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How to Talk to Your Doctor

Published: May 2008

Getting started

Building a good relationship with your primary care physician-or any doctor who may be giving you care-is a critical component in making sure that you get the care you need and the care that you want. To do so, you're going to want to communicate effective with your doctor and that includes asking the right questions and maximizing the time you have with your doctor. Remember, doctors are busy people, but the time you've reserved is your time and you should use it wisely. Here are a few tips on how to establish a great back-and-forth with your doctor.


Bring a buddy

Establishing good communication with your doctor might need a third party. Patients stuck with uncommunicative doctors have been shown to get much better results when they took active steps such as taking a friend or relative along on the visit or asking doctors directly about their experience treating similar cases.


Speak frankly

Doctors say they often encounter patients who are reluctant or embarrassed to talk about their symptoms. That makes the doctor's job a lot harder, said Howard Beckman, M.D., a clinical professor of medicine at the University of Rochester who has done extensive research on doctor-patient interactions.

By the same token, you can't always count on doctors to ask the right questions. Of patients who said their preventive-care doctors were aware of their issues, only a small percentage says it was because the doctors had asked them directly about it.

Not only should your doctor know what symptoms are bothering you, but "patients should also be as honest as possible about what they think may be causing the problem," Beckman said. If you fear your headaches indicate a brain tumor or an impending aneurysm, sharing those concerns could help. If the things you fear are outside the realm of possibility, the doctor can tell you so and save you a lot of stress; if not, voicing your gut instincts may lead to tests the doctor otherwise might not have ordered, and even a lifesaving early diagnosis.

Speaking up extends to asking for things you want from the doctor. In a study of patient visits with 45 physicians, patients who left with unvoiced desires--such as a referral to a specialist, medical equipment, or a different medication--were unhappier with their doctor and recovered more slowly than patients who made their desires known. Physicians, too, rated those encounters as more demanding.

Ways to frame your health concerns

Sure, you love your doctors. But your visits to them might be more rushed than you realize, studies show that your time with your doctor can be as little as 10 minutes per visit.

Prepare an agenda. The average patient gets 10 to 20 minutes with the doctor, according to national physician surveys and direct studies of patient visits. More than half of the doctors we surveyed said they had to see many more patients now than they did five years ago to maintain the same income and that on some days they saw too many patients to spend adequate time with each.

Deciding ahead of time which things you most need to discuss can make the most of your limited time. Almost half of our readers brought a written list of questions and concerns to their doctor visits. Prioritize the three or four issues you most want to talk about, and bring those up first. If you don't have time to get through the whole list, ask whether you can follow up with e-mail. A survey by the Center for Studying Health System Change found that 24 percent of U.S. doctors now exchange e-mail with patients.

Below is a list of questions you can ask to help make the most of the short amount of time you may have with your doctor. "Your doctor should be receptive to the right kinds of questions," says Beth Nash, M.D., who evaluates best treatments for the BMJ Group, publisher of the British Medical Journal. "If not, then you should think about finding a different doctor."

Tests

  • Why is this test necessary? What will it tell us that we don't already know?
  • Will the results significantly alter any treatment plans?
  • When will the results be ready? Should I call you for them, or will you call me?

Your ailment

  • What is my exact diagnosis? What's the cause of my problem?
  • How long will I be sick?
  • How long before I'll see improvement?
  • Under what conditions should I call you or come back? (Don't feel better in a week? Coughing doesn't stop? Pain becomes worse or spreads?)

Treatments

  • What treatments are used for my condition? Which is best for me, and why?
  • What does the research show about this treatment?
  • Is there any research on the horizon about treatments for my condition?
  • What can I expect from this treatment, based on your experience?
  • What are the side effects of this medication? Will it interact with alcohol, caffeine, or other drugs or supplements I take?
  • Are there any alternative treatments appropriate for me to try, either before or along with conventional treatment?

Lifestyle changes

  • How will these changes help my disorder? How soon should I expect to see an effect?
  • How drastic do the changes have to be to produce real results?
  • Do you have any tips that would make these changes easier?

Questions to ask about tests, screenings, and scans

Use the Done On and Your Levels column in this table as a handy way to track the care you receive from your physician. The first checklist helps you determine whether your doctor is providing the basic preventive health care and screenings recommended by national and professional guidelines. Certain exams and tests are applicable only to men or to women. People with symptoms, risk factors, or chronic diseases may need to be tested sooner, more often, or more extensively than indicated below. The bottom table lists the minimum treatment goals for common chronic conditions: diabetes, high cholesterol levels, and hypertension. If you don't meet those goals, find out what you can do.

