• Even with the best evidence from research, no one can tell you what treatment is best for you.
• You should feel OK about asking your doctor questions.
• You may find it helpful to take a friend with you when you go to see your doctor or to write down questions before your visit.
• You should ask your doctor what the research says about treatments for your condition.
• You should ask whether researchers studied people like you (for example, were they the same age).
• Sometimes no one knows what the best treatment is for a disease.
• There are a lot of "don't knows" and uncertainty in medicine.
• You should work with your doctor to figure out which treatment is best for you.

Even with all the best evidence from the medical research, no one can decide which treatment is best for you. Ideally, you and your doctor can work together to make a decision about your treatment. Your doctor can help you figure out which is the best treatment for you. (For more help, see How to make the best decisions about treatment.)Here are some things to remember when talking with your doctor about your condition and the choices for treatment:

• Don't be afraid to ask questions,
• Your values count, and
• You will need to Learn to deal with uncertainty.

Many people find it hard to ask their doctor questions. Sometimes their doctor's attitude doesn't encourage them. Doctors always seem so busy. You may worry you will look stupid if you use the wrong words. Or you may worry that you will annoy your doctor by asking questions. Sometimes you may feel too sick to take an active role in making decisions. And some people are happy just to do what their doctor tells them.If you just do what your doctor tells you, then you can't be sure that you will get treatment that is based on the best evidence and that is best suited to you.You may feel more comfortable talking things over with your doctor if you do some of the following things:

• Write down a list of questions to take with you when you go to see your doctor
• Have a family member or friend come with you to the appointment
• Make notes of what your doctor says during your visit
• At the end of the appointment make sure you know what your doctor has discussed with you and what should happen next. You can say something like, "I just want to make sure I've understood what you've told me." Or if you are not sure, try saying "Could you please run through what you said to me again so I can be sure I understand it?"
• Don't be embarrassed to write down medical terms and ask your doctor how to spell them.

A physician who is good at making decisions with you will:

• Use the best research evidence
• Share the evidence with you and help you understand it
• Encourage you to say what matters to you.

You should remember that times are changing. Many doctors encourage their patients to ask questions and encourage them to play an active part in deciding about their care.For each of the conditions covered on this Web site, we've given you some ideas of the questions you might want to ask your doctor.

• Do I need to take medication?
• Will I get better without it?
• What are my other choices for treatment?
• What does the medication do? How should I use it?
• How long should I use it?
• What benefits and harms can I expect from taking this medication?
• Is there anything I can do to avoid side effects?
• Can I use this medication with my other medications?
• When should I stop taking the medication? Or when should we talk about whether I need to keep taking it?
• What should I do if I miss a dose?
• What else can I do to help myself get better?

You can ask your doctor what the research says about the best way to treat your condition. You can ask about the benefits and harms of each treatment. You may need help in working out how that information applies to your situation.When you discuss the research with your doctor, ask him or her if the people who were included in the studies are like you. Many studies, for example, do not include women or children or people with more than one medical problem.

 

 

 

 

 

Source:
Tudor HJ
Hypertension guidelines. Other diseases complicate management.
BMJ;306:1337

 

 

 

 

 

¹ You also can't assume that the results of a study will apply to your situation. For instance, beta-blockers may not be as good as water tablets (

 

 

 

 

 

diuretics
Diuretics are a type of medicine that reduce the amount of fluid in your body. The extra fluid is removed in your urine.

 

 

 

 

 

diuretics) in lowering your blood pressure if you are black.

 

 

 

 

 

Source:
Veterans Administration Cooperative Study Group on Antihypertensive agents
Comparison of propranolol and hydrochlorothiazide for the initial treatment of hypertension. I. Results of short-term ti
JAMA;248:1996-2003

 

 

 

 

 

²A treatment that may help someone who has a high risk of getting a disease may not help someone who has only a low risk. If you have a high risk of dying from heart disease you will get more benefit out of taking drugs to lower your cholesterol (if you have high cholesterol) than someone who does not have heart disease.

 

 

 

 

 

Source:
Smith GD;Song F; et al.
Cholesterol lowering and mortality: the importance of considering initial level of risk.
BMJ;306:1367-1373

 

 

 

 

 

³ Studies show that 30 patients who have a high risk might need to be treated for five years with drugs to lower their cholesterol to save one life.

