Talking to Your Doctor? Speak Up
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The Tillies C®$»kb«**»k ...start sending in recipes note — Page 3-E People ...loohs at artist Travis WhitHeld — Page 19-E The Times Update Sunday, March 8, 1981 Advice Church news Features Shreveport-Bossier E By SALLY REESE Of The Times Staff When you talk to a doctor about a diagnosis, speak up. Ask questions. You have the right to know "anything and everything" about your case. When you've entrusted your care to a doctor, work with him. You have a responsibili-ty for the outcome as well as the doctor. This is advice from three professors at LSU School of Medicine in Shreveport who treat as well as teach. Dr. Perry G. Rigby, Dr. Leonard I. Goldman and Dr. Herbert D. Tucker are the authorities for this discussion. It has to do with how to get the most from the doctor-patient relationship. Rigby is the associate dean of the medical school. Goldman is associate chief of the sur-gery department. Tucker is an internist in the family medicine department. All agree it is important for the patient to be an active partner in his own care. "A doctor and a patient should work together like two people in a canoe," said Tucker. "You pull your oar and I'll pull mine." A patient should ask his doctor for all information that will help him work with the doctor in treating the illness, he and his col-leagues said. "One of my pet peeves is the patient who won't take any responsibility for his treat-ment," said Tucker. But it's important to recognize the dif-ferences in patients, Goldman said. Some pa-tients want to be intimately involved in the care they're getting, said the surgeon; others want a "father figure" to take care of them. "I don't think lots of patients really want to know all the details of their illness," Goldman said. "As a physician, this is something you have to appreciate. Sometimes you have to read a patient's needs and wants and manage him appropriately." It is important to establish rapport, said Rigby, whose medical specialty is hematology. "You get acquainted with your patient, and you go about it in such a way as to end up with an informed patient who's interested in his case and what's going on," he said. "In that sense, I want a patient to be better informed. He's more willing to cooperate." The doctor should begin the doctor-patient relationship with the intention that "the patient will be informed to a reasonable degree and you're going to discuss things," said the as-sociate dean. Lots of things can be handled well in a short time to establish a relationship for care, he said. "You want to promote mutual trust. That means the doctor needs to ask questions too. Is the patient following his advice? Is he taking his medicine?" Mutual trust, said Rigby, is one way the patient can be a partner. Patients needn't be abashed by medical terminology and medical procedures. If the doctor orders diagnostic tests, the patient should want to know why, these doctors said. The patient has the right to know the purpose of the tests. "Certainly patients can ask, 'Why are you doing that? What do you expect to gain by doing that?'" said Rigby. "Sometimes, the patient won't ask that." If risks are involved, the patient should expect the doctor tell him what they are and whether benefits outweigh risks. (It's the pa-tient's decision to have a test or not; he has the right to refuse.) In a book titled "Talk Back to Your Doc-tor," author Dr. Arthur Levin says the patient should ask how soon he will get the results, and when they are in, what are the exact findings, and what is the normal range. Patients should ask how much a test will cost, says Levin. They should not hesitate to inquire about fees. They can ask for a full explanation of all charges. Will that turn the doctor off? Drs. Tucker, Rigby and Goldman shook their heads. "Patients have a right to know anything and everything," said Goldman. "It would be a lot easier if they did discuss fees at the outset." "The patient may ask, 'Is this really necessary? Can I do without it?' I really ap-preciate that," said Tucker. Eventually, there's a discussion of "What do I have?" — a question better asked after the diagnostic workup, said Rigby. That's the time to "discuss the case in detail," to learn what the doctor thinks is wrong. The patient should expect the doctor to explain what the diagnosis means in terms he can understand, said the doctors. (He also can ask for-the official diagnosis for the purpose of checking reference works or consulting another doctor, says Levin.) He can ask what findings were used to arrive at diagnosis. What body