Test or procedure To detect or prevent How often Done on
Physical exam
Abdomen Enlarged liver or spleen, aortic aneurysm Every few years, especially in men after 50  
Breasts Breast cancer Every 1 to 2 years, starting at 40  
Heart Murmur, irregular heartbeat Every visit  
Height and weight Overweight; also osteoporosis in postmenopausal women Every visit  
Neck Thyroid nodules and narrowed carotid arteries Every few years, especially after 60  
Pelvic Cancer and other problems in bladder, ovaries, rectum, uterus, vagina Annually until age 30, then every 2 to 3 years  
Rectal Colorectal and prostate cancer Every 1 to 2 years, starting at 40  
Testicles and groin Inguinal hernia and cancer Every few years, especially between 20 and 35  
Immunizations
Hepatitis B Hepatitis B, a liver disease Once by age 20  
Influenza The flu Annually, especially after 50  
Pneumococcal Pneumonia Once at 65  
Tetanus booster Tetanus Every 10 years  
Varicella Chicken pox Anyone who hasn’t had chicken pox  
Screening tests: Definitely or probably needed
Blood pressure Hypertension Every visit  
Bone densitometry Osteoporosis Every 2 to 3 years after menopause; at least once after 65 in men  
Colonoscopy or sigmoidoscopy plus fecal occult blood test (FOBT) Colon and rectal cancer Starting at 50, colonoscopy every 10 years or sigmoidoscopy every 5 years plus FOBT annually  
Complete lipid profile High LDL-cholesterol or triglyceride levels, or low HDL level Every 5 years starting at 20  
Eye exam Glaucoma, macular degeneration, and other vision problems Every 3 to 5 years before 45 and every 1 to 3 years after that  
Fasting plasma glucose (FPG) Diabetes and the metabolic syndrome Every 3 years starting at 45  
Mammography Breast cancer Every 1 to 2 years, starting at 40  
Pap smear and human papillomavirus (HPV) testing Cervical cancer (Pap smear) and virus that causes it (HPV test) Annual Pap smear through age 30, then Pap smear alone or combined with HPV test every 2 to 3 years; can usually stop testing after hysterectomy or age 65  
Thyroid-stimulating hormone (TSH) Thyroid disease Every 5 years starting at 35  
Condition Measurement Goal Your levels
Tracking treatment for common conditions
Diabetes HbA1c, protein in blood that reflects average blood-glucose levels over three-month period Under 6.5 percent  
High cholesterol levels
Low-density lipoprotein (LDL), or “bad” cholesterol Under 70 mg/dl if you have diabetes or history of coronary artery disease; under 100 mg/dl if you have moderate-high risk of heart attack; under 130 mg/dl if you have moderate risk of heart attack; under 160 mg/dl if you are at low risk of heart attack  
Hypertension Systolic, or upper, blood pressure and diastolic, or lower, blood pressure Systolic 120 mm/Hg or lower, diastolic 80 mm/Hg or lower  


Thirty-four percent of a national sample of 300 primary-care physicians surveyed by the Consumer Reports National Research Center in August 2007 said their patients "very frequently" or "quite often" requested unnecessary or duplicative medical tests. And 66 percent said they had acceded to at least one such request within the previous month.

"We have a real cultural infatuation with the latest treatments and the latest technologies," said David Blumenthal, M.D., director of the Institute for Health Policy at Massachusetts General Hospital. "This is a fact of life in the U.S."

Ask which treatments have been shown by research to be best for your condition.

What you can do. Designate one doctor, typically your primary-care physician, to coordinate your care.


Missing evidence

Consumers are especially vulnerable to promotional persuasion in health care, because they assume that the medical treatments their doctors recommend are necessary and effective. They are frequently mistaken.
"About 80 percent of what we do in medicine today is not backed up by solid evidence--a clinical trial that proves it's really superior to other therapies," says Lee Newcomer, M.D., senior vice president for oncology at United Healthcare.


Questions to ask about testing

  • Why is this test necessary? What will it tell us that we don't already know?
  • Will the results significantly alter any treatment plans?
  • When will the results be ready? Should I call you for them, or will you call me?

Discussing a new diagnosis

Once you have articulated your symptoms to your doctor, gone through the necessary tests and your doctor has come to a conclusion and diagnosed you with a condition that requires treatment, what do you do? Obviously an educated patient is an empowered patient, so you will want to ask the appropriate questions to find out as much as you can about your treatment options and, with your doctor's help, decide which treatment is best for you.

