Talking to Your Doctor? Speak Up

              The Tillies C®$»kb«**»k
...start sending in recipes note
— Page 3-E
People
...loohs at artist Travis WhitHeld
— Page 19-E
The Times Update Sunday, March 8, 1981 Advice Church news Features
Shreveport-Bossier E
By SALLY REESE
Of The Times Staff
When you talk to a doctor about a
diagnosis, speak up.
Ask questions. You have the right to know
"anything and everything" about your case.
When you've entrusted your care to a
doctor, work with him. You have a responsibili-ty
for the outcome as well as the doctor.
This is advice from three professors at
LSU School of Medicine in Shreveport who treat
as well as teach.
Dr. Perry G. Rigby, Dr. Leonard I.
Goldman and Dr. Herbert D. Tucker are the
authorities for this discussion.
It has to do with how to get the most from
the doctor-patient relationship.
Rigby is the associate dean of the medical
school. Goldman is associate chief of the sur-gery
department. Tucker is an internist in the
family medicine department.
All agree it is important for the patient to
be an active partner in his own care.
"A doctor and a patient should work
together like two people in a canoe," said
Tucker. "You pull your oar and I'll pull mine."
A patient should ask his doctor for all
information that will help him work with the
doctor in treating the illness, he and his col-leagues
said.
"One of my pet peeves is the patient who
won't take any responsibility for his treat-ment,"
said Tucker.
But it's important to recognize the dif-ferences
in patients, Goldman said. Some pa-tients
want to be intimately involved in the care
they're getting, said the surgeon; others want a
"father figure" to take care of them.
"I don't think lots of patients really want to
know all the details of their illness," Goldman
said. "As a physician, this is something you have
to appreciate. Sometimes you have to read a
patient's needs and wants and manage him
appropriately."
It is important to establish rapport, said
Rigby, whose medical specialty is hematology.
"You get acquainted with your patient, and
you go about it in such a way as to end up with
an informed patient who's interested in his case
and what's going on," he said.
"In that sense, I want a patient to be better
informed. He's more willing to cooperate."
The doctor should begin the doctor-patient
relationship with the intention that "the patient
will be informed to a reasonable degree and
you're going to discuss things," said the as-sociate
dean. Lots of things can be handled well
in a short time to establish a relationship for
care, he said.
"You want to promote mutual trust. That
means the doctor needs to ask questions too. Is
the patient following his advice? Is he taking his
medicine?"
Mutual trust, said Rigby, is one way the
patient can be a partner.
Patients needn't be abashed by medical
terminology and medical procedures. If the
doctor orders diagnostic tests, the patient
should want to know why, these doctors said.
The patient has the right to know the purpose of
the tests.
"Certainly patients can ask, 'Why are you
doing that? What do you expect to gain by doing
that?'" said Rigby. "Sometimes, the patient
won't ask that."
If risks are involved, the patient should
expect the doctor tell him what they are and
whether benefits outweigh risks. (It's the pa-tient's
decision to have a test or not; he has the
right to refuse.)
In a book titled "Talk Back to Your Doc-tor,"
author Dr. Arthur Levin says the patient
should ask how soon he will get the results, and
when they are in, what are the exact findings,
and what is the normal range.
Patients should ask how much a test will
cost, says Levin. They should not hesitate to
inquire about fees. They can ask for a full
explanation of all charges.
Will that turn the doctor off?
Drs. Tucker, Rigby and Goldman shook
their heads.
"Patients have a right to know anything
and everything," said Goldman. "It would be a
lot easier if they did discuss fees at the outset."
"The patient may ask, 'Is this really
necessary? Can I do without it?' I really ap-preciate
that," said Tucker.
Eventually, there's a discussion of "What
do I have?" — a question better asked after the
diagnostic workup, said Rigby. That's the time
to "discuss the case in detail," to learn what the
doctor thinks is wrong.
