En español l Smart questions pave the route to better health care — and to a better partnership with your doctor. "Health care comes with so much information, doctors are so concerned about time, and patients have concerns not addressed," says Leana Wen, an emergency physician at Brigham & Women's and Massachusetts General in Boston, and coauthor of When Doctors Don't Listen. "Patients have to know what questions to ask. Don't wait until something bad comes up to communicate. Create a relationship while you're well."
To get the ball rolling, doctors weigh in on 10 essential questions to ask your physician now.
1. When do I need my mammogram, pap smear and colon cancer test?
"Ask your doctor to tailor screenings based on your personal, medical and family history, and your values," says Wen. "For instance, if you're 80, you may not want cervical cancer screening since it progresses so slowly." For each screening, ask what the risk, benefits and alternatives are. Women over 50 should ask about mammograms, pap smears and colorectal cancer, says F. Michael Gloth III, M.D., associate professor of medicine and director of outpatient services for the Division of Geriatric Medicine and Gerontology at Johns Hopkins Bayview Medical Center in Baltimore. Screenings for high blood pressure, diabetes, high cholesterol and osteoporosis should be on your radar, too, says Wen.
2. I think I've started menopause. Should I be doing anything differently?
Menopause, which officially begins 12 months after your last period, increases your risk for heart disease, the leading cause of death in women. Ask about related risks such as high blood pressure, diabetes, obesity and smoking. And address menopausal symptoms such as hot flashes, sleep difficulties and vaginal dryness. Postmenopausal women are at much higher risk for osteoporosis than men, says Wen. The National Osteoporosis Foundation recommends 1,200 mg of calcium and 800 to 1,000 IU of vitamin D daily for women over 50. Hormone replacement therapy may help reduce menopausal symptoms such as vaginal dryness and night sweats. But many women have become leery of HRT. A large 2002 Women's Health Initiative Study found that women who took HRT were at increased risk for breast cancer, stroke and heart disease. But then a 2012 16-year study at Hvidovre Hospital in Denmark found that hormone therapy begun right after a woman's final period protects women from heart attack and heart failure. And cancer risk for women who did or did not take HRT was the same. Ask your doctor about the timing, risk and benefits.
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3. I find that I'm less interested in sex these days. Is there anything I can do about it?
A menopausal drop in estrogen levels may cause sex drive to droop — as can a thyroid problem. "Your doctor may not bring that up, so you have to," says Wen. Ask your doctor to review your medications — studies show that prescription medications are often responsible for sexual problems. If sex is painful, you may simply need artificial lubrication or there could be an underlying medical problem. Sometimes a health scare can prompt a dry spell, but that doesn't mean you can't resurrect your sex life. An honest conversation with your doctor is a good place to start.
4. I'm newly single and have started dating. Should I be tested for sexually transmitted diseases?
Don't laugh. According to the U.S. Centers for Disease Control and Prevention, syphilis, chlamydia and gonorrhea have increased among ages 45-64 in the last decade. For instance, in 2000, there were 900 cases of syphilis in that age group. By 2010, the number almost tripled. "Older women are starting relationships," says Clancy. "But they may not think about protection. Ask your partner to wear a condom."
5. Should I start taking a daily aspirin?
A daily baby aspirin (81 mgs) can help prevent strokes and heart attacks, but your doctor may advise against it if you have blood clotting issues, stomach ulcers or take blood thinners, says Wen. Aspirin affects clotting and can cause stomach bleeding.
6. Am I at a healthy weight?
Describe your diet and exercise routines and ask how to improve them. "After menopause, hormones change and you can have trouble controlling your weight," says Wen. Ask your doctor if there are other reasons you might be gaining weight, such as diabetes or thyroid issues. "And ask what your healthy weight should be and ways to get there." Get referrals to a nutritionist and fitness trainer who can help you design a weight loss plan. A 2013 study of more than 500 overweight women in their 50s and 60s found that those who received counseling about dieting lost weight. The University of Pittsburgh study found that, in the long term, a diet that included more fruits and vegetables and less sugar, meat and cheese helped the women lose weight and keep it off.
7. Should I drink a glass of wine a day?
"One daily glass may be protective against heart disease," says Wen. "But 27 percent of women over 75 drink at least two alcoholic drinks a day. Talk about how much you drink and how it may affect you." A 2012 study at the Northern California Institute for Research and Education in San Francisco may sober you up. Researchers who tracked 1,300 women for 20 years until they were at least 65 found that at study's end those who drank seven to 14 drinks a week were 60 percent more likely to have problems with thinking and memory than nondrinkers. Other studies have found that moderate drinking increases breast cancer risk.
8. I've felt sad and listless lately. Could that be a sign of depression?
Depression affects 6.5 million Americans over age 65, and twice as many women as men. "If you have felt down, sad or hopeless, or had little interest or pleasure in doing things for the last two weeks, ask your doctor to screen you for depression," says Gloth. He or she will ask questions about energy level, sleep patterns and suicidal feelings. And the doctor may test for conditions such as thyroid disease. Ask about treatment options, including antidepressants, exercise and sleep changes.
9. What's my diagnosis?
If you are diagnosed with a condition, don't leave the office or hospital without asking how sure your doctor is of the diagnosis, and why, says Carolyn Clancy, M.D., director of the Agency for Healthcare Research and Quality in Rockville, Md. "If he doesn't know, ask how to get more information, or if it's a matter of wait and see." It's worth pushing for the information: According to 2012 statistics published in The American Journal of Medicine, 15 percent of medical cases in developed countries are misdiagnosed. And a 2012 Johns Hopkins study found that misdiagnoses contributed to the deaths of 40,500 intensive care unit patients each year; 75 percent of those patients had blood vessel-related problems such as heart attacks and strokes.
10. Help me understand my treatment options.
"Ask about the benefits and side effects of each option," says Clancy. If the treatment is medication, check on interactions with meds you're already taking. "Ask about alternatives, too," she says. "You'll want to know there are other options if one doesn't work." If the treatment is surgery or a procedure, ask why you need it and how often the doctor has done it. "You want to hear 'I've done a fair number,' not 'It's a procedure I'm dying to try,' " says Clancy.
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