Every treatment has trade-offs. The best treatment for you may be different from the best treatment for your friend or neighbor. We all have individual needs, and different things are important to each of us. If you play a part in making decisions about your treatment, you are likely to recover quicker than if you do not.

It is even more important to take part in making decisions when doctors do not know which treatment is best for you. Doctors should base their treatment decisions on what the research tells them. If your doctor knows what the research says about how to treat a condition and uses this information to make decisions about treatment, then he or she is practicing evidence-based medicine. This is a good way to practice medicine because it means your doctor is using evidence from medical studies that have looked at what happens to many thousands of people.


Key points to remember when choosing treatments

  • Check out all your choices.
  • Make sure you understand the risks and benefits of treatments or of doing nothing.
  • Make sure you understand how the risks and benefits will affect you specifically.
  • Make sure you have enough information to make a choice.


You and your doctor should talk about your options for treatment and make a decision together about the best treatment for you. This process of working together is often called shared decision making. Whenever possible, you should work with your doctor to decide on the best treatment for you. You should ask these questions before deciding on any treatment:

  • How involved do I want to be in making decisions about treatment?
  • What will happen if I do nothing?
  • What are my choices for treatment?
  • What are the benefits and harms of each treatment?
  • How do the benefits and harms balance out for me?
  • Do I know enough to make a choice?
  • How can I work through my choices?

Can lifestyle changes help?

From hip and knee replacements to high blood pressure, there are always things you can change in your day-to-day life that can help alleviate your ailments or even help them disappear altogether. However, the only way to determine just how much lifestyle changes will help your condition (or prevent conditions you may be pre-disposed to) is to speak with your doctor. Take lifestyle changes seriously, especially if you are at risk for heart disease, stroke, diabetes, or cancer. If you have a chronic disease, work with your doctor to devise a plan to manage it.

There are certain behavioral changes for specific conditions and doing some research on your own in addition to speaking with your doctor is a good way to come up with a lifestyle change plan. And there's hard evidence to suggest that small changes like these can help. For example, studies have conclusively shown that changes in lifestyle can reduce blood pressure substantially. And there are many other medical conditions that can be helped or avoided without drastically altering your life.

While each medical condition likely has its own specific lifestyle changes that can help, there are some general guidelines you can benefit from. Adding these healthy habits with any lifestyle changes your doctor recommends can help.

Eat whole grains. They reduce the risk of heart disease, several cancers, and inflammatory diseases such as asthma. It ranks among our tips for a longer life because studies have shown that breakfast cereal can be a good way to get grains.

Consider vitamin D. It's especially important if you're older than 60, when the body has a hard time converting enough vitamin D from sunlight. Studies show that vitamin D not only strengthens bones but also boosts immunity and protects against several diseases. In an analysis published in September 2007, older adults who took a vitamin D supplement (400 to 800 international units daily) had lower death rates from all causes.

Limit time in the sun. And use enough sunscreen, which may help reduce the risk of life-threatening skin cancers. Choose a product labeled waterproof or water resistant, with an SPF of at least 30.

Eat colorful produce. Rich, varied colors are best. They indicate that you're getting a range of phytochemicals, which may help fight disease.

Exercise. Burning more calories (and working the heart and lungs more) can reduce the risk of heart disease and certain cancers, lengthen your life, and improve the quality of life as you age. When it comes to tips for a longer life, anything that gets your heart rate up counts. Walk, climb stairs, throw a Frisbee with Fido-as long as it adds up to about 30 minutes most days of the week.

Get enough sleep. For most people, that's 7 to 8 hours a night. This is staple among tips for a longer life. If you don't snooze, you lose: You're at higher risk of hypertension, type 2 diabetes, high cholesterol, obesity, impaired concentration, and accidents, not to mention malaise. Newer research suggests that sleeping enough may also boost memory.

Don't smoke. And try to stay away from people who do. Evidence strongly suggests that secondhand smoke can shorten your life.

Eat fat (but the right kind). Mono- and polyunsaturated fats in nuts, seeds, vegetable oils, and fish protect the heart and help manage weight by keeping you full.

The omega-3 fatty acids found in abundance in many fish are linked to lower rates of heart disease and possibly a lower risk of Alzheimer's. Healthy people looking for tips for a longer life should aim for two small servings a week of low-mercury species, which include salmon, sardines, trout, and whitefish. If you have heart disease, ask your doctor about taking fish-oil pills. Plant sources of fat might offer other health benefits through phytochemicals (think polyphenols in olive oil and sterols in nuts).

