What can Patients Do to Improve Their Medical Care?
We have touched on the subject of the patient’s contribution toward their own best medical care briefly on various threads in the past but now I would like to devote an entire thread to the issue. There has been a host of topics dealing with what physicians and other healthcare providers could be doing better. And I believe there is much validity to many of the comments about deficiencies and excesses in the medical profession and the need for change.
But what about the patients themselves? Again, believe it or not, medical diagnosis and effective treatment is a two way street. Beyond physician responsibilities, it is the responsibility of patients to provide the history, the cooperation with examinations, compliance with treatment and timely communication with doctors regarding treatment course and complications.
I don’t want to write more here myself. I do want to read comments from my visitors regarding how they look at the need for patient participation and cooperation in their own medical care. It's OK to present any personal examples but no names please. ..Maurice.
posted by Maurice Bernstein, M.D. @ 10:46:00 AM
4 comments
4 Comments:
From a patient point of view:
-Show appreciation for your doctors’ efforts and time spent on your behalf. Doctors do a lot of work for which they are not paid, such as reviewing labwork and radiology and reporting the information to you between appointments and filling out paperwork for medical equipment, insurance appeals, or school or work.
-Communicate with your doctor. If you are unable to undertake a course of treatment or absolutely unwilling to take a certain drug, let him or her know, and be very specific why, while acknowledging the benefit your provider thinks the treatment will offer. Sometimes a patient needs to take a short break from procedures and tests because of stress or deal with a more pressing problem first; if it’s more urgent, your doctor will have the opportunity to let you know if you communicate. I’ve seen people at my PT’s office suddenly realize that their work schedule will not allow them to come in on a regular basis; not communicating this with your physician makes you seem like a noncompliant patient rather than someone attempting to take responsibility. If you don’t want to have a hysterectomy because you feel emotionally attached to your uterus or can’t take several weeks from work, your doctor will understand that better than your seeming unwillingness to undertake a recommended procedure that would help.
-Don’t expect miracles. Often you cannot be completely pain-free or cured from many conditions.
-Educate yourself about your illness or condition and your options, looking at reliable websites such as those from nonprofits that help people with your condition and those that offer peer-reviewed studies. If you have a rarer condition, don’t expect that your doctor has read all the studies about it and thus knows about all possible outcomes.
-Recognize that different doctors have different approaches and that the studies in medical journals often contradict one another. If you’d like a different approach, ask about it--don’t become hostile. You also can’t force them to prescribe something they don’t agree with, though you can make a case for your cause.
-Recognize that many physicians don’t approve of complementary therapies, even those shown in peer-reviewed journals to help a certain condition. Honesty is still needed about supplements and herbs, since they can interact with other drugs in dangerous ways. Your doctor may change his or her mind about some CAM therapies over time.
-Don’t come in “knowing” your diagnosis, unless you’ve already received that diagnosis from another doctor. It’s fine to say you think you have a particular condition, but most of the time you don’t know for certain. Don’t toss a stack of printouts at your doctor. Do write up a summary of the pros and cons of a couple of recommended therapies if there's a complicated decision to make.
-Admit your own uncertainties about symptoms. Try to be as exact as possible, but never exaggerate your symptoms or reactions. You’re doing yourself a disservice and you’ll lose credibility. You don’t have to be dying of pain or a condition to get help.
-Recognize that delays are sometimes unavoidable. Some time you may be the patient who needs a longer appointment, or who has to deal with a defective catheter during a procedure. (At the same time, physicians should not routinely keep you waiting several hours.)
-Be patient with office staff and nurses. They are people, and I’ve seen some patients forget this. If the office staff is too difficult to work with, let your doctor know or change doctors.
-If you think your physician is not listening because of bias (such as if you’re female, young, or does not believe you despite documentation), be gently insistent/self-advocating. Being as specific as possible (stating sleep lost, hours of work lost, activities you cannot participate in, foods you cannot eat) will help your physician understand how best to treat you.
- Overtreating patients can also lead to harm. Your physician is not negating your problem if he or she recommends against treating it yet, but may recognize that, for example, a failed back surgery would be more devastating than current back pain and may result in more surgeries. The side effects of some medicines may be stronger than the benefits until a certain stage is reached.
-Remember that some people go to the doctor for more minor symptoms; your doctor often cannot know if you worry about more minor symptoms or if you’re someone who waits until you are too sick to work or your spouse or friends “make” you.
-Don’t overwhelm your doctor. You can only treat so much at one appointment and may need to prioritize, dealing with the most pressing concerns first.
-Say thank you. You’d be surprised at how surprised they are.
The first and most important thing a patient can do to assist in his/her health care is to tell the truth. The patient needs to know that we don't really care that they drink a 6 pack of beer a day or do crack cocaine on a regular basis, but we need to know these things to take care of them properly. Hiding things from their doctor just compounds any problems they may have. It ties the medical providers hands and gives them false information that may directly impact the type of care provided.
I can't say it enough. Patients need to tell their doctors the truth......it is their responsibility!
Gosh, what further can I say? Well, one important point I think not mentioned by Friedawrites. That point is: all patients, within their capacity, should be responsible to check to make sure 1) that the patient understands the name of the prescribed drug, the dosage and frequency to be taken and the main side effects or complications for which to be aware. 2) that the drug that you get from the drugstore or is being administered to you in the hospital is the drug that you were told about and that the directions for use is also the same as you learned from your doctor. 3) If hospitalized, challenge the nurse administering the medications (by mouth or by injection) to identify each medication for you. This gives the nurse another opportunity to check what is about to be administered.
4) Don't forget or dismiss these patient responsibilities. Medication errors (by nurses, doctors or pharmacists)can be dangerous and if you have the capacity to check, you become the last link in a chain of events to promote safety. 5)When having surgery on one organ or limb and there are two such organs on each (right and left) sides of the body, check to see if the hospital staff has identified the site by some mark or remind your surgeon or anesthesiologist regarding the side. Operating on the wrong side has been not a rare occurrence.
Any more suggestions? By the way, if any visitor has disagreements with what is written on this thread, "speak up". ..Maurice.
One of the most important things you can do to improve your medical care is to chose the right care provider. For instance, if you choose a CYA ob/gyn, chances are, you will have unnecessary medical and surgical intervention. If you choose a midwife, chances are, you will have a natural birth.
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