Making Medical Decisions

Describe the Problem

Preventing Medical Errors

Be Able to Answer These Questions About Your Current Problem and Complaints

•  What do you think the problem is?

•  Are you in pain? If yes:

– What does the pain feel like? Is it a sharp, dull, and/or throbbing pain?

– Where is the pain?

•  When did the problem(s) start? Has it changed since then?

•  What makes it go away?

•  Have you felt like this before? Is so, when? What made it go away then?

•  Have you had any other symptoms or signs lately? Examples are:

– Fever.

– Blood in the urine.

– Shortness of breath.

– Anxiety.

– Insomnia.

Be Able to Give This Information About Your Health

•  Your medical history and your family’s medical history.

•  Allergies you have.

•  Medications you take.

•  Your daily habits.

•  Your work.

•  Pressures you are under.

Ask for a Diagnosis

Your Doctor or Health Care Provider Makes a Diagnosis From

•  Symptoms (things you feel, such as pain).

•  Signs (things that can be seen or measured, such as swelling).

•  Exams and tests.

When Your Doctor or Health Care Provider Gives You A Diagnosis

•  Ask him or her to explain the diagnosis in detail.

•  Ask questions if you don’t understand. If you need to, bring a trusted family member or friend with you to help ask questions.

•  Find out if your condition is chronic or acute. A chronic one lasts a long time. An acute one comes on suddenly and doesn’t last long. If your condition is chronic, find out how it will affect your life.

•  Ask if the diagnosis increases your risk for any other problems. If so, find out what they are and what you can do to prevent them.

Other Things to Ask

•  Is my condition contagious? If so, how do I not spread it?

•  Is my condition genetic? If so, what does this mean for others in my family?

•  How certain are you about this diagnosis? Are there are other symptoms to look for that would help confirm or disprove the diagnosis?

•  What books, pamphlets, and computer Web sites can I use to find out more about my condition? What organizations can I contact? Is there a support group in my area for this condition?

Find Out About Treatment

Ask your doctor or health care provider to state clearly and simply what the proposed treatment is. If medication is prescribed, ask these questions:

•  What is the name of the medicine? Write down the name and dose.

•  What will the medicine do?

•  Is there a less expensive, generic form?

•  When, how often, and for how long, should I take the medicine?

•  Do I take this medicine until I feel better or until it is used up?

•  When will the medicine start to work?

•  Could there be side effects? What should I do if they occur? What side effects should I let you know about?

•  Is this medicine okay to use with other medications I take?

•  Is there anything else I should or should not do while taking the medicine?

– Should I take this medicine with or without food?

– Is there anything I should not eat or drink when I take this medicine? Can I take this medicine with grapefruit juice?

– Can I have alcohol?

– Do I need to stay out of the sun?

•  What should I do if I miss a dose?

If Surgery is Prescribed

•  Find out about the alternatives to surgery.

•  Consider getting a second opinion. Your health insurance may require this.

•  Find out if your health insurance plan will pay for the surgery.

•  Ask what types of surgery there are for your condition.

•  Ask for a step-by-step account of the procedure. Find out what you need to do before surgery. Find out what is done during and after surgery. This includes anesthesia and recovery.

Questions to Ask if A Test is Prescribed

•  What is the test called? How will it help tell what is wrong?

•  Will it give specific or general information?

•  If the answer is general, where do we go from here?

•  How accurate and reliable is the test?

•  Is the test invasive or noninvasive? Invasive means something, such as a catheter, chemical dye, etc., is inserted into the body. Nothing is inserted into the body with an noninvasive test. Examples are blood pressure readings and simple chest x-rays.

•  What will I have to do to prepare for the test?

•  Where do I go for the test?

•  How and when will I get the test’s results?

•  Will more tests be needed?

Ask About Benefits

Medical treatments change over time as researchers learn more and technology improves. Make certain that you and your health care provider have access to the latest and best information.

•  Find out how the proposed treatment will improve your condition.

– Will it cure the problem?

– Will it help with symptoms?

– Can it lead to other problems?

•  Discuss with your health care provider what you expect the proposed treatment will do. Make sure you are being realistic about what you expect.

•  Find out what will happen if you don’t have the treatment.

A good rule of thumb is to make sure one strong reason can stand alone to justify going ahead with the treatment. In many cases, two or more not-so-strong reasons may not be enough. Discuss your concerns with your health care provider and loved ones.

Ask About Risks

If surgery is prescribed, ask about the risks for these things, during and after surgery:

•  Pain.

•  Anesthesia.

•  Infection.

•  Accidental injury.

•  Heavy bleeding (hemorrhage).

•  Another unplanned operation.

•  Death.

•  Weigh the risks versus the benefits before you decide to proceed with treatment. Discuss your concerns with your health care provider and others close to you.

•  With your health care provider, chart the risks and benefits. On a sheet of paper, draw a line down the center. List the risks on one side. List the benefits on the other. Weigh each item on a scale from 1 to 5 (1 = not so important; 5 = very important). Add up the columns to see which one has a higher score.

•  Ask about risks before you get any test or X-ray, no matter how minor it may be. If you are not asked about allergies, state them ahead of time. If you are female, tell your health care provider if you are or may be pregnant. If so, you should not get X-rays unless they are absolutely necessary.

