Although patients are the people who have the best knowledge of themselves and their particular concerns and who obviously have a strong interest in achieving a good outcome, they are often reluctant to ask their doctor questions.
This reluctance may sometimes lead to suboptimal care. Why is there a reluctance to ask questions? The reasons given are varied: “I don’t want to waste the doctor’s time” “The doctor is too busy” “I don’t want to look silly.” “I just trust the doctor to do what is best”.
Some of these attitudes are the fault of my profession. Some doctors like to give the impression of being too busy for questions, others may appear to be condescending towards their patients, even if they don’t mean it, others speak in medical jargon, rather than in clear plain English.
Of course many others are excellent communicators. Many realise that the patient is an integral part of the healthcare team and needs to be informed and involved. They have the attitude that if the patient has a question, it should be raised. Some even encourage their patients by telling them there is no such thing as a silly question and saying: If you are worried about anything, we need to discuss it. In fact, there is good evidence for better outcomes when patients are partners in their own care. Part of this partnership involves patients feeling free to ask questions.
Here are 10 questions we should ask our doctor. The small amount of extra time involved for the doctor may be more than saved in miscommunication, incorrectly followed instructions and patients just not understanding what is happening. It can result in better, safer care. Some doctors anticipate many of these questions by raising them as they talk with their patients, but patients should be prepared to ask them if they are not covered.
- What is this condition (or test) called? Ask the doctor to write it down for you. This really helps avoid confusion.
- What are my options? For example, are there other treatments that are simpler, or safer? This is can be difficult to ask, but sometimes there are other options and we need to know about before we make a decision. Most things in medicine are not emergencies so there is time to think things over and consider other options. Although a basic question in healthcare is: Tell me what is the matter with you? Another basic question should be: What matters to you? This second questions helps tailor decisions relevant to the patient’s needs. For example, the need of a younger person is likely to be that everything possible should to be done, whereas the need of an older person with chronic illness and pain may be just to be able to hang on long enough to attend her granddaughter’s graduation
- For procedures or for medications ask: What are the risks and side effects? Even though things generally go well, many medical treatments have some risks and side effects, so it helps to know, especially if the treatment or procedure is not essential. This leads to the next question.
- Do I really need this test? Or this treatment? Or this procedure? How effective is it? Following a very severe medical mishap, a friend of mine said: We were told all the benefits without being told any of the risks. Think about what percentages really mean. If you are told that the treatment has been found to work in 92% of cases, this also means that it does not work in one in twelve (8%) cases.
- When will I get the results? Do you let me know or should I come back for them? There have been instances with serious consequences where an important test result was inadvertently filed without the doctor realising this and without the patient being told.
- What will it cost me? It’s a hard question to ask but the answer may help a patient decide if the procedure is really necessary or whether to seek more information about what others charge for the same procedure.
- Can I have another opinion? Patients are often reluctant to ask this because they worry that the doctor may be offended. But second opinions are common and if it is a serious and complex problem most doctors readily agree.
- What will happen if I don’t do anything? Doing nothing (watchful waiting and regularly reviewing the patient) is an option in some medical conditions, so it is worth asking the question.
- For a surgical procedure, ask “How many times have you done this operation and what are your results?” This is difficult to ask, but we need to know if the doctor is experienced in the procedure and whether the results are what you are looking for. For all procedures there is a learning curve.
- Then there is the common, often unvoiced, concern of many patients, particularly parents: “What caused it?” “Is it my fault?” “Can I pass it on to others?” For most health problems, the answer is that it is not the patient’s fault or due to something the patient could have avoided. But unless patients ask this question they may carry an unnecessary burden of guilt.
Many of us go to the internet to search for medical answers. Some experts in diagnostic error say that unless the search is done correctly, the chance of getting something useful is about as good as flipping a coin. However, as well as the useless information available on the web, there are some excellent sites: www.healthdirect.gov.au an Australian government site is very good. For information about appropriate tests and medications, www.choosewisely.org.au is a good resource and supported by the Royal Australasian College of Physicians. For child health, especially developmental and parenting concerns try www.raisingchildren.net.au and a very good overseas resource for a wide range of medical and surgical concerns is www.mayoclinic.org
Kim Oates AM MD DSc MHP FRACP FRCP FAFPHM is a consultant at the Clinical Excellence Commission in NSW, Australia and Emeritus Professor in the Discipline of Child and Adolescent Health at Sydney University.