American Medical Association Guide to Talking to Your Doctor

Guide to Talking to Your Doctor

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Guide to Talking to Your Doctor

Angela Perry, MD

Medical Editor

JOHN WILEY & SONS, INC.

New York • Chichester • Weinheim • Brisbane • Singapore • Toronto

Copyright © 2001 by American Medical Association. All rights reserved

Published by John Wiley & Sons, Inc.

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The recommendations and information in this book are appropriate in most cases; however, they are not a substitute for a medical diagnosis. For specific information concerning a medical condition, the AMA suggests that you consult a physician. The names of organizations, products, or alternative therapies appearing in this book are given for informational purposes only. Their inclusion does not imply AMA endorsement, nor does the omission of any organization, product, or alternative therapy indicate AMA disapproval.

Photo credits: p. 4, © AMA; p. 12, © PhotoDisc; p. 36, © Corbis;

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Foreword

Most of us think of medicine as a high-tech science, which it is. But for doctors, the core of their practice is their interaction with patients. Good medicine is a partnership between doctor and patient, whether the doctor is performing a physical examination or listening carefully to a patient’s description of his or her symptoms. The American Medical Association Guide to Talking to Your Doctor is designed to help nurture and strengthen this relationship.

If you are reading this book, you have decided to take responsibility for your health and you want to learn how to get the information you need to help you make informed decisions about your healthcare. You may have older or younger family members whom you accompany to the doctor, and you want to help them get the best care possible. Perhaps you need a specialist or have moved to another town; this book explains the resources you can tap into to find a doctor in your new community. One of these resources is the American Medical Association Web site at http://www.ama-assn.org (click on Doctor Finder).

This book gives you information about how to prepare for a doctor’s visit or phone call. Should you tell your doctor about an alternative treatment you are using? Should you ask about a medication you saw advertised on television? If you need to undergo a diagnostic test, how do you find out how the test is done and what to expect during the test? At some time in our lives, each of us will have a health problem that we would rather not discuss. The section in the book on talking about sensitive subjects gives you some helpful tips on how to bring the subject up and gives you the encouragement to do so.

We at the American Medical Association hope that this information will help you feel more confident and comfortable the next time you visit your doctor. We wish you and your family good health.

American Medical Association

The American Medical Association

Contents

INTRODUCTION

1. CHOOSING A DOCTOR

What are you looking for?

Other issues to consider

How to go about choosing a doctor

Your rights and responsibilities as a healthcare consumer

2. WHAT YOUR DOCTOR WANTS TO KNOW ABOUT YOU

Personal health history

Your child’s health history

Family health history

Medications

Self-treatment

Lifestyle

3. TALKING ABOUT YOUR HEALTH AND MEDICAL CARE

Planning in advance what to say to the doctor

Making the most of an office visit

Learning about medical tests and treatments

Surgery

Understanding a diagnosis

Using medications correctly

Making lifestyle changes

Clearing up misunderstandings

4. TALKING FOR OTHERS

Accompanying your child to the doctor

Accompanying your older parent to the doctor

5. TALKING ABOUT SENSITIVE SUBJECTS

Sexually transmitted diseases

Homosexuality and bisexuality

Sexual problems

Alcohol dependence

Drug addiction

Family violence

Depression

Incontinence

Self-treatments

Dissatisfaction with treatment

End-of-life healthcare issues

6. SPECIAL SITUATIONS

Specialists and subspecialists

Getting a second opinion

At the hospital

In an emergency

Rare diseases

Participating in clinical trials

Doing your own research

RESOURCES

Advocacy

Clinical trials

Diseases and conditions

General health information

Government agencies

Health information Web sites

Home-care services and hospice

Long-term care and housing

Mental health

Rehabilitation

Self-help and support

Miscellaneous

GLOSSARY

INDEX

Introduction

Today the emphasis in health and medical care is on prevention. The American Medical Association Guide to Talking to Your Doctor focuses on the importance of an effective patient-doctor relationship in improving and maintaining your health and reducing your health risks. Use this book as a tool to become an informed, active healthcare participant and to take control of your health and medical care.

