Armand Leone Jr. MD, JD
Armand Leone Jr., MD, JD, a diagnostic radiologist and co-founder of Britcher, Leone & Roth, shares these 5 things your doctor knows, but may not tell you unless you ask.
If you want to make the most out of your time with your doctor, you’ve got to be honest. Keeping important details to yourself may harm you in the long run. Doctors also know a lot of things we don’t, so we patients have to ask the right questions.
1. Having elective surgery on a Friday or in the afternoon carries a higher mortality and complication rate than earlier in the week or day.
Obviously, when the situation is urgent, surgery can’t wait. But for elective surgery, you might want to consider the timing. Make no mistake about it — ALL surgeries come with risks and complications. On Monday, everybody there — surgeons, nurses, residents — are regular staff. At about 4:00 p.m. on Friday, regular crews leave. When you have surgery at the end of the day, those 12 critical post-op hours happen at night. Complications happen on weekends, but it’s more difficult to get immediate action on them because covering physicians don’t know the patients as well and are less quick to intervene for another doctor’s patient.
2. Fatal medication errors spike by 10 percent every July as new medical residents start taking care of patients (J Gen Intern Med 2010).
Depending on the situation, patients can’t always be aware of what medications they’re given. If you’re conscious and clearheaded, you should have a rough idea of the medications you’re supposed to get. Ask the nurses, confirm the details, and if it doesn’t seem right or if the medication looks different from what you’re usually given, ask the nurse to check with the doctor. Be vigilant and ask questions.
3. A misdiagnosis happens in at least one out of every 20 patient encounters in doctors’ offices (BMJ Qual Saf 2014).
Let’s start with this: Most medical errors in a primary care setting don’t make a difference. Primary care docs have less time to talk and examine a patient, so there are certain mental short cuts. For example, a doctor sees 10 patients with the flu and you come in with flu symptoms. There’s a bias toward diagnosing the flu. Leone says about half of this type of error have the potential for serious injury, but only a small percentage actually result in serious injury. The good news is that most times, if a doctor sees a patient and gives the wrong diagnosis, with continuity of care, it gets reassessed.
So, what’s a patient to do? If you sense your doctor is rushed or not listening, or that the diagnosis may not be right, you need to break the autopilot and focus them. Ask your doctor: ‘If the diagnosis isn’t right, how and when will we know?’ or ‘How will we know if treatment is working?’ Your doctor should respond with something concrete so you have something to gauge and will know when to follow up.
4. Your doctor’s surgical and procedure complication rates and how they compare to the national rates for the same procedure.
It’s not unreasonable to ask. For any procedure, there are known complications and national averages. Doctors should have a good idea of their personal complication rates. The surgeon who is dismissive or says it’s ‘not a problem’ or it’s a ‘walk in the park’ bothers me. I want the surgeon who goes in knowing there could be a complication and acknowledging they need to be on the lookout. If I ask a doctor about complication rates, I just want an honest answer. It doesn’t have to be an exact number. At the end of the day, it’s not so much the complication rate, but that they’re aware that complications can occur. I just want to know they’re watching carefully for complications and they’re ready to deal with them.
5. Doctors know the limits of modern medicine and most don’t choose heroic cancer treatments or end-of-life care for themselves.
So what do doctors know that we don’t? Sometimes, they know that heroic treatment won’t change the outcome. Just because it can be done, it doesn’t mean you should do it.
You have to be realistic about the chances for a cure. There’s a physical, emotional, and financial cost to medical treatment. Treatments have risk and drugs have adverse effects. When you know that, you can balance the equation differently. Is there a reason to put yourself through the ringer? Is it worth it? Quality of life is as important as length of life. That’s why most doctors opt for less heroic end-of-life care, unless there’s a specific reason to do otherwise.
The bottom line is that we patients should be partners in our own care. If we have a concern, it’s up to us to ask questions. A good doctor won’t mind. If your doctor discourages questions or dismisses your concerns, it’s time to find a new doctor.
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