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My Medical Manager

Ask the Tough Questions

Don't leave the doctor's office without getting the answers you need

Asking the right questions just might save your life. It's a message that can’t be repeated often enough. Study after study has shown that good communication and patient safety are inexorably linked. When communication with health care providers fails, patients are less likely to follow medication instructions, are subjected to more diagnostic tests and are more likely to have to return to the doctor's office, the hospital or the emergency room. And billions of dollars are added every year to the nation's health care costs.

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A 2007 report from The Joint Commission, which accredits U.S. health facilities, cited a "breakdown in communication" as the root cause of more than 3,000 unexpected deaths and catastrophic injuries reported to the commission since it started tracking such occurrences in 1985.

"I've seen numerous cases of medical errors and discovered after the fact that the patient or family member knew something was wrong and didn't speak up," says David Shulkin, M.D., professor of medicine at Albert Einstein College of Medicine in New York and editor of Questions Patients Need to Ask: Essential Information Every Patient Needs to Know (XLibris, 2008).

Shulkin tells the story of a woman who was given the wrong ID bracelet upon checking into the hospital and spent an entire day having tests she didn't need. "It seems ridiculous," he says, "but she thought it was her doctor's name, so every time that name was called, she responded. Ask what tests you've been scheduled for, and ask if the test you're about to be given is really for you," he says. "Simple proactive questioning can prevent a lot of problems."

Silence can be hazardous to your health

Experts agree that the responsibility for effective communication lies partly with the patient. "Patients need to see themselves as the center of their health care team," says Cathy Ipema-Brown, spokesperson for The Joint Commission. "They can't be bystanders."

But too often patients remain silent. One reason is fear of rocking the boat. Another is that patients can literally die because of embarrassment, says Vicki Rackner, M.D., a former surgeon who now facilitates patient-doctor communication through her company, Medical Bridges, in Seattle. "I once had a patient who couldn't tell her doctor about blood in her stool," Rackner says. "When she was finally evaluated for abdominal pain, her colon cancer had advanced and ultimately took her life. It probably would have been treatable if she had mentioned it sooner."

When patients are unengaged bystanders, their health suffers as a result. A recent survey from the AARP Public Policy Institute on the care of chronic diseases makes this clear. Of those who were less engaged, 36 percent experienced more medical errors — compared with 19 percent of those who were highly engaged.

Will Carpenter, a 57-year-old retired ship captain from Cookeville, Tenn., was determined to handle his surgery for renal cell carcinoma with the toughness he learned in 33 years in the U.S. Merchant Marine. When he met with the doctor, Carpenter didn't start with, "Am I going to die?" but he brought up more immediate concerns. "Not only did I ask the doctor if she had washed her hands, I also questioned her about the education, training and talent of the colleagues who would be assisting her," he says.

Many patients find it hard to speak up if doctors seem dismissive or unresponsive, even if they appear to be open to communication.

Medical Bridges' Rackner says many people were brought up on "old medical manners" — that is, to be "good" patients. "Being polite was more important in the doctor's office than in church," she says. Shulkin thinks that mindset is changing. "The days of 'doctor knows best' are waning, and the relationship is more about interaction," he says.

Next: How to ask good questions. >>

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