Dr. Steven Brown: Five Questions to Ask Your Doctor about a New Treatment
“Take two of these pills a day and come back in two weeks.”
“Be at the hospital at 6 AM on Tuesday and I’ll take out your gall bladder.”
“You’ll need these pills for the rest of your life.”
The statements above may have been all the information people wanted from their doctor two generations ago, but in the 21st century, we expect more. We want to understand our health problems. We want to be sure that we are getting the best treatment. We want to know whether we should get a second opinion. But too often, when the doctor recommends a treatment, our minds freeze and we do not know what to ask. Here are five questions that will give you the understanding you need.
1. Why have you recommended this treatment for me?
This open-ended question reveals your doctor’s thinking. The best answer? “Studies in people exactly like you show that compared to other approaches, this treatment will make you live longer.” Unfortunately, not all medical decisions are that black and white. Whatever the answer, it should demonstrate the doctor’s knowledge of medical science.
2. What are the risks?
Any treatment strong enough to help you will have some risk of harm. Even aspirin can cause stomach ulcers and bleeding. What are the worst-case scenarios? How likely are they to happen? If the health practitioner tells you there is no risk, consider a second opinion.
3. What are the benefits?
What should the treatment accomplish? What is the best-case scenario? How likely is that to occur? What should you expect to happen? The bottom line is that any treatment should either make you live longer or feel better. If the treatment will make you live longer, you may be willing to accept more risks than you would for a treatment that will only make you feel a little better.
4. What are the alternatives?
What other medicines or surgeries could be used instead? What are their risks and benefits?
What happens if you have no treatment? How likely are you to get worse or to die? As a doctor who treats heart patients, I find that many people do not understand the seriousness of their disease. Understanding what might happen with no action brings the risks of treatment into perspective. I would never voluntarily strap on a parachute and jump out of an airplane. But if the plane is crashing, I will be the first one out the door.
5. Would most doctors agree that this is the best treatment for me?
In this era, new scientific research spreads rapidly throughout the world. Ordinarily, a consensus forms quickly about the best treatments. If your doctor tells you her recommendation goes against the consensus, ask her why, and consider a second opinion. If your doctor tells you the issue is controversial, so that there is no consensus, you might also consider a second opinion.
Typically, if the question is controversial, the doctor will tell you why he has chosen his particular position on the issue. Listen carefully to his explanation. Does it reflect knowledge of the pros and cons? Does he seem threatened by the question, or does he welcome the opportunity to explain the issues?
Unless it is an emergency, an honest doctor will encourage you to get a second opinion if you want one. Since all treatments have risks, it is important that you fully understand and accept those risks up front. Simply tell the doctor that you have confidence in what she has told you, but that you (or your family) would feel better if you obtained a second opinion. Then ask him where he would send a family member for a second opinion about your particular problem. This approach gives you an inside track to finding an expert in the field.
Two generations ago, doctors may have just wanted people to do what they said. But the best doctors today do not want you to follow their recommendations blindly. They want you to understand your health problems and the reasons for your treatment. They want you to be an active partner in your healthcare, and not just a passive pill taker. They welcome your questions as a way to build that partnership.
You can get more inside health information about working with your doctor in my book, Navigating the Medical Maze, or on my website, www.drstevenbrown.org.
Comments
This information was very helpful.
One question I would have, though, is: under what sorts of circumstances would a doctor go against general consensus?
That's a great question.
Usually, going against the general consensus is a huge red flag. Sometimes I will hear of a doctor telling a patient something like this: "Most doctors don't agree with this treatment. That's because they don't understand these problems the way I do. I can tell you from my experience that this treatment really works."
If you hear a statement like this, run, don't walk, to the nearest exit. You see, in medicine, we do not determine truth by looking subjectively at our own experience. We determine what works by prospective, double-blind, randomized, placebo controlled trials. When I try a treatment, I really want it to work, so I will tend to exaggerate the success. And when something does not go so well, I will not want to remember that bad experience, so I will minimize my failure. (Chapter 5 of Navigating the Medical Maze covers this issue in detail.)
If a doctor has a unique treatment that they believe in, they should subject it to proper scientific study, because if they do and prove its effectiveness, everyone will use it. The only reasons not to do proper study would be either that I am greedy, or that I am a charlatan.
The valid reasons for offering a non-consensus treatment would include 1. The uniqueness of your particular problem; 2. Newer treatments that have only limited availability. (Typically these treatments will also have limited evidence of success. However, if you happen to be at a center that specializes in your problem, the new approach may be reasonable.) 3. The lack of effectiveness for you personally of the usual treatments for your condition.
The bottom line is that non-consensus recommendations are usually a good reason to get a second opinion.
Hope this helps!
for your response. I imagine that non-consensus was at stake when the first blue baby procedure took place, for example. Then again, such progressive surgery was undertaken after lots of lab tests and research.
I sometimes joke with one of my doctors that I'm just his guinea pig. Yet, I know he is always acting with my best interests and care in mind. :)
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