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Making Medical Decisions With Your Doctor

One of the most important things you can do to maintain health is to see your physician regularly. Everyone should have a primary care physician who is a general internist, geriatrician, or family medicine physician. The frequency with which these visits occur is between you and your primary care physician, but should be no less than once a year even if you are perfectly healthy. If your primary care doctor is helping you manage one or more chronic diseases, the frequency will be more often. Many conditions require a specialist, for example, a cardiologist for heart disease or an oncologist for cancer. The remainder of this column is designed to help you have the best decision making when discussing options for treatment with your doctor, either primary care or specialist.

What Is the Problem?

If everything is normal, there is no need for a treatment plan. However, there will be times when acute or chronic problems need a medical plan. It is important to define the condition that needs treatment. You as the patient have to understand what your problem is. This means writing down the diagnosis — so that if you wish you can investigate it further after leaving the doctor’s office or you can share it with family or an informed friend. When a new or old diagnosis is being discussed the important questions you need to have answered are:

  • What is the cause?
  • What lifestyle or other things should I do to prevent progression?
  • What is the prognosis for most people with this problem?

What Is the Treatment?

Many medical conditions have more than one treatment option. For you to make the most appropriate decision about your treatment there are several factors to consider. First, the treatment is your decision to make after your physician has fully explained the options. It is important for you to understand this. Next, the various options need to be given to you in full and best in writing. Each option is likely to have ramifications that vary. For example taking medicine versus having a procedure is likely to have different risks, but also different benefits. This, in fact, is the most vital part of the decision making: What are the risks and benefits for options available for treatment of my problem? Every medicine and every procedure have risks and benefits and these should be well known by your doctor. He or she has to explain them fully to you. Risks tend to change with the age of the patient and this must be taken into consideration. The older one is the higher the risks tend to be and this is particularly true with many surgical procedures.

What Is Best for Me?

The above risks and benefits tend to be based on other patients’ experiences and you are not other people. It is absolutely crucial that you make sure you explain to your physician when considering pros and cons of a treatment plan, what you are willing to have and to not have. For example, if there is a risk of a prolonged convalescence that requires chauffeur assistance but you live alone and far from family and close friends, then this treatment might not be best for you. Some medicines may cause you extreme discomfort while others tolerate them well. Clearly these medications are not appropriate for you. The costs of various options are also a decision that you must consider. Medicare covers many of the medicines and procedures for the elderly, but sometimes not all of the costs of some medicines and procedures are covered. A frank discussion about this with your doctor is mandatory.

Practical Questions

Listed below are a number of practical questions for you and your doctor to have concerning a new or old treatment plan. These questions come from a recent National Institute of Aging Publication. I highly recommend the Health & Aging series on their website.

  • What are my treatment options?
  • What are the pros and cons of my treatment options?
  • When should treatment begin and when should it end?
  • What are the costs and will insurance cover them?
  • What can/should I do to prevent, reverse, or treat my problem?

The Bottom Line

Medical decisions are up to you and may be in consultation with your family or close friend. To make the best decision you have to have a full and frank discussion with your doctor about all the options. Finally, since you are the one who will follow the plan it has to be a plan you want and that is best for you.