The doctor’s answer shocked us. No, he said, he could simply operate on my chest. That would cut surgery and recovery time in half. He had planned the more complicated procedure because he thought it would have the best cosmetic result. “I assumed that’s what you wanted,” he said. It was not. After consulting with my husband for five minutes, I told the surgeon to do the less-invasive procedure.
No one should have to make a major medical decision as she is about to go under the knife. But far too many patients consent to surgery without understanding all their options. Sometimes they simply haven’t asked the right questions. But sometimes doctors push the surgical procedure they prefer, rather than finding out what their patients really want. Such surgical “steering” helps explain geographic variation in the incidence of certain types of surgery. If you live in Boise, Idaho, for example, you’re five times more likely than people in Terre Haute, Ind., to have back surgery, according to Dartmouth Medical School’s Atlas of Health Care. “Like anyone else, doctors are often narrow-minded enough to think that reasonable people will have the same preferences as they do,” says Dr. David Share, who tracks quality of care for BlueCross BlueShield of Michigan.
How can you take control of your care? Start by avoiding snap decisions. When a doctor says you’ll need an operation, you feel a sense of urgency to act. In fact, very few ailments require emergency surgery. Take the time to get the information you need. The Foundation for Informed Medical Decision Making (fimdm.org) is a good place to begin. The foundation’s partner, Health Dialog Inc. (800-651-7912), contracts with big insurers to provide patients with medical support through a team of nurses. Its Web site, www.collaborativecare.net, links you to more than 20 good health resources.
Be careful when you’re surfing the Web: check the site’s sponsor to make sure it’s not promoting one type of treatment, and make sure the site lists a variety of treatment options. Some good options: the American Medical Association, ama-assn.org; the National Institutes of Health, www.nih.gov; the American Cancer Society, cancer.org, and the Centers for Disease Control, www.cdc.gov.
Choose a trusted relative or friend to help you throughout the process. Bring your advocate to all doctor’s appointments –so you’ll have a second set of ears in the room. Take a list of questions to all doctor’s visits, so you can make the most of your time there. Take thorough notes. If you still have questions, don’t be afraid to call your doctor back.
Get a second opinion. Many physicians are willing to provide referrals, or you can call other hospitals to get the names of leading specialists.
Of course, no matter what you do, there may be no easy choice. And doctors are the experts. But having the confidence to challenge the doctor made a difference for me. Within four weeks of surgery, I was swimming laps in the pool and shuttling my kids to music lessons and soccer practice. All thanks to one last-minute question.