The patient should expect the doctor to
explain what the diagnosis means in terms he
can understand, said the doctors. (He also can
ask for-the official diagnosis for the purpose of
checking reference works or consulting another
doctor, says Levin.)
He can ask what findings were used to
arrive at diagnosis. What body systems are
involved. What caused the illness. Is it con-tagious?
Will it spread? How could it have been
prevented, and when can he expect it to im-prove?
What signs of worsening should he
watch for?
He can ask what forms of treatment are
available, the risks and benefits of each,
and why the doctor chose the one he recom-mends.
If surgery is involved, the patient may
want to get a second opinion before making a
decision. This is a valid medical procedure, so
he can ask the doctor to suggest someone. (He
doesn't have to see the person the doctor
suggests — he can choose somebody else.)
Dr. Tom Ferguson, physician and editor of
the journal "Medical Self-Help," was reported
as advising a second opinion before agreeing to
any costly or potentially diagnostic procedure,
Talking to
your doctor?
Speak up
6A doctor and a patient should
work together like two people
in a canoe.' — Dr. Herbert D. Tucker
or any surgery other than minor surgery. (FDA
Consumer, September 1979)
Goldman said there are situations in which
a second opinion is not necessary.
As a matter of fact, there is a dispute over
the cost-savings benefits of a second opinion.
Some say a second opinion can prevent un-necessary
surgery and thus reduce patient
costs. Others say the difference of opinions is
negligible and thus a second opinion only in-creases
patient costs.
"Most of the time, where there's rapport,
patients don't want a second opinion," said
Tucker.
• I n the surgery realm, the patient wants
A the assurance that there is a need for
surgery and that it will be performed correct-ly,"
said Goldman.
"He looks to the surgeon for advice and the
feeling he's getting adequate support. That's
what a patient really wants, and, hopefully, we
can provide it."
If drugs are prescribed, the patient should
ask what they are, why they are indicated for
treatment, and how they work. "Will you ex-plain
these drugs?" is the umbrella question
Rigby advised.
All advised patients to ask about possible
side effects. They should expect a doctor to tell
them that, anyway.
"And if they have a side effect, fall out at
home, I want to know about it," Tucker said. "I
expect them to let me know."
(Some people will develop a side effect
simply because they know the drug may have
one, the doctors said. On the other hand, there's
the placebo effect. "Sometimes, you might
improve somebody just because he feels he
should be improved," said Rigby.)
The patient should understand what the
dosage is and how long he must take it (some
patients don't know this, because they don't
ask), and what if anything he should avoid while
he's taking the drug.
He can ask that a
drug be prescribed by its
generic name, if possible,
rather than by its brand
name. Tucker said doc-tors
are aware of the cost
factor and are willing to
do this if it is medically
appropriate.
Rigby said some im-portant
questions a pa-tient
can ask are: What is
the plan for me between
now and the next visit?
Are we trying to establish
a diagnosis? Do we have
one? Is a form of treat-ment
in view?
In turn, Rigby added,
the doctor might say we'll
do this now and this the
next time. In that frame, patient and doctor can
"work into" the issues that are important.
A patient can make it clear at the outset
that he wants to play a positive role in his
treatment.
"Rapport depends on what the patient
expects of you," said Goldman. "Some patients
can threaten a doctor. I mean, threaten his ego.
Where's there's trust, the doctor doesn't feel
threatened."
Rigby said he wants a patient to
participate in his own care, to be involved in the
outcome.
Unfortunately, some outcomes are
"lousy," said Goldman.
"But I'd like the satisfaction of knowing
I've done a good job, whatever the outcome."
Yes, said the surgeon, you should tell the
patient the prognosis, you should level with
him.
"You don't have to cite the statistics on his
chances. It's wrong to say to the patient,
'You've got two months to live.' It you have to
use a statistic, use it for the good. It's better to
recognize that some people have been cured of
the disease."
Said Tucker, "Don't take away all hope."