Talking with your doctor

Before the appointment

When you have a serious illness, many questions are likely to arise, and you have a right to the answers. During a doctor’s appointment, however, it’s easy to get side tracked. Anxiety often runs high and can block your clearest thinking. As well, doctors have schedules to keep. If you feel pressured during the appointment, it may be difficult to stay focused on addressing each of your concerns. We suggest you maximize your time with the doctor by preparing for your appointments beforehand. Here are some tips:

• Write down your questions and then prioritize them (for instance, put a 1 by the most important, a 2 by the next most important, etc.).
• If you see that you have many questions, you may want to call the doctor’s office and see if you can book a double appointment to be sure they all get answered.
• Bring all your medications with you to the appointment. This way, if the doctor prescribes something new or if you are experiencing distressing symptoms, he or she can review your medications to be sure there is no problem with drug interactions.
• When you arrive for the appointment, give the medical assistant a copy of your written questions and ask that they be put on the front of the chart so the doctor can see them.
• Have someone come with you into the exam room. This person should also have a copy of the questions. He or she can take notes during the appointment and help make sure your questions have been addressed to your satisfaction.
• Start by asking the doctor the most important question first, then the next most important, and so on. Stay focused on your questions. If you wander into interesting side stories you will lose valuable time.
• If you hear words you do not understand, ask for an explanation. Doctors get used to their “medical shorthand” and sometimes forget that it involves words the rest of us do not understand.
• When a procedure is recommended, ask about the benefits and the risks as well as any alternatives and their known benefits and risks. (See Specific questions below.)
• If the doctor does not have enough time, ask if someone else on his or her staff can answer your questions. If that is not an option, then ask if you can make another appointment so you can finish. Remember, you have a right to have your questions answered.
• Spend time after the visit talking with the person who came with you. He or she will likely have good insights about the appointment and can help you identify any areas that are still unclear.

Decisions about treatment: Questions you might ask

• How serious is this illness? If I do nothing, what is likely to happen?
• What exactly does the treatment accomplish? How does it work?
• Will the treatment you are recommending cure me? Give me added time? How much time?
• How much improvement can I expect? Will it allow me to return to my previous level of functioning? If not, will I at least be able to ____________________?
• What are the side effects of the treatment? How will they affect my daily life? Do they get worse over time?
• What can be done to manage the side effects? How well can we keep them under control?
• How and when will we know whether the treatment is working? What does “success” look like?
• Are there other options to this treatment? What are their risks and benefits? Expected outcomes?
• If our first treatment plan does not seem to be working, what would you recommend we do next?
• If no cure is possible, what are the chances I could at least improve?
• On the basis of my current condition, what do you expect in the next few weeks? The next few months?
• Do you think I would benefit more by focusing on comfort and quality of life rather than treatment? What is provided with comfort care? Can I have the support of hospice?

Getting a second opinion

You may wish to get a second opinion from another physician. Awkward as it might feel, it is a good idea to let your doctor know about your plans because the second physician will request copies of your chart, past lab reports, etc. Doctors understand that second opinions, especially in the context of serious illnesses, are a good idea. Sometimes they are required by insurance, and sometimes it’s simply something the patient needs to do to feel all options have been explored. If your doctor disapproves of your desire for a second opinion, remember that it is your health and therefore your decision to make.

Health care planning: Expressing your wishes

Once you have learned about the options available to you, weigh the information you receive in light of your personal values. Concerns about hope and quality of life are likely to surface. We suggest you look at the Important Decisions section of this website. It talks about some of the legal aspects of making your wishes known. In particular, you will want to write an advance directive describing your desires for life-sustaining treatment. (Even people in the “prime of life” would be well-advised to have written instructions of this sort in case something unexpected happens.) Talk to your family about your decisions and give a copy of your advance directive to your physician. This document will guide your family and the health care team if you eventually are unable to speak for yourself.