Choosing Treatments
Contents
Research shows that millions of Americans
receive treatments that are unnecessary, costly, and even
harmful to their health. On the other hand, millions of
Americans do not get the treatments they need.
Study after study has found that the use of
certain treatments varies widely—from region to region, State
to State, and city to city. But there are even large
differences in the use of treatments within a single health
plan or hospital, or by a single doctor.
That is why it is very important to work
closely with your doctor when treatment decisions need to be
made. Make sure your doctor knows your questions, concerns,
and preferences. Ask your doctor if the treatments he or she
recommends are based on the latest scientific evidence.
Quick Check for Quality
●
When choosing a treatment, make sure you
understand:
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What your diagnosis is.
●
Whether treatment is really needed at
this time.
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What your treatment options are.
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Whether the treatment options are based
on the latest scientific evidence.
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The benefits and risks of each treatment.
●
The cost of each treatment.
If you understand and feel comfortable with
your treatment plan, you are more likely to do your part to
make it work. And, research shows that people who are actively
involved in their own health care tend to get better results.
Learning About the
Problem
The first step in getting the right
treatment is to tell your doctor what's going on. This
information might include:
Your symptoms:
_________________________________________________________________________________________________
When they first started:
_________________________________________________________________________________________________
When they occur:
_________________________________________________________________________________________________
Are they getting better? Worse?
_________________________________________________________________________________________________
What makes them better? Worse?
_________________________________________________________________________________________________
Are they affecting eating, sleeping, or
other activities? How?
_________________________________________________________________________________________________
Medicines you take:
_________________________________________________________________________________________________
Before a treatment decision is made, your
doctor needs to make a diagnosis. Medical tests are an
important way to help your doctor learn about the problem. It
is important to make sure that any tests your doctor suggests
are appropriate for you.
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Medical Tests
Doctors order blood tests, x-rays, and other
tests to help diagnose medical problems. Perhaps you do not
know why you need a particular test or you don't understand
how it will help you. Here are some questions to ask:
How is the test done?
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What kind of information will the test
provide?
_________________________________________________________________________________________________
Is this test the only way to find out that
information?
_________________________________________________________________________________________________
What are the benefits and risks of having
this test?
_________________________________________________________________________________________________
How accurate is the test?
_________________________________________________________________________________________________
What do I need to do to prepare for the
test? (What you do or don't do may affect the accuracy of the
test results.)
_________________________________________________________________________________________________
Will the test be uncomfortable?
_________________________________________________________________________________________________
How long will it take to get the results,
and how will I get them?
_________________________________________________________________________________________________
What's the next step after the test?
_________________________________________________________________________________________________
One study found that anywhere from 10
percent to 30 percent of Pap smear test results that were
called "normal" were not. Errors such as this can lead to a
wrong or delayed diagnosis.
You want your tests to be done the right
way, and you want accurate results.
What can you do?
●
For tests your doctor sends to a lab, ask
which lab he or she uses, and why. You may want to know that
the
●
doctor chooses a certain lab because he or she has
business ties to it. Or, the health plan may require that
●
the tests go there.
●
Check to see that the lab is accredited
by a group such as the College of American Pathologists
(800-323-
●
4040) or the Joint Commission on Accreditation of
Healthcare Organizations (telephone 630-792-5800; Web
●
site
http://www.jcaho.org).
●
If you need a mammogram, make sure the
facility is approved by the Food and Drug Administration.
You can
●
find out by checking the certificate in the
facility. Or, call 800-4-CANCER 9:00 a.m.-4:30 p.m. EST to
find out
●
the names and locations of certified facilities
near you.
●
What about the test results?
●
Do not assume that no news is good
news. If you do not hear from your doctor, call to get your
test results.
●
If you and your doctor think the test
results may not be right, have the test done again.
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Getting the Diagnosis
When your doctor has decided what your
problem is, he or she will give you a diagnosis. But you
should know that reaching a diagnosis can be hard. Sometimes
it can take a long time. And sometimes it is hard to find out
exactly what is wrong.
Ask your doctor to explain what you have and
how it might affect you and your family.
What is the diagnosis?
_________________________________________________________________________________________________
What is my prognosis (outlook for the
future)?
