Please ask!

Too often I am told whatever you think doc.

I can see the point of this question, after all, I spent four years training to be a pharmacist, then another four to be a doctor, and six more years to pass my fellowship exams to become a GP with ongoing active education. Not a day goes by when I cant say I learn’t something new. My patients are often my greatest teachers.

But may I encourage you to questions your doctor, because it is after all your health we are talking about.

Choosing Wisely Australia is helping healthcare providers and consumers start important conversations about improving the quality of healthcare by eliminating unnecessary and sometimes harmful tests, treatments, and procedures.

Here are 5 questions to ask your doctor

1. Do I really need this test, treatment or procedure?

Tests may help you and your doctor or other health care provider determine the problem. Treatments, such as medicines, and procedures may help to treat it.

I have been taught that you order a blood test to answer a clinical question, for example, could this patient have an over active thyroid? Tests are not for fishing expeditions!

I have had some challenging consultation after a patient has seen a naturopath trying to determine which tests might be clinically necessary. The RACGP has come out with this document to support the decision making process.

2. What are the risks?

Will there be side effects to the test or treatment? What are the chances of getting results that aren’t accurate? Could that lead to more testing, additional treatments or another procedure?

Some tests, treatments and procedures provide little benefit. And in some cases, they may even cause harm. For example, for most lower back pain an x-ray may lead down a path of ending up with more invasive treatments which may not help. 

Even blood tests are not without risk. Any sharp instrument going through the skin can lead to infection!  An imperfect screening test for prostate cancer, Prostate Specific Antigen may lead a bloke on the pathway to a painful biopsy, then surgery which may leave him impotence and incontinent for the rest of his life. All for removal of a potentially slow growing cancer that he may have died with rather than from.

3. Are there simpler, safer options?

Are there alternative options to treatment that could work.

To reduce the risk of a heart attack, should you take a cholesterol lower medication with the risk of side effects or cut back on fast foods and exercise more?

Is it safer to take a tablet or injection to improve you B12 or iron levels?

4. What happens if I don’t do anything?

Ask if your condition might get worse — or better — if you don’t have the test, treatment or procedure right away.

This is a most challenging question because a doctor is trained to do something. Push on a chest, give a drug, order an x-ray, cut out badness…..
But sometimes doing nothing is all that is required. Recently, I chatted with a palliative care nurse who told me about a patient’s distress that the doctor who operated on her cancer didn’t visit in her final week. I replied it was probably because the doctor felt he had nothing to offer, that he had failed to cure her. But the patient wasn’t angry that the surgery didn’t work, she didn’t want more procedures, tests or medicine, she just wanted him to be present for a moment, to be seen at her door, to care. That was all. Sometimes it is okay to do nothing.

5. What are the costs?

Costs can be financial, emotional or a cost of your time. Where there is a cost to the community, is the cost reasonable or is there a cheaper alternative?

I meet people who seem genuinely surprised that they don’t necessarily need to see a specialist dermatologist for a skin cancer check; that a GP is able to do this usually then and there.

 

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