By Lead Writer: Amanda Gardner
December 03, 2012

You love your doctor (hopefully). But there will come a day when you dont see eye to eye. She wants you to take a medication or see a specialist—or not—and you think she is just plain wrong. Or you feel like you cant afford to follow her advice.

What should you do? For one, you shouldnt slink out of the office without bothering to mention your objections. (This makes physicians really cranky.) Think of your doctor as your partner, not as a supreme authority who issues orders.

Having questions or concerns doesnt make you a bad patient—but not talking about it, might. Heres how to do it.

You want to skip the shot
Scenario: Your doctor suggests a vaccine; you dont think you need it.

Vaccines for diseases such as HPV and hepatitis B are safe, but not every adult needs every shot. In some cases, however, they are truly lifesavers. Find out why your doctor thinks you need this specific shot at this time.

Make sure your doctor knows if youve already had certain vaccines, and when; you may be due for a booster, says Len Horovitz, MD, an internist and pulmonary specialist with Lenox Hill Hospital, in New York City. Ask about the new tetanus shot, which now includes pertussis to protect against whooping cough, which is making a comeback. If youre 60 and over, also ask about the shingles vaccine.

For more info on adult vaccine schedules, visit the U.S. Centers for Disease Control and Prevention or the American Academy of Family Physicians.

If you still decide to skip a shot, even after talking to your doctor, youll at least know the risks.

Next Page: You question hospital care [ pagebreak ]You question hospital care
Scenario: Your loved one is in the hospital; youre worried about his or her care.

If you suspect all is not well, start by contacting his or her primary care physician, who knows the patient best, says Lenore Janecek, the founder and president of Save the Patient, a patient advocacy group. Explain the situation, find out if you really should be concerned, and ask for the doctors advice.

You should also find out whos in charge of the care at the facility. If its an overworked resident, dont be afraid to go straight to supervisory personnel or an administrator, Janecek says.

You get an out-of-network referral
Scenario: Your primary care physician refers you to an out-of-network specialist; this could be pricey.

The medical world is so specialized these days that its not uncommon for a doctor to refer you to a specialist—or sub-specialist, or sub-sub-specialist—whos not covered by your insurance. If this happens, start by telling the referring doctor that the specialist isnt covered and ask if theres a person in-network he or she could recommend.

If that doesnt work, Janecek suggests that you check with your insurance provider to see if theyll make an exception. If they say no, you may be able to appeal the decision.

You cant afford the drug
Scenario: Your doctor writes an Rx, but the co-pay (or full cost) is a budget killer.

Although doctors have access to insurance drug coverage information, many of them dont keep track of that information for each of their patients, says Kristin Millin, MD, an assistant professor of pediatrics at the University of Wisconsin–Madison. Explain your concern to your doctor and ask about a substitute drug, perhaps a generic version of the one he just prescribed. "Many old medications work fine," Janecek says. "Sometimes you may be able to use an older medication that wont hurt you and is cheap."

If there are no alternatives to the drug, you can look for patient-assistance programs through websites such as Partnership for Prescription Assistance or RxAssist, a database of assistance programs sponsored by pharmaceutical companies.

Next Page: You want an alternative remedy [ pagebreak ]You want an alternative remedy
Scenario: Youd like to try herbs, vitamins, or another alternative approach; your doctor seems clueless.

These days, your doctor may actually know more than you think. "A lot of us have become more educated," Dr. Millin says. And some may even be willing to learn more on your behalf. If the physician doesnt know about a particular remedy, ask if he or she is willing to help you find more information or direct you to an integrative medicine clinic (maybe even one thats part of the same institution).

Your bill is financially crushing
Scenario: The doctor sends you a bill; you cant afford to pay.

Your doctor may not be the best person to talk to in this situation. "Most times the doctors are not involved in the billing as much as you think," Dr. Millin says. "They really dont like to discuss it." Its probably worth mentioning the problem to your doc, but be prepared to have conversations with members of the hospital or practices billing department.

If your doctor works for a not-for-profit hospital, ask about applying for charity care to cover part or all of your treatment costs. Theyre required to provide it, Janecek says. And if you know you cant afford a doctors visit beforehand, find a free clinic through the National Association of Free Clinics.

You dont want the antibiotic
Scenario: Your doctor prescribes an antibiotic; youre not sure you need it.

This is a legitimate concern. Overprescribing of antibiotics leads to drug-resistant strains of bacteria, or bugs that become difficult to treat because theyve figured out how to elude the drugs in our arsenal.Some doctors may give you an antibiotic because they think you want one, even though some infections resolve on their own with time. Dont be afraid to ask your doctor if you really need it, Janecek says.