systems are involved. What caused the illness. Is it con-tagious? Will it spread? How could it have been prevented, and when can he expect it to im-prove? What signs of worsening should he watch for? He can ask what forms of treatment are available, the risks and benefits of each, and why the doctor chose the one he recom-mends. If surgery is involved, the patient may want to get a second opinion before making a decision. This is a valid medical procedure, so he can ask the doctor to suggest someone. (He doesn't have to see the person the doctor suggests — he can choose somebody else.) Dr. Tom Ferguson, physician and editor of the journal "Medical Self-Help," was reported as advising a second opinion before agreeing to any costly or potentially diagnostic procedure, Talking to your doctor? Speak up 6A doctor and a patient should work together like two people in a canoe.' — Dr. Herbert D. Tucker or any surgery other than minor surgery. (FDA Consumer, September 1979) Goldman said there are situations in which a second opinion is not necessary. As a matter of fact, there is a dispute over the cost-savings benefits of a second opinion. Some say a second opinion can prevent un-necessary surgery and thus reduce patient costs. Others say the difference of opinions is negligible and thus a second opinion only in-creases patient costs. "Most of the time, where there's rapport, patients don't want a second opinion," said Tucker. • I n the surgery realm, the patient wants A the assurance that there is a need for surgery and that it will be performed correct-ly," said Goldman. "He looks to the surgeon for advice and the feeling he's getting adequate support. That's what a patient really wants, and, hopefully, we can provide it." If drugs are prescribed, the patient should ask what they are, why they are indicated for treatment, and how they work. "Will you ex-plain these drugs?" is the umbrella question Rigby advised. All advised patients to ask about possible side effects. They should expect a doctor to tell them that, anyway. "And if they have a side effect, fall out at home, I want to know about it," Tucker said. "I expect them to let me know." (Some people will develop a side effect simply because they know the drug may have one, the doctors said. On the other hand, there's the placebo effect. "Sometimes, you might improve somebody just because he feels he should be improved," said Rigby.) The patient should understand what the dosage is and how long he must take it (some patients don't know this, because they don't ask), and what if anything he should avoid while he's taking the drug. He can ask that a drug be prescribed by its generic name, if possible, rather than by its brand name. Tucker said doc-tors are aware of the cost factor and are willing to do this if it is medically appropriate. Rigby said some im-portant questions a pa-tient can ask are: What is the plan for me between now and the next visit? Are we trying to establish a diagnosis? Do we have one? Is a form of treat-ment in view? In turn, Rigby added, the doctor might say we'll do this now and this the next time. In that frame, patient and doctor can "work into" the issues that are important. A patient can make it clear at the outset that he wants to play a positive role in his treatment. "Rapport depends on what the patient expects of you," said Goldman. "Some patients can threaten a doctor. I mean, threaten his ego. Where's there's trust, the doctor doesn't feel threatened." Rigby said he wants a patient to participate in his own care, to be involved in the outcome. Unfortunately, some outcomes are "lousy," said Goldman. "But I'd like the satisfaction of knowing I've done a good job, whatever the outcome." Yes, said the surgeon, you should tell the patient the prognosis, you should level with him. "You don't have to cite the statistics on his chances. It's wrong to say to the patient, 'You've got two months to live.' It you have to use a statistic, use it for the good. It's better to recognize that some people have been cured of the disease." Said Tucker, "Don't take away all hope."
|Title||Talking to Your Doctor? Speak Up|
Consumer Health Information
Rigby, Perry Gardner
Goldman, Leonard I.
Tucker, Herbert D.
|Notes||Illustrations of physicians|
|Identifier||See reference URL on the navigation bar.|
|Source||Louisiana State University Health Sciences Center Shreveport Medical Library (http://lib.sh.lsuhsc.edu)|
|Coverage-Spatial||Shreveport (Caddo, La.)|
|Rights||Physical rights are retained by Louisiana State University Health Sciences Center Shreveport. Copyright is retained in accordance with U.S. copyright laws.|