What to Do When You Disagree With Your Doctor
Be a better patient
You trust your doctor (we hope). But there are times when you may not see eye to eye. She wants you to take a certain drug or see a specialistor notand you think she's just plain wrong. Or you're worried that you can’t afford it.
What should you do? Don't slink out of the office without bothering to mention your objections. (This makes physicians really cranky.) Think of your doctor as your partner, not your boss.
Here are some tips on how to express your questions or concerns in a number of common scenarios.
Your doctor suggests a vaccine...
Vaccines for diseases such as HPV and hepatitis B can be lifesavers, but not every adult needs every shot. Ask your doctor why you need this one.
And be sure to say if (and when) you’ve had vaccines for tetanus, shingles, and whooping cough (which is making a comeback); you may be due for a booster, says Len Horovitz, MD, an internist at Lenox Hill Hospital, in New York City. For more info on adult vaccine schedules, visit the U.S. Centers for Disease Control and Prevention or the American Academy of Family Physicians.
Your loved one is in the hospital...
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 doctor’s advice.
You should also find out who’s in charge of the care at the facility. If it’s an overworked resident, don’t be afraid to go straight to supervisory personnel or an administrator, Janecek says.
Your doctor refers you to a pricey specialist...
The medical world is so specialized these days that it’s not uncommon for a doctor to refer you to a specialistor sub-specialistwho’s not covered by your insurance. If this happens and you're not sure you can afford it, ask the referring doc if he or she can recommend someone in-network instead.
If that doesn’t work, Janecek suggests that you check with your insurance provider to see if they’ll make an exception. If they say no, you may be able to appeal the decision.
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 don’t 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 older medications work fine," Janecek says.
If there are no alternatives to the drug, you can try patient-assistance programs.
You’d like to try alternative remedies...
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 doesn’t 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 that’s part of the same institution).
You receive a medical bill...
The doctor may not be the best person to talk to. "Most times the doctors are not involved in the billing as much as you think," Dr. Millin says. It’s probably worth mentioning the problem to your doc, but be prepared to speak with the 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. And if you know you can’t afford a doctor’s visit beforehand, find a free clinic through the National Association of Free Clinics.
Your doctor prescribes an antibiotic...
This is a legitimate concern. Overprescribing of antibiotics leads to drug-resistant strains of bacteria. Some doctors may give you an antibiotic because they think you want one, even though some infections resolve on their own with time. Don’t be afraid to ask your doctor if you really need it, Janecek says.
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 doctor’s the best judge."
You want a mammogram...
Divergent guidelines have led to great confusion surrounding preventive care. In 2009, a federal panel issued new guidelines that say that most women should begin regular mammograms at age 50, while the American Cancer Society still recommends annual mammograms starting at age 40. Guidelines for cervical cancer screening vary as well.
Ask your doctor which guidelines he or she follows and why, and what the pros and cons of a screening test are. If you decide you still want the test, it's OK to insist, Janecek says.
Your doctor suggests a CT scan...
You're not the only one. The 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] you’ve been looking for."
A rule of thumb? Don’t insist on this type of scan if you have no symptoms, but do so if you have symptoms that suggest trouble, says Dr. Horovitz.
Your doctor prescribes a long-term medication...
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 you’re taking (or even with what you eat), Janecek advises. If you’re not reassured, ask to take the lowest dose possible.
You can also do your own research on the FDA’s MedWatch website, which tracks drug safety, or MedlinePlus, run by the National Institutes of Health.
You want to treat your cold with OTC remedies...
Your doctor may be right. Not all over-the-counter (OTC) remedies work, says Dr. Millin. (For example, though they may relieve symptoms, cough remedies can actually make you feel worse if used for more than a few days.) Instead, ask your doc about simple aids or OTC meds that actually do provide some relief, such as humidifiers or a neti pot.
Keep in mind that children under the age of 4 aren’t supposed to take cough or cold remedies, although ibuprofen and Tylenol are safe.
Your doctor recommends a genetic test...
This wasn’t an issue 10 years ago, but now you can get tests for a range of genetic mutations, including those that confer a greater risk for breast and ovarian cancer.
Before proceeding, ask your doctor what your options are if the test comes back positive. It could mean considering breast-removal surgery or, for colon cancer, it could be as simple as starting colonoscopies earlier in life. And get counseling along with the test. “It’s important to seek out a place that provides [that],” says Lillie Shockney, RN, the administrative director of the Johns Hopkins Breast Center, in Baltimore.
Your relative is terminally ill...
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 can’t 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.
When in doubt...
Most hospitals have a patient advocate on staff whom you can consult if you disagree with the care that you or a loved one is receiving. (At some hospitals, this person is known as an ombudsman or a patient representative.)
Usually all you need to do is call the hospital switchboard and ask for the patient advocate.