When I see patients, a typical encounter goes something like this:
1. Patient gives complaint
2. I ask questions; patient answers
3. I offer my diagnosis and recommend treatment
4. Patient goes home happy (usually)
Do you see anything wrong with that exchange? In fact, given the one-way nature of it, "exchange" is hardly the appropriate word. Within recent years, however, patients have become more informed, typically looking to the internet for health information. Unfortunately, it is becoming increasingly difficult for patients to understand what information is credible and what is simply junk. Research shows that patients don't understand how to interpret the evidence for health care. Let's face it -- health care data can be pretty complicated. And since you and only you can ultimately make your health care decisions, this can be a real problem. Imagine taking a new job or moving to a new home without understanding what you've just agreed to!
As a doctor, I appreciate when patients put their trust in me. It means I have connected with them and demonstrated that I can do my job well. But that doesn't mean that you shouldn't actively ask your doctors questions about your care. Sometimes, doctors make mistakes. Sometimes a doctor forgets to ask an important piece of information or a patient forgets to mention it. In any case, not all care is great care. You should make it a good practice to learn the guidelines for your condition prior to your appointment or to ask your doctor how medical guidelines might differ from what he/she is prescribing. But remember that guidelines are just meant to guide, they're not rules. Every patient is different, so with your input, your doctor can tailor the appropriate treatment for you.
A common misconception related to medical care nowadays is that newer is always better. Along with newer, it also usually means more expensive. Many patients often want the latest medication or medical device. And if they are well-insured, they often want the most expensive care. But the newest or most expensive is not necessarily the best care. When you hear of a new technology or medication, do you ever ask how it compares to what came before it? According to data, most patients think that just because it's new, it must work more effectively.
This is not always the case. For example, think about how many times you hear of new drugs or devices being recalled or taken off the market? Yes, science and technology advance with time, but that doesn't always mean that what's newer is always better than the well-tested older standard. Think about it: aspirin has been around for decades. How likely are you to stop taking it just because a new drug is out? I recognize that for some consumer goods -- cars, furniture, airline tickets -- more expensive can mean better service -- but remember that being prescribed a drug is not the same as buying a car!
Sometimes, less is more. What do I mean? Well, more care isn't always better care. In fact, more care can be burdensome, especially when it's not necessary. The tough part is that doctors want to make sure their bases are covered and a patient is fully cared for, so they may suggest more care. And some patients expect everything to be done when they got to the doctor's office, even if it is just for a sore throat. If a physician suggests less care, the patient may lose faith in the doctor. How many of you have gone to the doctor insisting on an antibiotic, even though you were told it was a viral infection, for which antibiotics don't help! The evidence shows that patients feel more comfortable with their treatment when they receive more care, but unfortunately, that doesn't automatically correlate to better care.
So what can you do to ensure that you receive the best care? You can start by being more active in the process. Take notes at your doctors' appointments. Ask questions. Use the internet, but look carefully if there are ads or sponsors on the site, which may question the objectivity of the site. Ask your doctor to compare treatments and speak up if you're unsure about something. With you as part of the process, you can make the best decisions for your health care.
K. Carman et al. "Evidence that consumers are skeptical about evidence-based health care." Health Affairs 2010, 29(7): 1400-1406.
Follow John Whyte, M.D., MPH on Twitter: www.twitter.com/drjohnwhyte