Choosing Health Treatments

Table Of Contents

Quality Health Care - The Variations

Health Care: How to Measure Quality

How To Assess Health Plans - Questions To Ask

Choosing A Doctor

Choosing Treatments

Choosing A Hospital

Choosing Long Term Care

Research shows that millions of Americans receive treatments that are unnecessary, costly, and even harmful to their health. On the other hand, millions of Americans do not get the treatments they need.

Study after study has found that the use of certain treatments varies widely—from region to region, State to State, and city to city.

But there are even large differences in the use of treatments within a single health plan or hospital, or by a single doctor.

That is why it is very important to work closely with your doctor when treatment decisions need to be made.

Make sure your doctor knows your questions, concerns, and preferences. Ask your doctor if the treatments he or she recommends are based on the latest scientific evidence.

If you understand and feel comfortable with your treatment plan, you are more likely to do your part to make it work. And, research shows that people who are actively involved in their own health care tend to get better results.

Learning About the Problem

The first step in getting the right treatment is to tell your doctor what’s going on.

This information might include:

• Your symptoms
• When they first started
• When they occur
• Are they getting better? Worse?
• What makes them better? Worse?
• Are they affecting eating, sleeping, or other activities? How?
• Medicines you take

When choosing a treatment, make sure you understand:

• What your diagnosis is
• Whether treatment is really needed at this time
• What your treatment options are
• Whether the treatment options are based on the latest scientific evidence
• The benefits and risks of each treatment
• The cost of each treatment

Doctors order blood tests, x-rays, and other tests to help diagnose medical problems. Perhaps you do not know why you need a particular test or you don’t understand how it will help you. Here are some questions to ask:

• How is the test done?
• What kind of information will the test provide?
• Is this test the only way to find out that information?
• What are the benefits and risks of having this test?
• How accurate is the test?
• What do I need to do to prepare for the test? (What you do or don’t do may affect the accuracy of the test results.)
• Will the test be uncomfortable?
• How long will it take to get the results, and how will I get them?

Before a treatment decision is made, your doctor needs to make a diagnosis.

Medical tests are an important way to help your doctor learn about the problem. It is important to make sure that any tests your doctor suggests are appropriate for you.

One study found that anywhere from 10 percent to 30 percent of Pap smear test results that were called "normal" were not. Errors such as this can lead to a wrong or delayed diagnosis.

You want your tests to be done the right way, and you want accurate results. What can you do?

• For tests your doctor sends to a lab, ask which lab he or she uses, and why. You may want to know that the doctor chooses a certain lab because he or she has business ties to it. Or, the health plan may require that the tests go there.

• Check to see that the lab is accredited by a group such as the College of American Pathologists (800-323-4040) or the Joint Commission on Accreditation of Healthcare Organizations (telephone 630-792-5000; Web site http://www.jcaho.org).

• If you need a mammogram, make sure the facility is approved by the Food and Drug Administration. You can find out by checking the certificate in the facility. Or, call 800-4-CANCER 9:00 a.m.-4:30 p.m. EST to find out the names and locations of certified facilities near you.

What about the test results?

• Do not assume that no news is good news. If you do not hear from your doctor, call to get your test results.

• If you and your doctor think the test results may not be right, have the test done again.

• What is my prognosis (outlook for the future)?

• What changes, if any, will I need to make in my daily life?

• Is there a chance that someone else in my family might get the same condition?

• Will I need special help at home for my condition? If so, what type of help? Ask for materials you can take home. You also might want to find out if there are any support groups for people with your condition.

Looking at the Options

The next step is for you and your doctor to look at your treatment options. Your doctor may recommend one or more of the following:

• Behavior change (for example: eating a healthier diet, getting more exercise, quitting smoking).
• Prescription medicine.
• Non-prescription ("over-the-counter") medicines.
• Surgery.
• Rehabilitation (such as physical therapy).
• Other treatments (for example, chiropractic services, massage, or acupuncture).

"Watchful waiting." (You and your doctor keep track of your symptoms and watch for any changes. If there are changes, then treatment might be the next step.) Not all treatments have been proven by research studies to work—or to be the best treatment for what you have. "Clinical practice guidelines" can help doctors and patients make the right treatment choices for some conditions. Some of these guidelines are based on scientific evidence about which treatments work for certain conditions and which do not.

Ask your doctor if there are evidence based guidelines on treatments for your condition.

Ask about any books or special materials that can help you decide which treatment is best for you. For example, "shared decision making programs" use video, audio, and computer graphics to help patients make decisions based on science and on their own values and preferences. Self-help groups, patient organizations (such as the American Cancer Society and the American Diabetes Association), the Internet, and your library are other sources of information. All treatments have benefits and risks. To learn more about them you may want to ask your doctor:

• What is the recommended treatment? Are there other choices?
• What are the chances the treatment will work?
• What are the expected results? When will I see them?
• What are the risks?
• What are the benefits?
• Are there any side effects? (Most treatments have them.) What can be done about them?
• Is the treatment painful? How can the pain be controlled?

Making Decisions About Surgery

Some surgery has to be done right away. But most surgery is not an emergency. That means you have time to talk with your doctor and decide what is best for you.

No surgery, not even minor surgery, is risk-free. To decide if a procedure is right for you, learn about it and its possible benefits and risks. Research shows that patients who know the facts about surgery and other treatments can better work with their doctors to make decisions based on science and on what the patient prefers. The result? A more satisfied patient.

Here are some questions you may want to ask your doctor or surgeon:

• Do I really need this surgery? Is there some other way to treat my condition?

• What will happen if I wait until later to have surgery? Or never have it at all?

• How often does this type of surgery help my kind of problem? How much does it help?

• Where will the surgery be performed?

• Does the surgeon, hospital, or surgery center have a lot of experience with this kind of procedure?

• Is the surgeon experienced and qualified to perform the surgery?

• What complications or side effects might I have?

• What kind of pain might I have? How will it be treated?

• How long will it take me to recover? Will I need help at home? What kind of help?

• How much does the surgery cost?

• Will my health plan pay?

Getting a Second Opinion

A "second opinion" is when another doctor gives his or her views about what you have and how it should be treated. A second opinion can help you decide whether the surgery is right for you at this time. Your doctor and surgeon should welcome your request for a second opinion. Your health plan may even require one for some types of surgery.

You can ask your doctor, health plan, a local medical school, or local medical society for help in finding someone to give you a second opinion. But first check to see if your health plan covers second opinions.