Antibiotics only work against bacterial infections (for example, strep throat or a urinary tract infection), not viral infections, so if you seem to have the flu or a nasty cold, chances are these pills wont do you any good. If your doctor insists, ask how long you need to take it for and whether you can wait a few days to see if your symptoms resolve on their own. Ultimately, Janecek says, "The doctors the best judge. Sometimes an antibiotic will prevent a major infection."

Next Page: You want a mammogram [ pagebreak ]You want a mammogram
Scenario: Your doctor tells you a mammogram or Pap test is unnecessary; you want one anyway.

Different preventive-care guidelines have led to great confusion. The U.S. Preventive Services Task Force recently recommended that women need not get regular mammograms before age 50, while the American Cancer Society recommends annual mammograms starting at age 40. Cervical cancer screening guidelines are similarly in flux, with the American College of Obstetricians and Gynecologists recommending Pap tests less frequently than in the past. Ask your doctor which guidelines he or she follows and why, and what the pros and cons of a screening test are. If you then decide you want the test but your doctor does not want to order it, listen to your body, advises Janecek.

Youre concerned about radiation
Scenario: Your doctor suggests you get a CT scan or other test; youre worried about the radiation exposure.

You wouldnt be the only one. The U.S. Food and Drug Administration (FDA) is concerned enough about radiation to have scheduled public hearings on the matter. "CT scans deliver a tremendous amount of radiation," Dr. Horovitz says. "If you do that often enough and enough years in a row, you will create the [cancer] youve been looking for."

A rule of thumb? Dont insist on this type of scan if you have no symptoms, but do so if you have symptoms that suggest trouble. "Dont go on a fishing expedition, but if a clinical exam turns up something, or if you have abdominal pain or fever, youve just bought a ticket for a ride in a CT scan," he says.

However, dont lose sleep over MRIs—those test dont expose you to radiation.

Youre worried about side effects
Scenario: Your doctor prescribes a long-term medication (a cholesterol-lowering statin, for example); youre not sure its safe.

Always ask your doctor what short- and long-term side effects have been observed in a particular drug, and if the drug may interact with other drugs or dietary supplements youre taking (or even with what you eat), Janecek advises. If the doctor reassures you and youre still worried, ask to take the lowest dose possible. And make sure you speak with your pharmacist when starting a new drug about the pros and cons of the drug; they are required by law to offer counseling.

You can do some digging on your own by visiting the FDAs MedWatch website, which tracks drug safety, or MedlinePlus, run by the National Institutes of Health. Save the Patient also has free "health caring cards" with questions to ask your doctor.

Next Page: You want an over-the-counter drug [ pagebreak ]You want an over-the-counter drug
Scenario: You want to kill your cold with over-the-counter remedies; your doctor warns against it.

Your doctor may be right. Not all over-the-counter remedies work, says Dr. Millin. For example, cough remedies may help relieve the symptoms but, if used for more than a few days, they can actually make you feel worse. Instead, ask your doc about nasal saline rinses (a neti pot, for instance) to combat the sniffles. And ask about simple aids such as humidifiers or OTC meds that actually do provide some relief, such as ibuprofen.

Keep in mind that children under the age of 4 arent supposed to take cough or cold remedies, although ibuprofen and Tylenol are safe.

You dont want a genetic test
“Scenario:” Your doctor wants you to have a genetic test; youre not so sure.

This wasnt an issue 10 years ago, but now you can get tests for a range of genetic mutations, including the BRCA1 and BRCA2 gene mutations, which confer a greater risk for breast and ovarian cancer.

Before proceeding, ask your doctor what your options are if the test comes back positive. For the BRCA genes, this could mean considering surgery to remove the breasts and/or ovaries to minimize risk or, for colon cancer, it could be as simple as starting colonoscopies earlier in life. And make sure you can get counseling along with the test. “Its important to seek out a place that provides counseling,” says Lillie Shockney, RN, the administrative director of the Johns Hopkins Breast Center, in Baltimore.

You disagree about end-of-life care
“Scenario:” Your doctor wants to stop treatment for a terminally ill relative; youre not convinced.

If this scenario arises, always ask for a second opinion, Janecek recommends. If your relative can still communicate, have the doctor and an administrator from the hospital listen to what he or she has to say. If the patient cant communicate, rely on his or her health-care proxy, a designated person who can make health end-of-life decisions on his or her behalf.

To be prepared, download state-specific forms for a living will (also known as an advance directive) from Caring Connections.