a doctor looks over a medical chart
(Photo/George Hodan-publicdomainpictures.net)

The questions to ask your doctor about diagnosis, testing and treatment

Following a scary health incident that sent him to the emergency room, my friend Artie (not his real name) recently had a chest x-ray to rule out pneumonia. The x-ray was inconclusive, so a chest CT scan was performed. He was reassured by the ER physician that the scan showed no evidence of pneumonia.

When Artie got home, he looked at the radiology report and noticed something the ER doctor had failed to mention: “There are mild to moderate coronary artery atherosclerotic calcifications.” Artie wasn’t sure what this meant, but it didn’t sound good. He was particularly concerned because his father had a heart attack at age 40. Being a proactive person, Artie took the initiative when it came to his health. He made an appointment to ask his internist about the report. He also consulted me about what kinds of questions he should ask.

Preparing questions in advance of a doctor visit is another way to be proactive when it comes to health care. It is important to gather the information you need to make good decisions. Here are some questions you might want to ask your doctor concerning diagnosis, testing and treatment.

Diagnosis

What diagnosis do you suspect? What else could explain the test findings or my symptoms? How serious is this? What symptoms should I watch out for?

Testing

What tests do you advise to diagnose my condition? How safe and accurate are they? When should I expect to get the test results? When should I follow up?

Sometimes it’s hard to assess the benefits vs. risk of a test, or even if the outcome of a test will influence treatment. For example, there may not be any point in having an MRI for back pain if you are not going to do anything different with the findings. When it comes to screening tests, it’s sometimes hard to decide whether to continue to do them after a certain age. This tool from UCSF can help.

The U.S. Preventive Services Task Force has created another good resource.

Treatment

What are my treatment options? What is the cost of the treatment? Is there a generic form of medication that is just as effective? Because of the nocebo effect (one that promotes negative expectations), doctors may be reluctant to mention possible side effects, but ask anyway. If a medicine should be taken once a day, is it better to take it in the morning or evening? For example, doctors have debated for many years what time of day is best to take anti-hypertensive medicines. After five years of follow-up, a recent study involving 21,000 participants to evaluate this found no difference in cardiovascular outcomes or mortality.

Some medicines are better taken on an empty stomach to improve absorption, such as thyroid and some osteoporosis meds. Others are better taken with food, including anti-inflammatory medicines such as ibuprofen and certain antibiotics.

Additional questions to pose regarding medicines might be: Will the new medicine interact with other medicines I am taking? What should I do if I miss a dose of medicine? Will my quality of life be affected while I am taking this medicine? How long should it take to see results?

If you might need surgery, here are some questions to ask: What surgical procedure are you recommending, and is there more than one way of performing it? What are the advantages and disadvantages of each surgical approach? What are the alternatives to surgery? What would happen if I didn’t have any treatment or surgery? What are the risks of surgery? What kind of anesthesia will be used? What is your experience performing this surgery? How long will I be hospitalized? What can I expect in terms of recovery?

Personally, I like when patients ask me questions because I have more confidence they will comply with my recommendations and treatment plan if their questions are addressed at the outset.

Getting back to Artie: He followed up with his doctor and had additional tests that showed a significant blockage of the left anterior descending artery, which informally is called the “widow maker.” Artie is now under the care of a cardiologist and is feeling fortunate that he was proactive. A fatal heart attack was averted.

Dr. Jerry Saliman

Jerry Saliman, MD, retired from Kaiser South San Francisco after a 30-year career and is now a volunteer internist at Samaritan House Medical Clinic in San Mateo.