Sheldon Greenfield and Sherrie Kaplan, who head the Primary Care Outcomes Research Institute at New England Medical Center, are well-known for examining the relationship between patient assertiveness and health outcomes. In four separate controlled trials that they led, people with ulcer disease, hypertension, diabetes, and breast cancer were given copies of their medical records and then coached by researchers for upcoming office visits. The investigators pointed out important parts of the records and helped patients prepare questions and negotiation tactics, as well as ways to overcome embarrassment, timidity and anxiety. The office visits were recorded, and people were subsequently given physical examinations and questions about their health status. Results were compared with a control group given no special prompting.
Outcomes in all four trials indicated that coaching increased a patient's involvement in care, which in turn was associated with improved health. The patients stated they felt better and functional limitations were improved. It is indicated that the results were associated with more control by patients, more expression of emotion by both doctor and patient, and a greater exchange of questions and answers (reported by Ronny Frishman, Harvard Health Letter August 1996).
The following are a few things one can do to get more out of "the doctor's visit":
- Come with questions and ask them. Make a list and bring it with you.
- If you have more questions after the first visit, write them down and either send a letter to the clinician, call the office or leave a message. It's best to write the letter; then you have documentation regarding your concerns.
- Don't by shy; it'll do you no good. Bring support if needed: your spouse, for instance, or a close friend.
- Keep the conversation on track. Don't go off on a tangent that is not related to your concerns. Don't allow the clinician's questions to interrupt your train of thought.
- Take notes or tape record your visit. Most patients don't remember half of what happened during their visit.
- If you do not feel confident with your clinician's recommendations, treatment or diagnosis, ask for a second opinion. Even though this can be difficult, a good clinician will honor your request.
- Let your clinician know your limits. If a test or treatment does not seem reasonable or seems too aggressive, let them know. You may not want to have that surgery or angiogram: what other choices do you have? Sometimes repeating a simple test may answer many questions.
My father had a blood test a few years ago, and his IGG (immunoglobulin G) had a myeloma spike. The physician wanted to perform a bone biopsy. He said, wait a minute, what kind of test is this biopsy, and what are you looking for? Well, after discussing this with his daughter, we decided to repeat the lab test. It came back normal.
- If you are given very disturbing news by your clinician and you feel just overwhelmed, just tell the clinician that you are overwhelmed and need to come back to talk another time. Then, you can prepare questions and research your condition.
- Educate yourself. If you have a chronic or serious illness, get a notebook and build your own reference library, with notes, medical records, responses to treatments, articles, etc. Be informed.
In my next article, I'll review some of the more common references and ways of finding medical information. What if your clinician reacts negatively to your questions and refuses to answer you to your satisfaction? You may have the wrong clinician. Get a second opinion!
Deborah Pate, DC, DACBR
San Diego, California
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