My wife came back from a doctor’s appointment the other day, and immediately, I noticed that she looked puzzled and somewhat confused. So, I asked her about her appointment. She went over her discussion with the doctor as I kept probing with questions about their conversation. I found myself asking the following question more than any other: “Well, did you ask him about…?” Before too long, doing what I do for a living, I could not help but wonder why patients aren’t more inquisitive. Is there something about the patient-doctor relationship that makes patients not want to ask questions of their physicians?
Surely, the primary responsibility for gathering information about the patient’s medical conditions is and should be with the physicians. After all, their knowledge of medicine is vastly superior to that of the average patient. Still, when a patient has questions, there is often no good reason not to ask them. Consider a physician who orders hormone replacement for a female patient with a history of blood clots or hypercoagulability of which the physician is unaware. Consider another patient who develops a series of complications after a surgical procedure but who decides to tough-it- out and not ask any questions during follow-up appointments with the physician. In both of these examples, the patient risks developing potentially life-threatening conditions, and, if the patient knows or suspects that possibility for whatever reason, it is probably not a good idea to assume that the doctor will be the one to ask the right questions. So, why are patients sometimes reluctant to ask more questions about their medical care or condition? I don’t presume to know the answer, but I suspect, in part, it has to do with the patient’s expectations.
For example, when I am pain, I don’t really want to have an extensive Q & A session with my doctor. I just want treatment! It is simply mentally relaxing to just let go and have someone else take care of me. In addition, my knowledge of medicine is superficial at best. I don’t feel comfortable asking questions if I don’t know what I am talking about. My ego would rather have me in pain than allow me to question a doctor at the risk of looking like a fool.
On a subconscious level, I am probably also dealing with preconceived notions about doctors. As long as I can remember, I have been told that doctors are intelligent and in control. After all, who else is capable of getting into medical school and then have the stamina to survive some seven to ten years of medical training? All of this makes me think that my doctor can only make the right decisions about my medical care. And then there is the medical office or the hospital. The smells, the patients (most with problems far worse than I have), the complicated machines that look like they belong in a sci-fi movie don’t exactly add-up to a familiar, comfortable environment. I am in pain, uncomfortable, and somewhat intimidated – not exactly an environment conducive of critical thinking.
Well, if this is how other people feel, I think that might explain why patients are sometimes not as inquisitive as they should be. What do you think? If you are a patient or a physician, your feedback is much appreciated. Of course, everyone is welcome to comment.
Contributing author: Jon Stefanuca
Editor’s Note: This piece was written by Jon Stefanuca. My own wife has an advanced degree in pathology, did surgical pathology and autopsies. She DOES ask questions! Do you really need a medically-related degree, however, to ask the basic questions so that you have a clue what you’ve just agreed to by way of medical care? I think not. Moral of the story: be your own patient advocate! If you need help, then have a family member or a close friend accompany you if you have any doubt.
Tags: informed consent, Nash & Associates, patient advocate, patient care, patient-doctor relationship
Medical Malpractice and Catastrophic Injury Litigation | Eye Opener: The Nash & Associates Blog 
May 31, 2010 at 5:48 pm |
I think you’re on the mark about people not asking doctors questions about what they don’t really understand. When I was a busy executive, I just trusted that if something came up on test results that I should know about, doctors would tell me and prescribe appropriate treatment. I figured everyone is busy, and if there was nothing material to discuss, this was one less thing I needed to be concerned about. Then I became really, really ill and found what that the doctors I thought were my “buddies” didn’t want to have anything to do with me anymore. So I gathered my records and read a great deal about medicine, illnesses and the U.S. medical care system. I learned that doctors were just filing my reports and ignoring abnormal findings. I learned that doctors do not have the patient’s best interest in mind in running their businesses. After gaining some knowledge, I started asking a lot of questions, which I found the doctors could not or would not answer. I also got a lot of none answers aimed at avoiding the subject at hand. Some doctors even complained that I was “nit picking” or “interrogating” them when I was looking for answers about my becoming chronically ill. I don’t know if doctors are largely incompetent or just callous. What happened is I became disabled six years ago at age 50 unnecessarily. My blog http://doctorblue.wordpress.com is filed with descriptions of patient-doctor encounters in which doctors deflected my questions. Using the results from the tests they ordered and performed, I self-diagnosed, got Social Security Disability benefits and am seeking treatment on a piecemeal basis because doctors are so specialized and none appear to be ultimately responsible for a diagnosis or treatment plan. If I hadn’t spent all of my money seeking medical care, futilely for a large part, I would have spent it on hiring a medical malpractice attorney for failure to diagnose and treat. Virginia has a “continuing care” exception to the statute of limitations. It’s still my dream to one day file a medical malpractice claim because it would make a most interesting and hilarious documentary seeing each doctor point to the other and explain their nonsensical responses–sort of what you get a lot in hearings on Capitol Hill.
