Saturday, October 17, 2009

Questions for your doctor?

I had a rewarding experience last week when one of my patients asked me a range of excellent questions about their condition. I had just diagnosed them as having an anxiety disorder. This patient was clearly concerned about possible medication side effects, having had difficulties with these in the past, and wanted to know in detail about the type of psychotherapy that would be most likely to help them. I recommended that they read about the illness on the handouts that I printed out for them, and on a number of websites I suggested, before coming back to see me again to decide on a course of treatment. It was pleasing to have a good open discussion about their best therapeutic options, to not need to simply prescribe and undertake a treatment program immediately, and to be able to take the time for the patient to do their own research, and then come back and make a joint decision on the best therapy together. This is the way medicine, in non-emergency situations, should be practiced.

Unfortunately this is not the usual way that physicians practice, partly because it takes more time to communicate and arrive at a mutually agreed treatment plan, but also because most patients still do not really plan in advance what questions they should ask. This leads to doctors still having to second guess what patients want to know when they give them an opinion, and of course they therefore often omit telling patients key information of particular importance to that individual.

Most doctors like patients to ask appropriate relevant questions about their health condition. Two way information flow is a key component in any doctor-patient relationship. It is just as essential that patients ask questions of doctors about their diagnosis and treatment, as it is for doctors to ask patients questions to help them decide what tests are necessary, and what treatments are best.

Think about the last time you bought a major consumer item, such as a television, computer or an expensive piece of furniture, or even something cheaper, such as a cell phone or new clothing. What research did you do? Did you go online and compare all sorts of products? Did you go to various stores and compare prices, availability and replacement guarantees? How much time did you spend on your research before making your purchase?

What about when you last went to see your accountant or your lawyer? Did you think through what issues might come up beforehand and plan some possible questions? Did you think of several potential scenarios that might occur, and try and work out what your response would be to those?

Now compare this with the last time you went to see your doctor. Did you check out various different hospitals if you needed surgery? Did you read up on a variety of possible medications if you needed drug therapy? Did you confirm your diagnosis by reading about your disorder and all possible treatment modalities? Did your doctor tell you what he or she thought was wrong, and then offer information to help you make a decision on what to do next?

The Agency for Healthcare Research and Quality has been running an excellent public campaign called "Questions are the Answers". This campaign encourages patients to create their own list of questions whenever they visit the doctor, or need to have any sort of medical procedure. The campaign consists of both print and internet resources, as well as television advertisements. The Agency has created all sorts of lists of questions which I would encourage any patient to use, and has sorted them by a number of differing situations and encounters that commonly occur in the health field. Examples of some of the core questions are "What is this test for?", "How many times have you done this?", "Are there any alternatives to surgery?" and "How do you spell the name of that drug?" These may all sound like very simple questions but it is astonishing how often patients, when confronted with a potentially life changing or serious diagnosis, have very few questions at the time of the doctor's consultation. Of course people often think of questions afterwards, and will then hopefully read up on their condition and arrange another appointment to ask their doctor about these issues, but not all do, leading to people receiving all sorts of medications and surgeries for reasons that they simply do not understand.

So do help your doctor, and plan your questions as much in advance as much as you can. Most doctors will be appreciative of your questions, and will be happy to answer them so that your treatment can progress with your full understanding.

Peter Yellowlees MD has recently published “Your Health in the Information Age – how you and your doctor can use the Internet to work together”. It is available at and most online bookstores.


  1. It's also scary to think that your doctors are the ones who resist to learning. "Primary care physicians and their information-seeking behavior" (

  2. I like to analyze the demographics of a population. As a habit, I analyzed the composition of students I met in last Wed.'s seminar. This is what I found: "One Chinese Kaiser primary care physician, one Chinese pharmacist, two American nurses, one ex dentist (from Nepal), one American from the Department of Public Health, one Saudi with less than a year job experience but educated in MIS and something else, two from India (don't know for sure their background), and two are from IT."
    Now it's the question: "What about the American doctors?"