Monday, 26 January 2009

How To Treat Your Doctor

The writing of this article was inspired by some data about epileptics and some of my own experiences in being diagnosed with a condition it now seems I don't have. It has been estimated that 20% of diagnosed epileptics don't actually have the condition. This means about 70 million people in the world are on the wrong medication. This is certainly debilitating, most likely distressing and potentially dangerous.

The days of treating doctors with undue reverence are over. The internet is a huge storehouse of medical advice with virtually every known disease sprouting a support group. Learning how to use that information is one thing but the next step is learning how to discuss this with your doctor.

A patient arrives to a consultation somewhat at a disadvantage in seeking advice on an unwanted condition. But the doctor is also at a disadvantage in as much as they won't have a clue about what is wrong with you until you open your mouth. So, to help make the consultation as informative, fruitful and beneficial as possible, here are some tips on how to treat your doctor.

List your symptoms

It is amazing how easy it is to forget things. Even after going over in your mind many times everything that you need to say to the doctor, chances are you will forget something. The best thing is to write it all down. Start your list as soon as possible and update it as you remember things or if new symptoms start to emerge. And don't forget to take the list with you!

Take a notebook

A consultation is a two-way process. The doctor will be making notes about your case so it is perfectly reasonable that you should be making notes about what you are being told. Your doctor should actually be pleased about this as, if you are required to do certain things, at least you won't forget. If this is a follow-up consultation you will also have notes from all the previous visits. If your condition requires serious medical attention then you need to do as much as you can to help yourself.

Do not be afraid to ask

Most people have a slight feeling of inferiority when dealing with doctors, or indeed any professional. But medicine is one profession that is supposed to be helping you. There is no need to be afraid or feel that you are wasting the doctor's time. Sometimes it can feel as if time is short, the queue outside long and the doctor rushes into a quick decision. If you have brought your pen and paper just ask those question you need answering – they will not be answered by the receptionist outside. I you are offered some new tests that's great, if you are prescribed new medications understand why and how they are different to your current ones. Certainly treat your doctor with respect, but not with reverence.

Learn the medical jargon

Being a doctor is, like many other professions, full of jargon. From the outside this appears to be a way for outsiders not to understand what is being said. But medicine is a precise science and conditions need to be described as accurately as possible. Understanding medical jargon is really no different to using a dictionary. If you don't understand a word just look it up online. If you don't understand what the doctor is talking about just ask her. There is no harm in asking “What does that mean?” rather than nodding in ignorance.

Using the internet

If this is your first consultation chances are you don't have much of an idea what the likely diagnosis will be. However, if the symptoms you manifest are potentially due to different causes, or if your condition has a multitude of potential cures, then no doubt you will start to research on the internet. There are help groups and forums on every imaginable condition – head for those as they will be a source of information and support. Forums are also a good way to screen out quack cures and expensive promises that can also be found on the net. As above, either write down anything interesting or print copies of useful information.

The dangers of self-diagnosis

After your internet research you will be armed with a wealth of information. This is particularly important if the precise nature of your condition is still unclear or if there are still different courses of treatment available. However, the one danger of self-diagnosing over the internet is that you can end up thinking you have all kinds of rare diseases just because your symptoms seem to match up. Medical sites list conditions in terms of their symptoms so it is very easy to end up with a long list of conditions. The skill of your doctor is in not only knowing which symptoms correspond to which conditions but also in knowing which are the most important and which ones are missing. It is vitally important to know and understand not only which symptoms you have but also which ones you don't. I have yet to find a medical site that also has this negative test. For example, you may fear you have some incurable disease because you have 5 of the listed 7 symptoms on the internet. But one of those missing symptoms is possibly the key indicator for that disease, the other 5 may be consequences of that key symptom.

