May 21, 2008

Legal Advice for Boomers: What to ask your doctor

I recently reviewed a book full of practical and legal advice for Baby Boomers and their loved ones called Alive and Kicking. I learned a lot from the book, and the authors were kind enough to send me some columns to use as guest posts. Here's the last one.

Questions to Ask Your Doctor

It's flu season. Your spouse wakes up with the classic signs: fever, cough, aches and pains. What do you conclude?


You're not alone. Most probably, your doctor would too. "A lot of that going around." Both of you might be wrong.

In a terrific new book, How Doctors Think, Dr. Jerome Groopan warns that doctors often misdiagnose, perhaps 1 out of 10 times, perhaps slightly more. Like the rest of us, they tend to jump to conclusions. To make sure they haven't, Dr. Groopan recommends we ask three questions:
  1. What else could it be? ("Well, now that you mention it, it could be . . .")
  2. Is there anything in the exam or tests that doesn't fit? ("Well, now that you mention it, your fever isn't typical.")
  3. Is it possible I have more than one problem? ("Well, now that you mention it, sometimes folks get the flu because they are already sick with . . .")
A good friend, Dr. Jack Boyer, suggests a fourth question: Have you considered whether I want to get the treatment or not?

This question shifts focus from sickness to treatment, a treatment which may be routine, proscribed without much thought: what are its costs and benefits?

Of course, it is easy for me (and probably Dr. Groopan) to sit safely behind our computers urging you to be brave, urging you, recalling the 60's, to "Question Authority!"

It is always a good idea to take someone with you, not only to ask to the difficult questions, but to actually hear what the doctor says – often patients are so emotionally involved that they really don't hear what's said. If you can't get someone to go with you, when it comes to the difficult questions, blame me:
"Doc, I know you are absolutely correct in your diagnosis but a column I've read tells me I should feel guilty if I don't ask you . . ."
Many of us feel we are imposing on our doctor's time. Our job is to quickly state our compliant ("Sore throat, doc") and then sit back and answer questions – and, of course, to breathe deeply and, perhaps, cough. In most office visits, doctors start asking questions in the first 18 seconds of the visit. The best advice Dr. Groopan received in his medical training:
"If you listen to your patient, he is telling you the diagnosis."
The best advice you might receive:
"You are not wasting your doctors' time; you are telling them the diagnosis."
What we have to say matters. Don't just state your complaint and sit back and let your doctor do the driving. Insist on disclosing all your symptoms even if they seem trivial. Even if they are embarrassing. (I could give examples but fear the wrath of my editor.) Remember this: doctors have heard it all before and they come to cure you, not judge you.

"Am I dying?" "Is my mother dying?" There will come a time, and you know it, when these questions will be very much on our minds. Yet we shudder at the very idea of asking them. Don't expect your doctors to volunteer the information. In A Death Foretold, Dr. Nicholas Christakis tells us that doctors shy away from terminal prognosis. Why? There are many reasons. For one, it tends to undercut their sense of professional competence, their belief that they can cure most anything. Further, many doctors are as uncomfortable with the idea of death as are the rest of us. And they fear making self-fulfilling prophecies. In Oscar Wilde's The Importance of Being Earnest, a character is told that another died after his doctors have given him only weeks to live.
"He seems to have had great confidence in the opinion of his physicians."
So there you have it. Patients and their families don't ask about death and doctors don't volunteer. The result?
"The great majority of American die in institutions rather than at home as many would prefer; most die in pain being in the care of health providers; many die alone; and many have deaths that are financially devastating for their families."
So writes Dr. Christakis.

"Am I dying?" "Is my mother dying?" You will need to know. As long as everyone is in denial, intensive care treatment continues. Doctors will not terminate it on their own. Living Wills indicating that treatment should not be continued are generally ineffective unless that decision is supported by members of the family. But that won't happen as long as family and physicians don't discuss death.

Avoiding a bad death is not our only concern. We want a good death, a natural death, not in an hospital among strangers, but at home surrounded by family and friends. Hospice care can do that. It provides medical help (doctors, nurses, and pain medications) as well as grief counseling for patient and family. Medicare picks up almost all of the costs, not only in the last days or weeks of life, but for the last six months of life.

How do you get this wonderful care for your mother? For yourself? It may be difficult and you may not want to know, but all you have to do is ask.

Kenney Hegland is a Professor of Law at the University of Arizona and has taught at Harvard and UCLA. Robert Fleming in one of the nation's leading elder law lawyers. Visit their website at


Anonymous said...

This is some great medical advice for anyone. One of my biggest frustrations through my three miscarriages has been medical folks who are reluctant to tell me what's going on. As with older people dying, often times, you've already got it figured out, you just want them to tell you so you can plan what you need to do. I'm sure it is hard for the doctors in these situations too. I've learned to be more aggressive and ask more questions - and it's gotten better and better.


Clean ClutterFree Simple said...

That's a great book, How Doctors Think. Really, doctors are just folks who've had specialty training in the physical body and in the effects of a whole passel of drugs. They're not gods.

Chief Family Officer said...

I agree with you both! This advice is great for anyone, and doctors are human too.