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What changes, if any, will I need to make in
my daily life?
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Is there a chance that someone else in my
family might get the same condition?
_________________________________________________________________________________________________
Will I need special help at home for my
condition? If so, what type of help?
_________________________________________________________________________________________________
Ask for materials you can take home. You
also might want to find out if there are any support groups
for people with your condition.
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Support
"Self-help" groups offer support to people
with disabilities, cancer, and many other health problems. The
groups are made up of people who have "been there" and who
share experiences and information.
Call the American Self-Help Clearinghouse
for information on national groups. It also can refer you to
any State or local self-help clearinghouses in your area. If
you want to start your own self-help group, the Clearinghouse
has information to help you at its Web site:
http://www.mentalhelp.net/selfhelp/.
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to Contents
Looking at the Options
The next step is for you and your doctor to
look at your treatment options. Your doctor may recommend one
or more of the following:
●
Behavior change (for example: eating a
healthier diet, getting more exercise, quitting smoking).
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Prescription medicine.
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Non-prescription ("over-the-counter")
medicines.
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Surgery.
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Rehabilitation (such as physical
therapy).
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Other treatments (for example,
chiropractic services, massage, or acupuncture).
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"Watchful waiting." (You and your doctor
keep track of your symptoms and watch for any changes. If
there are
●
changes, then treatment might be the next step.)
Not all treatments have been proven by
research studies to work-or to be the best treatment for what
you have. "Clinical practice guidelines" can help doctors and
patients make the right treatment choices for some conditions.
Some of these guidelines are based on scientific evidence
about which treatments work for certain conditions and which
do not. Ask your doctor if there are evidence-based guidelines
on treatments for your condition.
Ask about any books or special materials
that can help you decide which treatment is best for you. For
example, "shared decision-making programs" use video, audio,
and computer graphics to help patients make decisions based on
science and on their own values and preferences. Self-help
groups, patient organizations (such as the American Cancer
Society and the American Diabetes Association), the Internet,
and your library are other sources of information.
All treatments have benefits and risks. To
learn more about them you may want to ask your doctor:
What is the recommended treatment? Are there
other choices?
_________________________________________________________________________________________________
What are the chances the treatment will
work?
_________________________________________________________________________________________________
What are the expected results? When will I
see them?
_________________________________________________________________________________________________
What are the risks?
_________________________________________________________________________________________________
What are the benefits?
_________________________________________________________________________________________________
Are there any side effects? (Most treatments
have them.) What can be done about them?
_________________________________________________________________________________________________
Is the treatment painful? How can the pain
be controlled?
_________________________________________________________________________________________________
What happens if I choose to have no
treatment at all?
_________________________________________________________________________________________________
How much does the treatment cost? Will my
health plan pay?
_________________________________________________________________________________________________
Once you have the answers to these
questions, you might want to make a chart of "Benefits and
Risks" or "Pros and Cons" to help you decide if the treatment
is right for you. Here is a sample chart:
|
Benefits (Pros) |
Risks (Cons) |
|
|
|
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Treatment has worked well for others with my
●
condition.
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The medicine only needs to be taken once a day.
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No major side effects are expected. |
●
Some minor side effects (rash, stomach upset)
●
could be
troubling.
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The medicine is costly. |
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What Can You Do to
Help the Treatment Work?
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Ask about anything you do not understand.
●
Follow the doctor's directions. If you have a problem
with the directions, tell the doctor—the sooner,
●
the better.
●
If you have made any changes in the treatment plan,
tell the doctor.
●
If you feel worse, have new symptoms, or have side
effects from the treatment, call your doctor.
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Making Decisions About
Surgery
Some surgery has to be done right away. But
most surgery is not an emergency. That means you have time to
talk with your doctor and decide what is best for you.
No surgery, not even minor surgery, is
risk-free. To decide if a procedure is right for you, learn
about it and its possible benefits and risks. Research shows
that patients who know the facts about surgery and other
treatments can better work with their doctors to make
decisions based on science and on what the patient prefers.
The result? A more satisfied patient.
Here are some questions you may want to ask
your doctor or surgeon:
Do I really need this surgery? Is there some
other way to treat my condition?