May 31, 2010 at 7:20 pm |
After reading your comment, I couldn’t help but go to your blog and start reading your posting of May 17th. I then decided maybe to understand better what you’ve been through, I should start with ‘Story #1: The Beginning.’
As I was doing so, I couldn’t help but take note of the following passage:
In discussing your office visit with Dr. Halloran, the ENT specialist, you narrate that after he went through the pathology findings with youi, the following took place:
“At the time, he just looked at me and said, “You don’t know what I’m talking about, do you?”
No, I didn’t. I just sat there with my deer in the headlights look. I didn’t ask him to explain. Perhaps I rationalized that if it was important, he’d explain without my having to ask. Perhaps I didn’t say anything because I was scared that it was something bad that I didn’t want to hear about.”
This is precisely the nature of the problem this post and others were intended to address.
Your blog and comment you kindly posted here tell a too often heard tale of poor communication, over-specialization, abject frustration – all, it sounds, contributing to your unfortunate state of ill health.
You mention you were a busy executive and relied on the medical professionals to tell you if something was wrong. As you reflect back on it now, what would you have done differently? If someone with you background and education wound-up in such a situation, what chance – one might ask – is there for others of lesser education and experience?
Can you share – if you are willing to – what your life experience has taught you to tell others in the way they interact with medical professionals?
Some have suggested creating a list of symptoms, signs and questions before the examination. Others suggest that a family member or special friend attend special conferences/examinations/meetings.
What is your advice to our readers on how you believe the can at least optimize their chances of a meaningful encounter with healthcare personnel.
Thanks so much for sharing your comment and your blog. Hopefully, others will take the time to read your story.
Best – Brian Nash
June 1, 2010 at 9:01 am |
Thank you for taking the time to respond in such a meaningful fashion and for sharing your story with the public. Part of your comment invoked a topic of special interest to me – the not so infrequent inability of physicians to coordinate the care of patients who really require in interdisciplinary approach to treatment. It seems like you have encountered this problem on more than one occasion. I personally think that our healthcare system is ill-designed to promote communication and, more importantly, cooperation among physicians of different specialties. This fundamental flaw can and does result in tragedy.
June 1, 2010 at 9:33 am |
To add another dimension to this discussion, which really hits upon major concerns in today’s health care industry….1) A patient should PREPARE for every doctor appointment in advance. Write a list of questions, and SHOW it to the doctor to have him answer every question right then and there. You, the patient should bring a (big) tablet and pen with you to write down the answers. Ask the doctor to please speak slowly and explain things in non-medical words. IF he says he doesn’t have time, ask for his nurse; 2) Bring a Patient/Health Care Advocate with you to every appointment to be an extra set of eyes and ears, and ALSO take notes. This person can be a friend, family member, or a Professional Patient Advocate. While the latter, a Professional Patient Advocate is not covered by insurance (i.e., private pay), an “experienced” voice working SOLELY to help YOU, the patient, will SAVE you from making mistakes, enormous amounts of time, and the frustration and confusion of the medical rollercoaster. To find a professional in your area of the country, go to: National Association of Health Care Advocacy Consultants — http://nahac.memberlodge.com/. I emphasize “SOLELY to help YOU” because there are “patient advocates” who are so-called “free” but beware, they work for insurance companies, “hospitalists” at hospitals, and the like; their primary allegiance is to their EMPLOYER, NOT YOU, the patient.
Sheryl Kurland
Patient Advocates Of Orlando
June 1, 2010 at 6:23 pm |
Excellent comment and suggestions, Sheryl.
If you have read any of our other posts on ‘informed consent’ and related topics, we are absolutely pushing all the time for our readers to take the kind of steps you are advocating (no pun intended).
We have also suggested that if a physician will not give the time a patient needs to discuss fully what concerns he/she may have and/or to give the patient the time he/she needs, then maybe it’s time to move on to a new physician.
The suggestion to do notes before the appointment is key and should be taken to heart. It does a number of things: (1) it makes the patient think about what is really important and on his/her mind – what questions they have, what concerns, what is confusing to them; (2) it demonstrates a involvement on the part of the patient that I believe is good for a caring doctor to see; (3) it also shows respect for the doctor’s time and schedule – you are prepared in order get the information you need but not in a time-consuming haphazard fashion.
