Tuesday, October 14, 2014

Questions to Ask to Reduce Diagnostic Disasters

Part Three of a Seven-Part series on Medical Care
Humans are incredibly adaptable. You can put us into the most bizarre situations, and we somehow learn to cope; eventually, we even begin to accept an untenable situation as almost normal. Unfortunately, this happens in medicine, too. Arrogance, ego, and hierarchy have become entrenched within the culture of medicine. This has led to what Dr. Peter Pronovost describes as “normalization of deviance.” . . . . To have an impact on the millions of misdiagnoses that occur each year physicians are going to have to overcome some ingrained behaviors.
Although some signs and symptoms are obvious indicators of a particular condition, many others are ambiguous and require sleuthing, intuition, testing, and modern technology to determine a correct diagnosis. . . . Ultimately, the most important component to successful diagnosis will be good communication and collaboration between patients, nurses, and physicians. That requires attentive listening by health professionals. Patients need to be able to tell their stories without being interrupted. Seemingly trivial details may provide the key to unlocking a mystery.
Top 10 Questions to Ask to Reduce Diagnostic Disasters
·         What are my primary concerns and symptoms?
Think about a conversation with your physician as if it were a noisy cell phone conversation with a friend. . . . Your doctor may be preoccupied or just not hearing everything you are saying clearly. . . . . The same thing is essential when you tell your story to your physician. Ask her to “teach back” to you what she heard. That way you will be sure she got all the key points.
·         How confident are you about this diagnosis?
Getting the diagnosis right requires a healthy degree of open-mindedness and the realization that something else might be going on. Encourage your doctor to share his level of uncertainty about your diagnosis.
·         What further tests might be helpful to improve your confidence?
This is a slippery slope. On the one hand, you want an accurate diagnosis. . . . Finding the balance between accuracy, affordability, and safety is critical to any decision to seek additional testing.
·         Will the test(s) you are proposing change the treatment plan in any way?
Most doctors are curious. That’s a good thing. They want to know what is causing your symptoms. But sometimes their curiosity can lead to expensive, invasive tests that hurt and may not change anything about your treatment.
·         Are there any findings or symptoms that don’t fit your diagnosis or that contradict it?
Once a doctor anchors onto a diagnosis, it can be hard for him to dismiss it, even if there is evidence that doesn’t quite fit the pattern.
·         What else could it be?
This is huge! If we had time to ask our doctor only one question, this is probably the Big Kahuna. Always ask this question regardless of how sure your physician is that he has your diagnosis nailed.
·         Can you facilitate a second opinion by providing me my medical records?
This is hard. Really hard! Even though patients have the legal right to review or obtain a copy of their medical records, it takes chutzpah to ask a doctor to provide a copy. Many people fear that they will antagonize their health care provider by requesting this document. Some doctors will be annoyed, but the growing movement toward electronic medical records is encouraging patient access.
·         When should I expect to see my test results?
Will you call with them, or will they come by mail or electronically? Doctors and doctors’ offices can be disorganized, just like the rest of us. They are human, after all. The trouble is that their disorganization can have life-threatening ramifications.
·         What resources can you recommend for me to learn more about my diagnosis?
When a doctor gives you a scary diagnosis, it can be overwhelming. Even something fairly common like diabetes or hypertension can seem overwhelming. When you get home and process the information, you may be tempted to turn to Dr. Google for more insight about your condition. . . . The Web has an amazing amount of helpful information if used skillfully, but people may also end up scaring themselves to death with inaccurate diagnoses. Patients can benefit from this incredible tool if they are selective and consult their doctor for interpretations and recommendations.
·         May I contact you by e-mail if my symptoms change or if I have an important question?
If so, what is your e-mail address? Be prepared for your doctor to say no. Most doctors reserve their e-mail for family, friends, and colleagues. Doctors seem to fear that they will be inundated by long messages and questions from patients that will take up significant amounts of their time. . . . Although there is not a lot of research on e-mail communication in medicine, the doctors’ fears appear to be unfounded.
In the world of Veterans Administration healthcare, the MyHealtheVet online system is intended to help with this aspect of your care and communication with your health care provider. However, having said that at this point it is a relatively new system and not fully mature, so don’t expect too much of it.
According to the web information (https://www.myhealth.va.gov),as a veteran or VA patient, in addition to accessing your records (at an authenticated Premium level) you may:
Use Secure Messaging to communicate online with your VA health care team. You may send messages to request or cancel VA appointments. Use it to ask about lab results or find out about a medication or health issue. Or simply to discuss other general health matters.

Part Four will discuss Mistakes Doctors Make When Prescribing Medications

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