_________________________________________________________________________________________________
What will happen if I wait until later to
have surgery? Or never have it at all?
_________________________________________________________________________________________________
How often does this type of surgery help my
kind of problem? How much does it help?
_________________________________________________________________________________________________
Where will the surgery be performed?
_________________________________________________________________________________________________
Does the surgeon, hospital, or surgery
center have a lot of experience with this kind of procedure?
_________________________________________________________________________________________________
Is the surgeon experienced and qualified to
perform the surgery?
_________________________________________________________________________________________________
What complications or side effects might I
have?
_________________________________________________________________________________________________
What kind of pain might I have? How will it
be treated?
_________________________________________________________________________________________________
How long will it take me to recover? Will I
need help at home? What kind of help?
_________________________________________________________________________________________________
How much does the surgery cost?
_________________________________________________________________________________________________
Will my health plan pay?
_________________________________________________________________________________________________
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Getting a Second Opinion
A "second opinion" is when another doctor
gives his or her views about what you have and how it should
be treated. A second opinion can help you decide whether the
surgery is right for you at this time. Your doctor and surgeon
should welcome your request for a second opinion. Your health
plan may even require one for some types of surgery.
You can ask your doctor, health plan, a
local medical school, or local medical society for help in
finding someone to give you a second opinion. But first check
to see if your health plan covers second opinions.
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Ambulatory Surgery
Centers
Today more and more surgeries are done in
places other than hospitals. These are "in and out"
(ambulatory) surgery centers, where you may stay for a few
hours or up to one night. If you plan to have surgery at such
a center, call your health plan or visit the center to find
out:
●
If your health plan will cover your care
there.
●
If it is licensed. Then check to see if
it is accredited by a group such as the Joint Commission on
Accreditation
●
of Healthcare Organizations (telephone
630-792-5800; Web site
http://www.jcaho.org) or
the Accreditation
●
Association for Ambulatory Healthcare
(847-853-6060). The accreditation certificate should be
posted in the
●
facility.
●
How well trained and experienced the
center's health care professionals are.
●
If the center is affiliated with a
hospital. If it is not, find out how the center will handle
any emergency that could
●
happen during your visit.
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Sources of Additional
Information
Be Informed: Questions to Ask Your Doctor
Before You Have Surgery
A list and in-depth discussion. 12 pages. Free.
Web site:
http://www.ahrq.gov/consumer/surgery.htm
The National Guideline Clearinghouse™ makes
clinical practice guidelines available to the public via the
World Wide Web. The Clearinghouse was developed by AHCPR, the
American Medical Association, and the American Association of
Health Plans.
Web site:
http://www.guideline.gov
FDA Guide to Choosing Medical Treatments
Designed to help consumers avoid fraud and deception when
choosing medical treatment. Use publication number (Reprint
95-1223) when ordering. 6 pages. Free.
Food and Drug Administration
Office of Consumer Inquiries: HFE-88
5600 Fishers Lane
Rockville, MD 20857
1-888-463-6332
Web site:
http://www.fda.gov
Taking Part in Clinical Trials: What
Cancer Patients Need to Know
This booklet by the National Cancer Institute describes how
clinical trials work, and their possible benefits and
drawbacks. 18 pages. Free.
Cancer Information Service:
1-800-4-CANCER (1-800-422-6237)
9:00 a.m.-4:30p.m. EST
Also available on the Clinical Trials Web
site:
http://cancertrials.nci.nih.gov
When You Need an Operation
This brochure by the American College of Surgeons covers how
to assess a surgeon's qualifications, whether to seek a second
opinion, and informed consent and cost issues. It and 12 other
informational brochures are available free from:
The American College of Surgeons
Office of Public Information
633 N. Saint Clair St.
Chicago IL 60611
(312) (202) 5391
Web site:
http://www.facs.org
Health Pages
Information about women's health, men's
health, and treatments for arthritis, diabetes, and other
conditions is available from the Health Pages' online
magazine.
Web site:
http://www.thehealthpages.com
healthfinder®
Provides a gateway to reliable consumer health information
from the Federal Government and other organizations.
Web site:
http://www.healthfinder.gov
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