Are You Getting “Best Care” From Your Doctor?

This is a question that needs an answer! When a doctor resorts to using engaged and other words to mask communication, this is when you, as the patient, need to find another doctor. Even this doctor, that in general I respect, has to muddy the communication waters by using words other than communication.

The truth is that as patients, we have to learn in the health care atmosphere of today. Thirty to sixty years ago, we often could depend on the doctors to be more careful and spend the time necessary to give us the care we needed. Little by little, the insurance industry has taken time away from the doctors and forced them to become less caring, more time conscious, and often less proficient in treating patients.

Medical care today needs to meet the following criteria:

1. It should be grounded in the most recent medical knowledge, which is generally reflected in the relevant expert guidelines, as well as in peer-reviewed clinical resources. This doesn’t mean that doctors should follow guidelines blindly, practice “cookbook medicine,” and go on autopilot. It does, however, mean that for you to get better health care, your doctor should be aware of recent recommendations for how a given condition should be evaluated and managed. When doctors decide that your circumstances merit a different approach, they should be prepared to explain their reasoning.

2. These recommendations should be adapted to your preferences and values when it comes to medical care. In most cases, especially when it comes to people who are middle-aged or older, “one size fits all” medicine is not optimal. That’s because often there are a number of reasonable ways to manage a certain health problem.

3. An optimal medical recommendation should be made after informing a patient of the options for treatment and involving the patient in the medical decision-making process. The doctor should also tell you about these two approaches, and then you’d decide together which to start with. This is called shared decision-making. Unfortunately most doctors will never consider this and their egos insist that they are all the patients needs.

Many medical recommendations don't even come close to measuring up to these criteria. The reason is that many doctors have not been trained to practice this way. Then you need to remember that the insurance cartel influences how doctors practice. Under the Affordable Care Act, many doctors know that they are the only doctor in the area that your insurance authorizes and they act accordingly and you can be forced to follow their directions and their way as you will pay higher by going out of the network. The drug companies continue to spend a lot of time and money to influence doctors to prescribe their products. Finally, doctors tend to develop habits and do whatever takes less mental and emotional energy.

The fact is that medicine is usually practiced according to the doctor’s preferences, rather than according to what the best evidence and best practices recommend. Now that you know the truth, here are some ideas of what you can and should do (providing your insurance does not limit you in your choices):

#1. If you can, look for doctors who seem open to discussing options with you. A doctor who gets defensive when you ask about guidelines or alternatives is probably not a good choice.

#2. Do your homework when it comes to your health conditions and treatment options. There is really no substitute. Even if your doctor is progressive and used to shared decision-making, you’ll participate better in the process if you’ve done a little preparation beforehand. Prepared patients and families generally get better health care.

To learn more about your health conditions and your options for evaluation and management, go to reputable websites. I find that the Mayo Clinic website is generally quite good. You can also get useful information and support by accessing online communities of people with the same health problem. SmartPatients.com (for cancer) and PatientsLikeMe.com (general medical problems) are two well-established sites. Remember, your goal is not to be a doctor yourself, but to arrive at your doctor's office with good questions and to have a good discussion.

#3. Be prepared to ask about alternatives. When the doctor makes a medical recommendation, be sure to ask what other alternatives are available. You may want to specifically ask about non-drug options for treating a problem. These often exist and are even often now recommended as first-line treatment. But busy doctors may not think to suggest them unless you ask them.

#4. Consider a second opinion. Especially if you’re considering a treatment of significance, such as a major surgery, it can be good to get a second opinion (if your insurance will allow this). Maintaining your own copies of your medical information in a personal health record can facilitate this.

Taking care of your health, or helping your parents with their health, is like investing energy in maintaining or even renovating your home. You don’t have to be super involved in monitoring the people involved in the process and things very well might turn out okay. But then again, they might not. The people working on your home, after all, have less at stake than you do. For them, it’s one of many jobs. For you, it’s your home and your money.

The body is like your home, except you have much more at stake. For better health care, plan to do your homework, prepare to ask questions and remember that the medical care should be based on your preferences, not the doctor’s preferences when appropriate.