Find Out Costs

•  What is the cost of the proposed treatment?

•  Does this include the cost for follow-up? If so, how much is covered?

•  Check with your insurance plan to see what it will pay and how much you will have to pay.

•  Ask what you need to do to get maximum benefits. An example is pre-authorization for surgery. Find out if your health care provider and hospital accept your insurance.

•  What related costs do I need to consider? Look into costs of medication, costs for time off work and child care and transportation costs.

Find Out Success Rates

The success rate is how often a treatment works compared to how many times it is done. For example, if a certain surgery has been done 100 times and was successful 80 times, it has a success rate of 80%.

 

If surgery is prescribed, ask your health care provider and the medical facility where you will have the surgery these questions:

•  What is the national success rate?

•  What is the success rate at the hospital/medical facility where my treatment is planned?

•  What is the surgeon’s success rate and experience with the surgery?

•  How many procedures are the above success rates based on?

•  Are there any personal factors that will affect my odds either way?

•  How long will the results of my surgery/treatment last?

According to several studies, you are less likely to die or suffer complications from surgery or other procedures if you go to an accredited hospital that performs a large number of that procedure each year. Some experts advise at least 200 surgeries. If you are given a success rate percentage, find out how many procedures the percentage is based on. A success rate of 80% doesn’t mean much if it is based on only 5 surgeries. For more information on hospital surgical success rates, read the book Best Medicine by Bob Arnot, M.D.

Ask About Other Options

Discuss other options that can diagnose and/or treat your condition. There is usually more than one option. Sometimes, the best choice at the time may be no choice. This is called “wait and see.” If this doesn’t work for you, make a list of other options. Ask your doctor or health care provider these questions:

•  What might happen if I decide to do nothing?

•  What are my other options?

– Ask about options that don’t need surgery, such as lifestyle changes (diet, exercise, stopping smoking, etc.).

– If surgery is proposed, ask about outpatient surgery, laser treatment, laporascopic surgery, and the newest ways to treat your condition.

•  If you are not satisfied with your options, discuss this with your provider. If you are still not satisfied, consider consulting another health care provider.

•  Look into every option in depth.

Ask When Treatment Should Begin

When you decide to go ahead with a treatment plan, ask these questions:

•  When is the best time to get started with the plan?

•  Do I have to undergo treatment right away? If not, how long can I safely wait? Don’t assume that it has to be done as soon as possible. You may be able to delay the treatment until a time that best fits your schedule.

•  Decide the best time for you to begin the treatment.

Make a Decision

After you get the answers from steps 1 to 9, decide what to do.

•  You can also decide to refuse treatment, but you should ask your health care provider what can happen if you do this.

•  If you feel rushed or uncomfortable when you discuss your decision with your doctor or health care provider, tell him or her how you feel.

•  Read about “Informed Consent” and “Advanced Directives” on the last 2 panels. If you have not already done so, consider writing a living will or signing a durable power of attorney for health care.

Informed Consent

Informed consent is a legal issue in medicine. It means that you agree to treatment only after it has been explained to you and that you understand it. You should know:

•  The nature of the treatment.

•  Its benefits and risks.

•  The likelihood of the treatment’s success.

•  If your treatment is experimental in nature.

The physician should review any options you can get instead of surgery or other procedures. There are no guaranteed outcomes in medicine, but informed consent enables YOU to make a rational and educated decision about your treatment. It also promotes greater understanding and joint decision making between you and your health care provider. With informed consent:

•  You cannot demand services that go beyond what are considered “acceptable” practices of medicine or that violate professional ethics.

•  You must recognize that you may be faced with some uncertainties or unpleasantness.

•  You should, if competent, be responsible for your choices. Don’t have others make decisions for you.

•  You should also know about “Advance Directives.”

Advance Directives

Advance directives are a legal way for you to state your wishes to choose or refuse medical treatment. There are two types of advance directives:

•  Durable Power of Attorney for Health Care – This document names a person(s) who would make treatment decisions for you if you are not able to make them yourself. This person would state your wishes. Your condition does not have to be terminal or irreversible to have someone speak on your behalf.

•  Living Will – This written document states what medical treatment you would want or not want. A living will applies only when you can’t express your wishes on your own and you suffer from a terminal illness or condition and aren’t expected to survive.

In writing, you may choose or refuse:

•  Measures to Support Life, such as a respirator (a machine to breathe for you).

•  Measures to Sustain Life, such as tube feedings and kidney dialysis (a machine that does the work of your kidneys).

•  Measures to Enhance Life. These keep you comfortable, but don’t prolong life. Examples are pain medications and hospice care.

Each state has its own laws on advance directives. Get forms for them from your lawyer, local hospital or library, or from your state’s Web site. You can also get forms and information from these Web sites: www.putitinwriting.org and www.uslivingwillregistry.com.

 

After you complete advance directives, discuss them with your family and close friends. Give your doctor a copy, too.

This website is not meant to substitute for expert medical advice or treatment. Follow your doctor’s or health care provider’s advice if it differs from what is given in this guide.

 

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