October 17, 2012

More Assumptions Patients Should Not Make

Having written this blog about assumptions patients should not make, I need to revisit the topic to add a few more assumptions not to make and a few things that it is better to avoid. Some of these ideas have appeared in other publications.

Never assume you are receiving continuity of care.
This is more difficult especially when you have multiple chronic diseases or illnesses where you need to see a variety of specialists. This is a problem area that requires vigilance on the part of the patient and/or family members. This should be something that you consult heavily with your pharmacist to prevent conflicts of medications. Some doctors are great in looking at your records before issuing a prescription, but others can upset the best plans and it only takes one to mess it up and put you in grave danger.

Never insist on self-diagnosis or self-treatment.
While we know our bodies better than anyone, self-diagnosis by the patient can be deadly and is not recommended. It is better to write down all the symptoms that you notice and hand them to the doctor. A diary of symptoms can be a lifesaver when doctors put you off and make unwarranted assumptions. Sometimes these assumptions can be correct, but often they may not be completely correct and the partial treatments may mask the real problems. Let the doctor ask some questions and start eliminating possible problems. The doctor can then order any tests necessary to confirm or rule out illnesses.

Never assume your doctor is always right.
This is a problem for many patients. We do not want to believe that our doctor could be wrong. If you are one of these patients like me, just spend a few months watching the “Discovery - Fit and Health” channel and the “Mystery Diagnosis” program. Yes, most doctors haven't a clue of what is going on as we are talking about rare medical conditions, but the way these doctors handle these cases almost makes you want to reach into the TV and choke the doctor. Patients are often accused of wanting attention or are letting their imaginations get the better of them. While these are the extreme, I hear stories like this from people around me when they are angry with their doctor for ignoring them or not taking them seriously.

Do not assume that the doctor has preformed all the necessary tests.
As a patient, this may be impossible to know whether the necessary tests have been done. This is one time you, as the patient, may need to ask some very direct questions. Never mind what the doctor thinks, it is your health and these questions may save your life. How do you know what to ask? First, you need to ask what tests have been done and what they determined, if anything. Second, ask what other tests could be run. If the doctor starts dodging the questions, you know that there are more tests that may be of value, but this doctor does not know enough about them to be comfortable using them. This is when you know that you may need to seek another doctor.

Do not assume that the doctor is giving you the correct medication or dosage.
Many doctors will give you the best medication after evaluating you and your condition. They will ask questions and probably use some tests to make this determination. If the medication is new to you, make sure you get the correct spelling and then look it up in the Internet to determine if this is an established medication or whether you are being used as a guinea pig for a new medication. Some new medications may be excellent for you, but always be alert for unusual side effects and do not be afraid to talk to your doctor about taking you off the new medication and to an established medication. Read this by Trisha Torrey as she has some good discussion points for you to ask the doctor. It may be in your best health interest not to be a guinea pig for a new medication.

The next question is whether you are receiving the correct dosage. Most doctors will start with a lesser dosage and increase the dose if needed. Be cautious if you are started on the highest dosage and the doctor does not want to discuss his reasons with you or discuss alternative medications. I was considering changing doctors, but during the first appointment, the new doctor insisted that all my medications would need to be changed. When he ignored that I received many medications through the Veterans Administration and stated that I would be coming off insulin and go on oral medications for diabetes, I knew this was not a doctor I could work with. When he stated that my A1c of 6.1 was too low and that I should be between 6.5 to 7.5, I admit I went a little overboard when I asked if he had gotten his medical degree as a prize in a cracker jack box. I said that if he objected to one hypoglycemic reading of 63 mg/dl, then he had no understanding of diabetes and I would keep my endocrinologist and other doctors. That was the end of my appointment, and I suspect by mutual agreement.

Do not assume that your doctor will give you a referral if one is needed.
This can be a delicate issue. Some doctors are willing to refer you to a specialist. Other doctors are so puffed up with their own importance that they feel that they are the only source of medical care you need. Still others will just tell you to find another doctor if you ask for a referral. The last two types are doctors you need to avoid if at all possible. Be cautious if you live a long distance from your primary care doctor and it is even farther to the specialist or another primary care doctor. This article is a good review of possibly how to approach the topic, but be careful if you suspect you have a doctor mentioned above. Some doctors may seem hard to approach; however, done properly, you may get the referral needed. If you know that the referral is necessary, then you may need to request it and replace doctors if necessary. One alternative I have found that works is talking to my medical insurance company and explaining the situation. I was sent a list of acceptable primary care doctors and even a few specialists that I could see without a referral. I may have been fortunate with the person I talked to, but everything worked out for the best when I needed it.

I will continue to look for additional ideas for another blog on this topic.


Rick said...

Great advice! We all do have to take responsibility for managing our own bodies.

Robert K Fenton said...

Thanks RicK!

Many doctors do right for their patients, but it is right to always be on the alert. Many years ago, I was seeing a doctor (now deceased) and he was scheduling me for a test and I had no idea what is was for, so like a good patient I had to ask. He all but bit my head off for asking and then settled down. I could see he was thinking and he asked to be excused.

When he came back, he apologized for snapping at me and thanked me for questioning him. He never did explain the test he eventually scheduled me for, but since it was one I was knew, I did not need to ask.