to this appeared on Glass Hospital, where John Schumann offered his own wry version of the question list. My less wryer, and more drier response appears below.

While I agree with Shots that education is power, a closer look at the question list demonstrates that the intent to educate may obfuscate instead.

First, the post is entitled, Ten Questions to Ask Your Doctor, suggesting that patients arrive at their physician’s office armed with 10 inquiries spanning a spectrum of medical knowledge and philosophy including medical treatment strategy, physician qualifications, risks of treatment, medical treatment alternatives, choice of hospitals and even how to spell the names of their medications. (I guess Shots believes that spelling counts!)

Some of the questions sound reasonable, but could patients make sense out of the answers? For example, Shots suggests asking which hospital is best for my needs? Patients often are focused on the choice of hospital, when they should be more interested in which physicians will be caring for them. While the hospital matters, it’s much more important who will be performing your surgery, then where it will take place. Are patients equipped to evaluate hospital quality anyway? Is a good reputation or a shiny exterior a true surrogate for medical quality? Patients often have a negative view of a hospital based on an isolated anecdote, which they may not have even experienced first-hand.

Another suggested question is how many times have you done this procedure? Will this provide useful information for patients? I agree that for many medical procedures, a higher case volume means a lower risk of complications. But, will it enlighten a patient to know that the gastroenterologist has performed 2000 colonoscopies or 5000 or 10,000? Better questions, which can’t be quantitatively answered, would be how many times have you done this procedure well, or, how many of your procedures were truly medically necessary? I object to Shots’ version of the ‘how many’ question which simplistically reduces medically quality measurement to a check-off form, paying homage to the deities who gave life to the pay-for-performance beast. What really counts can’t be counted. Paradoxically, what can be counted, will count.

In addition, if you bring your doctor the 10 question list, be prepared for some frustration when your office visit ends and you’ve only covered the first 3 items on the list. There may not be time left for you to discuss the issue that brought you t see your doctor in the first place. It may take a few visits and a fair amount of dialogue for you to understand your physician’s philosophy and style of medical practice. This important information can’t be acquired by taking a multiple choice test or answering a series of questions.

The question list on the blog Shots is a guide that needs to be prioritized. You simply can’t cover them all in a single visit, and you shouldn’t have to. Experienced physicians know that patients often want to cover every last medical concern and we will often begin a visit with a question from our own ‘top ten list’. What are the 1 or 2 issues that we need to cover today?

Any questions?


A. Bailey said...

I think this is a reasonable list and I wouldn't begrudge anyone asking me any of the questions.

There are questions patients should be prepared to answer honestly and reliably:
1. What medications are you on, name and dosage (two blue pills a day doesn't count).
2. Really, why are you here to see me? If you don't know, would you come back when you do?
3. Who else have you seen for this problem?
4. Tell me every test you've had for this, including date and institution.
5. What are your honest expectations of me? Review prior work-up? Repeat all the studies? Work miracles?

Toni Brayer, MD said...

A. Bailey: Love the "work miracles".

Liz said...

excellent questions for both doctor and patient, as your commenter suggests.

yes, work miracles.

ShakesandStones said...

As a regular patient I have to agree with most of what is written. However, every person is different as are your medical problem, therefore the question set changes for each person and each appointment.

In my experience I follow these steps:-

Do your homework before you go to the doctor so you know what to ask.

Qualify your doctor. Ask questions that satisfy you that you are being treated by the right person.

Understand your symptoms so you can articulate them to your doctor effectively and ask questions about them.

After your appointment do your research so you can learn more about your diagnosis and treatment options and whether you have the right option for you.

Ps. A Bailey, I think your reverse questions are bang on. When I see a new doctor I cone armed with a file that outlines my medical history and medications etc... I don't however include my expectations. I think it goes without saying that I should expect miracles;)

GlassHospital said...

Dear MDW:

Thanks for the shout out! Great post on an interesting "do the right thing" topic.....

-GlassHospital (aka John)

Michael Kirsch, M.D. said...

@shakesandstones, right on! As for working miracles, I assume this shold be our minimum standard.

Aileen said...

P.S. I'm not sure if evolution is an uphill or downhill progression. What if it didn't have a directional value at all? Perhaps evolution can be best understood as either a constant or not. Either a species is "progressing" or it isn't. Projecting this perception to say, various segments of today's human race could we not say evolution is struggling to exist?

Devolution exists friends, it is simply evolution in the state of dormancy.

Aileen said...

O.K. you two, Michael&John I'm with you on your opinions and I empathize, truly I do!

Consider: With your hand on the doorknob, you are told only that you are about to enter into " an encounter with another primate". With only this knowledge, which of millions of questions flash thru your mind as you hesitate ? physical..a gorilla..verbal..a human..danger..necessary ..LOL why.. Uhmmm . . and how do you feel ?

While appreciating your takes on the Ten Questions advice, a better question might be "Why is the general public so ignorant about everything related to their health ?"
In the 21st century awash with information absolutely everywhere, after a minimum of 12 whole years of absolutely-need-to know 'education', how can this be?
Could it be that they're programmed to be . . . to whose benefit . . to what utility . .or profit. . . . how could this even be considered . . . such an advanced society . . is the species devolving . .

Now how was it you said YOU felt standing there with your hand on that latch . . . ?

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