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
No comments:
Post a Comment