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How to Get What You Want from the Doctor

The Biggest, Baddest Communication Gaps
Medical malpractice insurance is often blamed for the mess in our current health-care system. There are undoubtedly some rotten doctors out there who deserve to be sued for their bad work, but in nearly three-quarters of malpractice lawsuits, the core reason for patients' unhappiness is their doctors' bad communication skills, not their technical ability. In most cases the patients did not understand the procedure, or what the tests meant, or how long the recovery would take. The lack of understanding, coupled with the doctor's poor bedside manner, left them feeling betrayed and cast aside, and those basic human emotions are what fuel most lawsuits. This is good news, because it means that despite all the scary stories about malpractice lawsuits and incompetent doctors, you actually have a lot of control over your health care. You just need to be aware of the points at which communication most often breaks down.

Barry D. Lang, M.D., of Boston, has particular insight in this area. Lang practiced orthopedic surgery from 1975 until 1996 and then did an about-face: he went to law school and became an attorney specializing in medical malpractice. "I think doctors are their own worst enemies," he says. "I believe that many of my clients, or at least some, would not come to see me even if the doctor did something wrong, if there had been better communication. This is one reason chiropractors are rarely sued. Chiropractors listen to their patients and doctors don't, and I can say that because I'm a doctor."

Many of Lang's lawsuits involve surgery, and the problems are concentrated in a few key areas. First, there is the "complete and unfettered trust" some patients place in their doctor. "They assume the doctor has more education, knows what he's doing, and will do the best for the patient—and most times this is true. Sometimes, unfortunately, it's not. If somebody goes in for a complicated hip procedure, for instance, he may be reluctant to ask the doctor, 'Have you done this before?' And the doctor is not going to tell him unless he asks."

Dr. Lang also warns patients to ask about the specific complications of their surgery, and to get it in writing. A great many of his cases involve arguments about informed consent. "The patient says, 'Gee, the doctor never told me that my foot could drop off in this operation'; the doctor says, 'Of course I did.' Many times the doctor has not even approached the subject. They give the patient a general, generic release that that says, 'My doctor has informed me of every complication,' and the patient signs it. The release is made up by the hospital. The hospital isn't privy to what the doctor and patient discussed."

Patients should also ask how long it will take them to recover from surgery—meaning a complete return to normal functioning—and how traumatic or painful the recovery period will be. Says Lang, "Doctors have a well-meaning tendency to tell a patient, 'I've done this a thousand times and everything's going to be super.' When everything isn't super, guess who the patient is angry at? The doctor." Another malpractice lawyer, Evelyn W. Bradford, attempted to educate physicians about this problem in an article for Medical Economics: "Don't gloss over surgery's effects. I hear this lament again and again in my office: 'If that doctor had told me what to expect, I wouldn't have gone through with the surgery.'...Orthopedists, I've found, are the most guilty of poor communication."

The message to the patient is clear. "Ask questions," says Barry Lang. "There is no such thing as a stupid question. Your doctor wants to help you, but he is not able to look into your mind."

If you are considering any type of surgery or treatment, be sure to ask the doctor:

  • Have you done this procedure before? How many times?
  • Exactly what are you going to do?
  • How necessary is this procedure?
  • What are my chances of being completely cured?
  • What are the possible complications?
  • What is the least and most amount of time it will take for me to fully recover?
  • What will the recovery period be like? Is the recovery painful?
  • What is your pain-management plan for this procedure and the recovery period?
  • What will happen if I do not have this procedure?
Don't feel pressured to make a decision right then and there in the doctor's office. Go home and think about it. If you aren't satisfied with the doctor's answers or don't understand them, research the issues yourself, call the doctor and ask her to clarify them, or get a second opinion.

Speak Up and Stay Well
Health care is truly in a state of flux, not just because of stingy HMOs and flip-flopping insurance practices but also because so many extraordinary medical breakthroughs are being made every year. Gone are the days when you could find one good, trustworthy doctor and rest easy. You will probably deal with many doctors over the course of your life, so the person you need to trust is you. You have to trust yourself to ask the right questions, speak up, and stand up for yourself. You have to trust yourself to judge the doctor instead of worrying about the doctor judging you. Luckily, this is a skill guaranteed to pay off in a big way as you get older. If you teach yourself to speak up when you're thirty, by age eighty you'll be a master—just when the whole machine is starting to sputter and you really need that expertise.

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From Say the Magic Words by Lynette Padwa. Copyright © 2005. Used by arrangement with Penguin Group (USA) Inc.

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