In many patient-doctor relationships, the doctor is the more active participant. The doctor talks and the patient listens, the doctor asks questions and the patient provides answers. This limited communication can cause problems for both doctor and patient and can have a negative impact on the patient’s health and medical care. For example, if you don’t understand the information your doctor provides, you may become confused and frustrated and lose confidence in the doctor. You may even stop following his or her instructions, and, as a result, your treatment may not be effective and your health problems could get worse.

Many people are hesitant to talk to their doctor even though they want to ask questions or discuss their health problems. Embarrassment and fear of bad news are two common reasons for not talking to the doctor. Other possible explanations include both real and imagined time limitations, reluctance to question the doctor’s authority, limited ability to speak English, feeling that one’s questions and concerns are unimportant, and not wanting to appear stupid. But to get all you need from your medical care and make informed health-related choices, you need to assume an active role in your own health and medical care. Your doctor relies on information only you can provide, such as details about symptoms, before he or she can make an accurate diagnosis or provide proper treatment. He or she also must have confidence in your ability to follow instructions carefully so that your treatment can be effective.

Your doctor should encourage and support your active participation and always should be willing to take time to address your questions and concerns. The highest levels of satisfaction with medical care and the best treatment outcomes occur when both doctor and patient communicate openly and honestly and work together closely to achieve shared goals.

To become an active partner you need to listen carefully, ask questions, discuss treatment options and goals, participate in decision-making, follow instructions carefully, know what to expect from your treatment, and provide feedback. All of this requires clear communication between you and your doctor. Although it may be difficult at first, you will discover that you and your doctor will gradually work together more easily as you get to know each other. Both you and your doctor will benefit.

The book is divided into six chapters. Choosing a Doctor helps you find what you are looking for in a physician and tells you how to go about the search. Use the checklists and record-keeping forms in the second chapter, What Your Doctor Wants to Know about You, to keep your and family members’ health histories. Talking about Your Health and Medical Care, Talking for Others, and Talking about Sensitive Subjects give you guidelines for discussing your health risks and healthcare needs with your doctor. These chapters also prepare you for talking to doctors for members of your family, such as a child or an older parent, and encourage you to overcome any embarrassment or hesitation you may have about talking openly and honestly with your doctor about sensitive subjects such as sex. The Special Situations chapter helps you evaluate the benefits and risks of treatment options such as surgery that you may be faced with and enables you to make an informed decision about an appropriate treatment for you.

At the end of the book, the resources section and the glossary help you find information about specific topics and understand terms you may have heard or read or that your doctor may use in your visits. The resources section gives the names, addresses (including some e-mail addresses), phone numbers (usually toll-free), and Web sites of diverse associations and organizations that provide information on health or healthcare-related topics. The resources section is subdivided into segments such as advocacy, clinical trials, diseases and conditions, health information Web sites, home-care services and hospice, long-term care and housing, mental health, rehabilitation, and self-help and support.

An Active Partnership

Your relationship with your doctor is a working partnership with a common goal: to keep you healthy. When choosing a doctor, look for someone who takes the time to listen to your concerns and who answers your questions clearly and in a reassuring tone. You want to have confidence in the doctor and feel comfortable enough with him or her to be able to express your concerns openly. The more open and honest you are with your doctor, the better able he or she will be to evaluate your health risks, diagnose an illness, and provide effective treatment.

1

Choosing a Doctor

There are many reasons why you might need to choose a doctor. A change in health insurance, a move to another city, the need for a specialist, your doctor’s retirement, or a communication problem with your present physician all could be factors. If you or a family member recently had a baby, you need a pediatrician or a family practitioner to care for the child. Take your time and ask questions while you are in the process of choosing the physician who is right for you. Don’t make this important decision in a rush. And don’t wait until you are really sick or you have a medical emergency to explore your options.

What Are You Looking For?