Discussing your self-diagnosis with your doctor

Most doctors are aware that patients do their research online and most are happy to discuss this. You may still find a few who are defensive about this self-diagnosing and see it as an encroachment on their profession. You may not know what reaction you will get so the technique I have found most useful is to approach the subject in the same way as you would ask any question. Do not open a file of printouts and start claiming that in your opinion the original diagnosis is wrong and that you have discovered your real condition! This is going to irritate any consultant. Instead, bearing in mind the previous point made above, show a list of what you have discovered and ask the doctor's opinion as to which are likely and which are unlikely. The doctor can now show you why a professional is better than a hundred websites.

Resolving an Argument

Sometimes you may reach a point in your consultation when you and your doctor do not see eye to eye. Keep calm; this happens. Try firstly to think about what is really at stake here. Are you being refused a new test on an uncertain diagnosis? Are you being refused the latest treatment because it is too expensive? Do you feel as if your concerns are being dismissed? Arguments don't usually happen on a first consultation but rather after a period during which either the medicines are not working or the side-effects are getting worse, or perhaps even that a solid diagnosis has not been reached. These situations can be difficult but this is my suggestion.

A medical diagnosis is reached based on the accumulation of facts. These facts include your own testimony as well as any tests that have been done. If you feel you have been misdiagnosed then ask the consultants which further tests are needed to resolve the argument. This will often be enough to delay a decision awaiting further evidence. You are probably getting emotional by now but don't get angry and write everything down. Some tests are expensive and some decisions are based on the probability that a new test will yield meaningful new information. If the consultant still refuses then ask why. Which aspect of your current condition makes a new test pointless? Write it down. Is the doctor making sense here? Is the logic of the argument solid? I've been in this situation and forced the doctor to spell out exactly why he just wanted to take the easy road by prescribing different medicines rather than looking closely at the symptoms. In the end I went to see someone else. If the discussion has reached this point then you may well have to see a new specialist. This is no bad thing in itself as a fresh mind may take a different course of action. Just don't get angry – it won't change the outcome.

Suspected or Confirmed?

After a consultation with a specialist at a hospital you will usually receive a typed report outlining the diagnosis, further tests and treatment. Read this very carefully. It will be in medical jargon but you've already learnt that so understanding it should not be a problem. Any new words, go and look them up. However, there are two fairly ordinary looking words you also need to watch out for; suspected and confirmed. If you have had a disagreement about your diagnosis these two words will actually tell you how certain the doctor really is in that diagnosis. If your condition is suspected rather than confirmed then you may have been right in your doubts. This shows that there is still work to be done and that even the doctor is not wholly convinced and just acting on probabilities. It is important not to waste your time trying to convince new doctors that your confirmed condition is wrong. It is a wholly different matter seeking further advice for a condition that is still suspected but not as yet confirmed.

Going to the top

If your condition seems hard to diagnose or the treatment is not working consider doing a bit of research on who are the real specialists in your field. Pretty easy these days on the net to look at who are the top people in their field. See what books they've written and which papers published. You might think these people have better things to do than talk to you, but you'd be dead wrong! Most respected specialists work in hospitals, most often research hospitals, and are only too keen to discover difficult cases that have challenged their colleagues. You may even be lucky and find some research projects for your condition. Just do a search and find somebody who you like and have confidence in, at least from reading their profile and interests. Then write a concise but detailed description of the history of your condition and the current state. You should already have all of this in your notebook and in any medical reports you have been sent. Your email will be read by a secretary and if it seems interesting will be passed to the specialist. Easy!


riverking said...

This is some great advice especially for those who are just starting this overwhelming journey of epilepsy. We have been traveling it for 22 years now with my daughter and I can still get over whelmed when it comes to dealing with doctors. I am so grateful for the internet and support I have found there. I found a new site with some great info and support it is I left a link there to this blog also.

Atlanta Plastic Surgeons said...

Writing what you need to report to the doctor is a very good habit. Because most of the time we forget in the excitement of the meeting.hernia surgery Los Angeles

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