I have also suggested that if a person suspectst that they will need a fair amount of time to address their issues and concerns, they should advise the staff of such at the time of setting the appointment. This may help lessen the time concerns for all participants.
Again, Sheryl, thanks for your comments and thoughts.
June 1, 2010 at 11:21 pm |
What am I doing differently now having become disabled due to lack of diagnosis and treatment? I write a letter to the doctor I’m seeing which outlines: 1) reasons for the visit – what I hope to accomplish, 2) summarizes the results of relevant medical tests and lists copies of test results attached, then puts the results into perspective based upon on-going, thorough research, 3) lists present symptoms, concerns and questions. The summary basically serves as the “evidence” for my self-diagnosis. I hand the letter to the doctor when he enters the exam room, and then the letter works as an agenda of sorts for our meeting. Doctors have told me that this is very helpful to them because it provides a written record of the answers to the questions they typically ask. It also works as a “jumping off” point to which knowledgeable physicians add new information that has been helpful and informative to me.
Not all the doctors I see are confident doctors who appreciate the effort, however. I found that many doctors refer specialists based on friendship. Some doctors are “put off” by findings or questions with which they are ill informed and shut down, even though I take great care to be assertive rather than aggressive in my approach. The effort is a work in progress which I continually strive to improve.
I also talk to as many other patients as possible about their illnesses, treatments, the doctors they’ve seen and outcomes. I learned about new therapies and competent medical experts from patients who said they learned of them from the same doctor I was seeing. I puzzled over why my doctor hadn’t mentioned some of these possible treatments to me — such as non-surgical treatments for compression of discs in the spine. Could it be because I hadn’t made that symptom a priority in my letter (because I wasn’t aware that such non-surgical therapies existed)? Communication is an art form.
It takes me considerable time and forethought to put these letters together. It’s also taken me quite a while to get used to the idea that one has to thoroughly research and become competent in every aspect that touches one’s life before hiring someone claiming to be an expert in that field. It’s a daunting feat. I’ve had to re-examine how I lived my life and slowed way down as a result.
What happened to me is that I had an undiagnosed gastrointestinal obstruction – an intussusception – that caused a build up of toxins and waste in my system. This lead to ulcerative colitis, an autoimmune condition, that caused adrenal fatigue, hypothyroidism, venous congestion… I contracted multiple systemic infections that I am still fighting today. The infections and inflammation wrecked havoc on my spine and joints. Once on Medicare, I made an appointment with a colon specialist at The Cleveland Clinic (7.5 hours away by car). I had a resection and rectopexy this past February there. Now I’m working on eradicating these infections, getting my autoimmune and gastrointestinal problems addressed as well as trying to find ways to mitigate the pain from severe osteoarthritis — all while staving off creditors and the foreclosure of my home. I was fired from my job in January 2004 when I could no longer perform to the level expected, and haven’t been able to work since then.
Thank you for your interest. I find your blog posts helpful and informative.
June 2, 2010 at 7:00 am |
Once again, the effort, time and thought you obviously put into crafting your reply comment are immensely appreciated. I can only hope that our readers take the time to read and take to heart your suggestions.
Your technique of preparing a letter is a great suggestion. Needless to say, you (nor I) are not suggesting, I assume, that this is necessary for ‘routine’ visits. This type of endeavor would best be used when there is concern on the patient’s part over some significant acute or chronic complaint. That being said, ‘laying it out’ for the physician is an outstanding way to (1) provide key medical history, (2) give the detailed nature of the chief complaint; and(3) encapsulate the patient’s concerns and issues in order to be a pro-active participant in one’s own heath and treatment.
We have all seen our ‘chart’ sitting in the plastic holder outside the exam room. While some doctors keep detailed, informative medical records, having reviewed thousands of medical records for over three decades, I am utterly convinced that these are the exception rather than the rule. Parenthetically, it is amusing and disconcerting when I take a treating physician’s deposition and ask them to read their entries or the entries of one of their associate physicians who happened to see the patient previously and they can NOT even read what is in the chart. So much for understanding the past medical history and record of prior treatment. Don’t think for a second that this is all that rare an occurrence!
I take particular note of one other comment you made: “It’s also taken me quite a while to get used to the idea that one has to thoroughly research and become competent in every aspect that touches one’s life before hiring someone claiming to be an expert in that field. It’s a daunting feat.”
Most unfortunately, you have learned the hard way what we have been preaching for a long time – the patient MUST be proactive in their own healthcare.
All of us – and I will speak particularly for myself – sincerely hope and pray that your health will at a minimum return to a level where you are able to get back to a meaningful, relatively pain-free life. God bless!