Whether you are looking for a primary care physician or a specialist, consider your own preferences and needs. You can easily find a great deal of information about a doctor—from board certification (see page 49) and education to practice philosophy and number of years in practice. What is important to you? Perhaps you prefer a physician who is older than you are, or of the same sex. Would you like your doctor’s cultural background to be similar to yours? Are you more drawn to a person who is warm and personally connected to you, or are you more interested in a doctor’s technical knowledge? If a doctor’s technical knowledge is more important to you, look for a doctor who has a teaching position at a university or has clinical privileges at a respected hospital.

Choosing a Doctor

Q I’m interested in finding a new doctor in my community. What kind of information on physicians can I get using one of those telephone or online doctor-finder services?

A Most doctor-selection services organize physicians by medical practice and location. Some provide information about their background, interests, education, and training. Expanded listings may include photographs of the physicians and their professional achievements. Patients can have a number of different reasons for choosing a physician. For example, some may prefer a doctor who speaks their native language. Or they may feel more comfortable with a physician of the same sex or about the same age.

Other Issues to Consider

Besides personal preference and philosophy, you also will have to consider issues of time, location, and cost. A doctor’s office hours or location may enter into your decision. Find out if you will have to make an appointment far in advance and if his or her office hours and days are convenient for you. Who can see you when your doctor is away or otherwise unavailable? How far will you have to travel to an appointment?

If you are in a managed care plan, your choices are narrowed because you need to choose your doctor from a list of those in the plan. Or you may need a doctor who will accept Medicare. If you do not have health coverage through work, or if you have an individual health plan with limited benefits or no insurance at all, you will have to consider cost along with all the other factors.

Under many health insurance plans, changing doctors means selecting another from the list of physicians whose services are included in your plan’s coverage. Before you make a choice, ask around. Other people in the same plan may be able to recommend a physician whose approach would be good for you.

Should You Change Doctors?

Q I have been seeing the same doctor for 10 years and suddenly I am having a hard time making an appointment. When I do get an appointment, I have to wait at least an hour before seeing her. I don’t know what to do because I have always had confidence in this doctor and I respect her medical knowledge. Should I complain to her or someone in her office or should I just get another doctor?

A Because you like and respect your doctor, you should see if there is a way to solve the problem before you look for another doctor. It’s important that you have confidence in your doctor. In a calm, courteous way, let the doctor know about the difficulty you’ve been having getting in to see her. She is probably unaware of the problem and will be happy to have your input. If the problem persists or gets worse and you feel no effort has been made to improve it, then you might consider finding another doctor.

How to Go about Choosing a Doctor

You can choose a doctor in a number of ways. Ask friends and relatives about their doctors and if they have had good experiences. Ask specifically why they like their doctor; you might not have the same preferences. You also can ask medical specialists and other healthcare professionals for recommendations. Check with a nearby hospital or medical school. An old standby is to ask a doctor the name of his or her doctor; this usually works well when you need a specialist (Who checks your eyes? for example). Local medical societies can give you the names of doctors who are accepting new patients in your area. And many hospitals offer physician-referral services at no charge.

The newest way to find a doctor is through an online doctor-referral service (see General Health Information Web sites starting on page 171). These services will be able to provide you with most, if not all, of the above-mentioned criteria. Whether you need to stick to a list of physicians or are free to choose for yourself, you can find out more about any physician by searching Doctor Finder on the American Medical Association’s Web site. Access it from the AMA’s home page at http://www.ama-assn.org (see page 173). Here you can locate doctors in your area by specialty and find out specifics about their medical training, specialty certification, and practice. After you have made your decision, have a copy of your medical records sent to your new doctor.

Your Rights and Responsibilities as a Healthcare Consumer

People who communicate openly and effectively with their physician and other healthcare professionals and who also know their rights as healthcare consumers are better equipped to make informed decisions about their health and healthcare. You have the following rights as a healthcare consumer:

To receive considerate and respectful care without regard to your sex, age, race, ethnic background, religion, or income.

To be fully informed, in terms you can understand, about your disease or condition,