The Right Amount of Care

Readers of this blog and savvy health-care consumers are familiar with the risks of overtreatment-how overtesting and overdiagnosis can, instead of promoting and preserving good health, undermine it.

Too much medical care is not only expensive, it can lead to tests rendering a false positive, leading to more tests and the possibility of complications such as infection. It can lead to results not generally considered “normal,” but that might be for you-something can be technically abnormal but if it had never been discovered, would never have done harm. Overtesting of the prostate is a prime example.

So, asks Dr. Leana Wen, who practices emergency medicine and wrote “When Doctors Don’t Listen: How to Prevent Misdiagnosis and Unnecessary Tests,” how do you ensure you’re getting the right amount of care? How do you know when you should consult a medical professional when you should follow his or her advice, and that it’s good advice in the first place?

Writing on KevinMd.com, she offers five ways to ensure your Goldilocks ration of health care so that it’s juuust right.

1. Work in partnership with your doctor.

The key to getting good medical care is a trusting relationship between you and your doctor. That doesn’t mean that you never question your doctor-in fact, good practitioners appreciate a robust curiosity and interest in your physical reality. It means developing a relationship of mutual respect that makes you the expert when it comes to your body, and the doctor the expert when it comes to medicine.

2. Make sure your doctor listens.

Wen says studies confirm that a patient’s history will point the way toward a diagnosis 8 out of 10 times, without the need for tests or further interventions. If your doctor orders tests instead of listening to your story, that leads to unnecessary testing-and potential misdiagnoses. Prevent this by telling a good story-that is, presenting a concise picture of your medical history, your family influences and your current complaint-and making sure it’s heard.

If your doctor isn’t interested in your story, or only mildly so, it’s time for a new doctor.

3. Ask about your diagnosis.

Become a student of your condition. Understanding what you have is key to figuring out what should do to feel better. Before you get any tests done, ask your doctor what he or she thinks you might have. That will give you some idea of what tests may be necessary, and also focuses your doctor to remember the important tests and have a justification for tests ordered.

Ask if there are options to tests or interventions he or she recommends, and what are the risks and benefits of each.

4. Ask about every test that’s performed.

Every test has a risk, whether it’s a blood draw or a lung screening. So make sure you understand why each is necessary. Ask about the risks. Ask about how it would determine your condition’s management-what happens if it’s negative? What happens if it’s positive? And-this is important-what happens if nothing is done at all? The answers will help you gauge how important is it that the test be done now.

This applies whether you are visiting your doctor’s office, or are in the hospital.

5. Do your own research.

This is especially important when it comes to treatments. Browse the Internet, mindful that there’s a lot of junk out there (see our blog, “Medical Mumbo Jumbo: Understanding Patient Information”). Ask your friends and family. Although information varies in quality, it can help you formulate questions to ask your doctor. Also, you might want to look up your doctor to see if he or she has conflicts of interest that you may not be aware of-drug company affiliations, for example, can be found online. Write down questions, and ask them.