Chill out. Within the research into tips for a longer life, lots of evidence ties excess stress and hostility to hypertension, coronary artery disease, reduced immunity, and increased risk of heart attack and stroke. Measured breathing, meditation, and mindfulness exercises (involving nonjudgmental awareness of the present moment) can induce physiologic changes that reverse your body's stress response. Job stress can be especially insidious; find out whether your company offers an on-site stress-management program (many do).

Asking about medications

To secure the approval of the Food and Drug Administration for a new drug, its manufacturer need prove only that it works better than a sugar pill, not that it's better than other remedies. So most of the "new" drugs that the FDA approves--75 percent in 2005--are me-too versions of existing remedies rather than genuine breakthroughs. Drugmakers must convince consumers and physicians that their new pink pill is better than the older green one.

As a result, it's important to discuss your medication options with your doctor. In a recent Consumer Reports Survey, almost one-third of the doctors failed to discuss side effects of prescribed drugs, and two-thirds never brought up costs of treatments and tests, patients said.

And it can save you money by asking if there is a generic version of a particular drug. Consumers are already voting with their dollars for generics, which now make up more than 60 percent of U.S. prescriptions dispensed. Half the doctors we surveyed said their patients frequently ask for them. But research suggests that the U.S. could save more than $8 billion with increased use of generics. If you're offered a newer drug, ask whether it has been proven better or safer than its predecessors. Twenty-five percent of doctors in our survey said they frequently observed adverse effects from newer drugs.


Ignore drug ads

There's another party in the examination room with you and your doctor: the pharmaceutical industry, which spends billions of dollars a year trying to get you to pester your doctor for expensive new brand-name drugs--and wining and dining doctors so that they'll prescribe them.

Almost all the doctors we surveyed said they make at least some time to meet with pharmaceutical company representatives who arrive bearing free samples, gifts, and sales pitches for their drugs.

But it's not just the doctors that pharmaceutical companies are trying to sway. Seventy-eight percent of doctors said patients asked them at least occasionally to prescribe drugs they had seen advertised on television, a request that 67 percent of the doctors surveyed said they sometimes honor. It's critical to ask questions and learn as much as you can about a drug, because it's unlikely that you've gotten enough information from a snappy television advertisement.

Patients most frequently ask about drugs for acid reflux, impotence, allergies, and insomnia--mainstays of the television ad lineups. Very few of the patients we surveyed--7 percent--admitted to asking for advertised drugs for their most bothersome health condition over the previous 12 months.

Older drugs can be just as effective, have a longer safety record, and often cost less. The new drug might not be on your health plan's list of approved medications; 60 percent of the doctors we surveyed complained about such restrictions.


Explore your alternatives

Alternative medicine is starting to emerge from the long, bitter battles between believers and debunkers, often waged in the virtual absence of scientific evidence. Treatments such as acupuncture, massage, guided imagery, relaxation training, therapeutic touch, tai chi, and yoga are now used in clinics and hospitals alongside conventional treatments. Indeed, such methods are now often called "complementary" or "integrative" medicine. Asking your doctor about alternative treatments is something that should be considered.

Mainstream medical schools offer courses in alternative methods. Most important, alternative therapies are being tested in well-designed clinical trials, and reliable evidence about safety and efficacy is starting to emerge.


Americans pay the most for drugs

Eighty percent of people we surveyed said the pharmaceutical price gap between the U.S. and the rest of the world is unacceptable. Here's the average retail price for a month's supply of popular brand-name drugs in the U.S. and in six other countries.

COUNTRIES Actos (diabetes) 15 mg, 30 pills Lipitor (cholesterol) 10 mg, 30 pills Fosamax (osteoporosis) 70mg, 4 pills Nexium (heartburn) 20 mg, 30 pills Singulair (asthma) 10 mg, 30 pills
U.S. $86.13 $68.37 $64.16 $92.04 $83.40
Australia 41.10 24.27 32.98 22.23 57.21
Canada 62.22 48.45 35.07 60.69 63.21
France 31.38 19.53 34.11 30.63 43.02
Germany 38.52 29.73 37.35 19.26 58.08
Japan 21.48 30.57 23.61* NA 59.97
United Kingdom 45.72 34.17 40.31 35.04 51.09

*35-mg dose. Source: IMS MIDAS

   

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