Your doctor recommends a thing, and you do it. That’s the simplest version of how the doctor-patient relationship might go, but it’s not always the best one. You may find out later that there were other options for treatment that you never knew about, or that the drug you took has risks that may outweigh its benefits. To get the full picture, ask these four questions.
What are the chances this will help me?
This is the easy one: if a health care professional is recommending something, they think it may help. But how likely is it to actually help?
John Mandrola, a cardiac electrophysiologist who has written about the four questions, notes that this question has two components: the statistics on the treatment’s benefit (or, if we’re talking about a test, its accuracy), and how you and your doctor define benefit. For example, lowering your cholesterol does not always lower your risk of death by heart attack. So make sure to ask about real-world benefits.
What are the chances this will harm me?
Everything has risks, even treatments or tests that seem pretty straightforward. The only drugs with no risk of side effects are the ones that don’t work. Even tests can be harmful in the long run, if they lead to interventions, like drugs or surgery, that turn out to be unnecessary.
That said, risks and harms can’t always be separated from the benefits. Chemotherapy for cancer is extremely harmful to the patient, but that has to be balanced against the benefit of not dying of cancer. Think of the risks and disadvantages as the “cost” of the medicine (and, yes, financial cost can be included here too.) Is the benefit worth it?
What are the alternatives?
Sometimes there’s only one real option, and if you ask about alternatives, your doctor can explain why other treatments don’t fit the bill. But sometimes there are other alternatives you can consider.
If you don’t ask your doctor, you might find out years later that your aunt/friend/co-worker had a similar health issue and got a totally different treatment for it. Maybe your doctor recommended the treatment that’s truly best; then again, maybe they recommended the surgery that they’re personally really good at, or the drug that most patients prefer. It’s always worth asking what other options are available,
What happens if we do nothing?
Doing nothing is also an option with potential harms and benefits. Your doctor is often trying to problem-solve, to come up with the best action to take care of the issue you came for. But sometimes doing nothing is a fine option as well.
Often, doing nothing takes the form of “watchful waiting” — seeing whether your condition gets serious, rather than treating it today just because you happen to be in the office today. Or perhaps a treatment just doesn’t have much chance of benefit, and you could skip it and, most likely, get the same outcome either way.
If your doctor is recommending a test, this question gets especially interesting: what would we do differently with test results than without them? Sometimes the treatment is the same either way, and the test isn’t needed at all.
These four questions help because they guide a conversation. Your doctor gets to understand which benefits and which harms are most important to you; you get to understand why your doctor is recommending certain treatments over others.
This is a good and important conversation to have, and it’s not wrong or improper to expect to understand your treatment and to have a say in decisions. It’s your body, after all, and you will be the one to live with the consequences. Doctors and other health professionals are usually happy to answer questions, and if your doc doesn’t like you asking questions, they’re a jerk and you should find a new doctor.
I’ve found doctors often really welcome these questions. If there’s a clear benefit that outweighs the risks, they can explain it simply and I’m on board: let’s do it! But other times I’ll ask about a test, and they’ll say “oh, the computer always adds that to the order. We don’t really need it.” You won’t know until you ask.
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