Doctors are more pressed for time than ever, with health-care reform adding to it to the crunch doctors are facing today. Millions more insured Americans are entering the health-care system, just as a growing number of doctors are nearing retirement age.
That’s one reason doctor errors cause as many as 500,000 U.S. deaths annually, many of them due to inaccurate diagnoses, as well as surgical mistakes, errors in prescriptions, plain incompetence, according to the newly published book, Top Screwups Doctors Make—and How to Avoid Them by Joe and Terry Graedon.
That’s why it’s critically important to make the most of your doctor visit, says Leana Wen, M.D., an emergency physician and director of Patient-Centered Care at the Department of Emergency Medicine at George Washington University. Dr. Wen, author of “When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests,” tells Newsmax Health patients must become better advocates for their own care—a tough task at a time when the typical appointment runs 10 to 15 minutes.
“We have a problem in our country with our healthcare system,” says Dr. Wenn, in an interview on Newsmax TV’s Meet the Doctors program. “We know that doctors are under more pressure to see as many patients as possible in very little time and also doctors are not reimbursed for time with patients; we’re reimbursed for things that we do to patients and, as a result, we just don’t have the time to listen.”
Dr. Wen notes that studies show that 80 percent of all diagnosis can be made just based on listening to a patient talk about his or her symptoms and medical history.
“There are ways that patients can tell a better story to help their doctors better help them,” she explains. “Know your own medical history. Help me help you.”
Dr. Wen’s book was inspired by her own experiences as a physician, but also by her mother’s battle with metastatic breast cancer.
“When I was a medical student, my mother was misdiagnosed for over a year before she was finally diagnosed with what turned out to be stage 4 breast cancer,” she notes. “She kept telling her doctors that she was feeling tired and short of breath and they kept on diagnosing her with depression and anxiety. But as it turned out she had cancer. And I learned so much in that process of why it’s so important for patients to be their own best advocate.”
Dr. Wen’ recommends the following “Eight Pillars to Better Diagnosis” that can help you make the most of the short time you spend with your doctor:
1. Tell your whole story. Studies have shown that the vast majority of diagnoses can be made by listening to a patient discuss his or her medical history. Unfortunately, doctors sometimes steer patients toward a cookbook “chief complaint” or a series of “yes/no” answers. Learn to tell a succinct, effective story. Prepare and rehearse it.
2. Assert yourself in the doctor’s thought process. Find out what your doctor is thinking as you tell your story, and let your doctor know what’s on your mind. Starting out on the same page makes it easier to develop a productive partnership.
3. Participate in your physical exam. If you’re being examined, make sure you know what the doctor is looking for. Don’t be afraid to ask about any findings.
4. Make a ‘differential diagnosis’ together. This simply means you should make a list of all the possible diagnoses that could explain your symptoms. Make sure you and your doctor jointly devise a thorough list, handicapping the likelihood of each possible diagnosis. Keep asking what else could be going on.
5. Participate in the decision-making process. Work with your doctor to narrow down the list of potential diagnoses. By partnering with your doctor, you can often come up with diagnosis without a lot of tests.
6. Apply tests rationally. If you do need to further testing, make sure you understand how a particular test will help, as well as and what the risks and alternatives are. Look out for “cookbook medicine,” and make sure your doctor is tailoring an approach that works for you.
7. Use common sense. Don’t just leave the doctor’s office without a working diagnosis that makes sense to you. Don’t just assume the doctor must be right.
8. Integrate any diagnosis into the healing process. Talk through your diagnosis with your doctor and make sure you understand how it will have an impact on your life and health. What are your treatment options, and what risks and benefits do they carry? What warning signs should you be on the lookout for?
Dr. Wen’s book has been published in the wake of a new report from the Institute of Medicine that found the U.S. healthcare system squanders about $750 billion a year on wasteful spending—up to 30 cents of every dollar spent—much of it on unnecessary tests and procedures that do little to improve patients’ health and well-being.
There’s even a new initiative involving some 60 medical groups and patient-advocacy organizations, called the Choosing Wisely Campaign, that has identified 90 common tests and procedures that are often unnecessary, costly, and may in some cases do more harm than good.
Among those questionable tests and procedures are CT and MRI scans—for instance, for low-back pain and minor head injuries—that are just not necessary. Others involve medication, such as prescribing antibiotics for sinus and respiratory infections, which usually caused by viruses and not bacteria, so the drugs have no effect. And even heart-stress test, such as echocardiograms, are often recommended for people at very low risk for heart disease, even though they are usually worthless.
Organizers of the campaign say it’s important to question your doctor if he or she prescribes any test or procedure that makes you wonder: Do I really need that? You can and should work with your doctor by being an active participant in your own health. Ask questions, provide background on yourself, give details—engage in a conversation. You’re not a math problem for your doctor to solve; you’re a human being with a full, and probably complicated, life.
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