On Being a Smart Patient

There are many obvious and not-so-obvious questions you should ask yourself as well as your doctor when you consult her:

1. Is it difficult to get an appointment or reach my doctor in an emergency? Does the office have a convoluted automated call system, does my doctor return calls or do I hear from the office nurse or secretary? Is it difficult to get prescriptions re-filled?

2. When I have a physical complaint like back, muscle, or chest pain, does he/she examine me? If I have abdominal pain does she examine my abdomen while I’m lying recumbent on an examining table-and with my belly exposed. With new or unexplained abdominal pain, does she do a rectal or pelvic examination. (Which reminds me of a long-ignored surgical adage from my old friend, Dr. Goodman: “Put your finger in it before you put your foot in it.”)

3. Does my doctor encourage specialty consultation in serious, chronic, or unexplained illness, or am I reluctant or embarrassed to ask for an outside opinion?

As I have previously pointed out, it has long been accepted knowledge that an office visit generally concludes in one of three ways: the patient receives a prescription, an order for some tests-or both. With a new or chronic complaint, does the doctor rattle off a list of possible diagnoses. Beware the Rule-Out doctor. Patients, laboring under a sense of entitlement because they pay so much for health care, often are only too willing to collaborate in this clinical farce. One of our friends once remarked, “Why not get all the tests possible, check everything out, go for broke? It’s already paid for.” (By whom, I might I add? She was a nurse too.)

The idea that generally the more tests the better is a supreme example of deeply flawed thinking or clinical inexperience. Misguided, excessive medical investigation often discloses an innocent abnormality which far too often catalyzes an uncontrollable series of unforeseen events leading to clinical catastrophe, the so-called “cascade effect” (about which more later.) Moreover, unnecessary and redundant medical testing is one of the principal reasons our healthcare system is lurching into bankruptcy.

A critical consideration in ALL medical testing: Will the results of this test change my treatment? No medical test or procedure should be performed as a fishing expedition or for mere curiosity, but only for the purpose of changing the management of the patient. This is especially important with invasive testing, such as endoscopic studies or cardiac catheterization, all of which carry minute but measureable risks of misadventure.

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