Fear of Speaking Up in the Doctor’s Office Costs Lives, and Money

Evan Falchuk, Best DoctorsBy Evan Falchuk, Vice Chairman, Best Doctors

“Shy” isn’t a word you associate with Americans, but when it comes to talking with our doctors, it seems like it’s the best word for what we are.  A 2012 study in Health Affairs found that patients were afraid to ask questions – and often regretted not being more assertive with their doctors about their concerns.

Now, we could dismiss this finding as an odd quirk of American culture, or maybe an example of how doctors sometimes are seen as intimidating.  But this isn’t what really matters. Published studies show that anywhere from 15-28% of patients in developed countries end up misdiagnosed in that office visit – causing needless suffering and wasted dollars.  Importantly, this same research shows that asking questions – the thing patients seem most reluctant to do – can have some of the greatest impact on getting a diagnosis right in the first place.

You can understand the dilemma facing a patient and his or her doctor.  Our healthcare system is designed in a way where doctors often see a hundred or more patients a week, and are able to spend just a few minutes with each.  Studies – and common sense – tell us in many cases that this isn’t enough time.  The sad irony is that doctors today are the best trained and educated that they have ever been, and yet our system values their insights so little they are unable to practice the medicine they were trained to do.

It doesn’t have to be this way, and there are some practical things we can do to help make this problem better.  For starters, we must figure out ways to add even a few more minutes to each visit.  If hospitals and doctors would track instances of misdiagnosis – and give their colleagues regular feedback on misdiagnosed cases – the impact of starving doctors and patients of needed time would come into sharper focus.  Measuring a problem is the surest way to get people working on solutions for it.

Second, we must keep encouraging patients to be more engaged in their care.  Public education programs like AHRQ’s “Questions Are the Answer” are an important step in demystifying the doctor-patient relationship.  More can be done to encourage patients to ask questions, to be curious and insistent while still being polite.  What if doctors gave questions lists of useful questions to ask, covering areas they know are probably are on the patient’s mind?  It would give patients ‘permission’ to ask, and make it more likely the patient will ask an unexpected question – or volunteer some new information – that could change the course of their care.

Third, patients should be encouraged to get second opinions, especially for things that are serious or that involve surgery.  Obviously, second opinions shouldn’t be necessary for everything, but need to be a more important part of our healthcare landscape.  While we’re doing that, we need to remind patients that treating that second opinion visit as if it were the first time a doctor has heard of your problem is more effective than simply saying “Doctor X said this is the following – what do you think?”

Finally, patients should be encouraged to take someone with them to important doctor visits.  It’s hard to listen to difficult medical news and pay attention to all the details at the same time.  Bringing along a friend or family member to keep track of important questions – and answers – and to take notes on what the doctor told the patient is important.  Often, the only person with a truly comprehensive view of the patient’s situation is the patient himself, and keeping track of everything that goes on gets harder as a medical situation becomes more difficult.

The fear that often keeps patients silent in the doctor’s office may or may not be irrational.  But when you consider the costs and suffering that can be avoided by just asking a few questions, the answer becomes clear: get over it.

Evan Falchuk is vice chairman of Best Doctors Inc. (www.bestdoctors.com), a global health company that brings together the best medical minds in the world to help people get the right diagnosis and treatment.

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