 

 

 

 

 

Source:
Smith GD;Song F; et al.
Cholesterol lowering and mortality: the importance of considering initial level of risk.
BMJ;306:1367-1373

 

 

 

 

 

³ But 300 patients at low risk would need to be treated to save one life.

• Does the study give me information about what I'm interested in?
• Does it cover the harms and benefits of treatment?
• Does it have people like me in it?
• Does it compare treatment with other suitable choices?
• Is the evidence reliable?

Just because the research says that a treatment works doesn't mean you have to have that treatment. You need to make a decision on the basis of both the evidence and your personal preferences and values.Here is an example of a case where some people prefer not to do what the evidence suggests could be helpful.If you have the type of irregular heartbeat that is known as an

 

 

 

 

 

atrial fibrillation
Atrial fibrillation happens when your heart beats in an uneven or irregular way. Normally the beating of your heart is controlled by electrical signals. The signals make the upper parts of your heart (the atria) squeeze blood into the lower parts which then squeeze blood out into your blood vessels. If you have atrial fibrillation, the electrical signal doesn't work well, so the upper parts of the heart don't beat at the right time.

 

 

 

 

 

atrial fibrillation, you are more likely to have a stroke. There are two main types of stroke. One happens when the blood supply to your brain is blocked and the other happens when there is bleeding into your brain.

 

 

 

 

 

randomized controlled trials
Randomized controlled trials are medical studies designed to test whether a treatment works. Patients are split into groups. One group is given the treatment being tested (for example, an antidepressant drug) while another group (called the comparison or control group) is given an alternative treatment. This could be a different type of drug or a dummy treatment (a placebo). Researchers then compare the effects of the different treatments.

 

 

 

 

 

Randomized controlled trials show that taking a drug called warfarin, which thins the blood, will reduce your risk of getting the first kind of stroke. However, it increases the risk of getting the second type of stroke because it makes your blood thinner. For some people, the chance of getting a benefit from warfarin treatment outweighs the risk of the harm.Yet many studies show that some people who would benefit from taking warfarin refuse to take it. Even when they understand that the benefits outweigh the risks for them, they still do not want to take it.

 

 

 

 

 

Source:
Protheroe J;Fahey T; et al.
The impact of patients' preferences on the treatment of atrial fibrillation: observational study of patient based decisi
BMJ;320:1380-1384

 

 

 

 

 

⁴ Just because the evidence shows that a treatment is likely to work doesn't mean that everyone will want to have it. Sometimes people want to have a treatment even if there is no research to show it works. This is especially true of people who have life-threatening conditions such as cancer who may feel they want to try anything.

 

 

 

 

 

Source:
Crocetti E. Crotti N. Feltrin A. Ponton P. Geddes M. Buiatti E
The use of complementary therapies by breast cancer patients attending conventional treatment
European Journal of Cancer. 34(3):324-8, 1998

 

 

 

 

 

⁵ Sometimes no one knows what the best treatment is for you. Patients often don't realize that there is a lot of uncertainty in medicine. Not every question about treatment has a clear answer. Even when there is good research that shows that a drug works, the drug may work better in some people than in others. Everyone is an individual and will respond differently to treatment.It's also important to know that research is better for some conditions than for others. There is good evidence that gives us answers to many of the most common medical questions facing patients and their doctors. But there are not good answers for all conditions and all treatments. When no one knows what the best treatment is, it is even more important that your values are taken into account. A common example can show you what we mean. There is no clear answer about whether healthy men should be screened for early signs of prostate cancer as they get older. In this case, screening means testing to see if they have raised levels of a chemical called PSA (prostate-specific antigen) in their blood.

 

 

 

 

 

Source:
Yamey G, Wilkes M.
Prostate cancer screening--Is it worth the pain?
San Francisco Chronicle January 18, 2002: p. A-29.

 

 

 

 

 

⁶Not all men with high levels of PSA will have cancer. Of those who do have cancer, some will benefit from treatment but some will get serious complications from it. These complications may include problems in having erections. In some men, their cancer may grow so slowly that they will die from something else, not the prostate cancer. The problem is that no one knows which cancers will grow fast and need treatment and which will grow so slowly that they will not be a problem.There is not enough good evidence to know if screening for prostate cancer does more good than harm.In this situation it is best if a patient and his physician make the decision together.To deal with this uncertainty, some people decide to join research studies to help try to find answers to the questions for which the evidence is unclear. Sometimes charities fund medical research in areas in which the answers aren't clear. You could try contacting a charity that focuses on your condition to see if they know about any research projects.