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Speak up when talking to your doctor

Ask about costs, consent forms, and more

Consumer Reports magazine: September 2012

Photo: LWA/Larry Williams

In more than two decades of practice, I’ve not been asked even once by a patient whether I’ve washed my hands, even though many people know that the hands of doctors and nurses can teem with infectious diseases. We’re all naturally reluctant to be impolite, and often that’s a good thing. But a doctor-patient interaction is not a social occasion. Its only purpose is to protect your health—and letting your fear of offending the doctor trump all reason can have harmful consequences.

Here are six scenarios in which you could become a victim of your own politeness.

1. You feel pressured into signing an informed consent form. Initiated by the doctor, informed consent is intended to be a two-way discussion in which the patient learns about the risks and benefits of an intervention the doctor is suggesting and then decides whether to agree to it. Though ethical guidelines dictate that those discussions be free of coercion, you might still feel pressure to agree to the treatment, especially if a doctor or nurse is hovering over you with a pen. If the situation isn’t an emergency and you have questions, voice them, or ask whether you can have a day to think about it before making a decision.

2. The treatment is too costly. Patients often hesitate to admit that they can’t afford treatment because they’re embarrassed. The fact is that doctors often don’t know the actual costs of various medications and therapies, but if you raise your concerns, we can help you find the answer. We’d rather work on it together now than discover later that you never picked up your prescription.

3. You want a second opinion. Some people—my parents among them—are so afraid of hurting their doctors’ feelings with this request that they tend to avoid it entirely, even when their better instincts suggest otherwise. But most doctors welcome it, and if they don’t, it should raise a red flag.

4. You didn’t follow the doctor’s orders. It’s hard to ’fess up when you haven’t been compliant. But believe it or not, medical personnel tend to be among the worst offenders in this area, so we often understand on a gut level when you tell us you didn’t stick with the regimen we prescribed. Let us know so that we can develop a plan you’re more likely to follow.

5. Your doctor sells products. Although the American College of Physicians and the American Medical Association frown on it, some practitioners sell items such as supplements or dermatologic products in their offices or on their websites. Some of my patients have told me that they’ve felt compelled to buy such things, especially when a doctor pitched them aggressively. Having a financial stake in promoting a product is a conflict of interest and subverts the responsibility of physicians to put patients’ interests first. This is a situation in which you should just say no.

6. You don’t want to enroll in a study, but your doctor will get a fee if you do. Imagine your doctor has advised you to enroll in a clinical trial after disclosing to you—as ethical guidelines state—that he or she will get a referral fee if you sign up. You don’t want to do the trial, regardless of whether your doctor profits from it. But you worry that if you decline, the doctor might take it to mean you think he or she is corrupt. Decide based on what’s best for you. Your doctor will get over it.

Orly Avitzur, M.D.

Medical Adviser
Editor's Note:

A version of this article appeared in the September 2012 issue of Consumer Reports magazine with the headline "The Price of Being Nice."

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