Your doctor isn't the only one who should prepare for appointments. By asking the right questions, you can help prevent medical mistakes.
Recently, I told a patient she needed surgery to repair a damaged mitral valve that was causing blood to rush backward into her heart, decreasing blood flow to the rest of her body. Instead of being frightened by the prospect of surgery, my patient was relieved. For several years doctors had mistaken her condition for an anxiety disorder, because symptoms of mitral valve prolapse (fatigue, chest pain, and difficulty breathing) can look confoundingly like stress. Not surprisingly, the medications she'd been prescribed had done nothing to improve her health. It wasn't until we arrived at the correct diagnosis that she could look forward to feeling better—and finally moving on with her life.
Despite our best efforts, physicians do sometimes get it wrong. In fact, a 2013 study of more than 350,000 malpractice claims found that missed, incorrect, and delayed diagnoses were the most dangerous mistakes doctors made, and they're estimated to result in permanent injury or death for up to 160,000 Americans annually. But you can protect yourself: The best way to dodge medical mishaps, from medication errors to unnecessary surgeries, is to help your doctor help you. Start by asking these questions at your next appointment.
Do you need to see the tests my other doctor ran last year?
I always urge people to learn their full family medical history, because it helps doctors detect conditions that can be hereditary, like heart disease and cancer. But you don't want to be so busy tracking Aunt Mona's medications that you forget to thoroughly chart your own health history. A study in the Archives of Internal Medicine found that 10 percent of diagnostic errors occur because doctors lack the patient's complete medical history.
Be prepared: Call any doctor you've seen in the past five years (if you can go back further, even better) and ask for copies of your records. These files contain much more than just your vitals; they include consent forms, physicians' orders, test results, pathology reports, and immunization records. The information could help specialists avoid repeat testing (and spare you unnecessary radiation from scans) or connect the dots to a diagnosis another doctor might have missed. You may have to fill out some paperwork or even pay a small fee (for postage or copies of X-rays or MRI films), but don't let that deter you. You have the right to access your health information.
Unless you're being wheeled into the operating room as you read this, the answer is probably yes. While seeking a second opinion or conducting your own additional research might seem like a no-brainer, 70 percent of Americans never do so, according to a 2010 Gallup poll. Yet research suggests that in up to 30 percent of pathology cases, second opinions can lead to a corrected diagnosis. One Johns Hopkins study that reviewed more than 800 tissue samples from patients with head and neck tumors found troubling discrepancies in 7 percent of diagnoses, with some that had been pronounced malignant turning out benign.
Be prepared: Stop worrying that you'll offend your doctor. Smart physicians know that smart patients seek out other points of view before making major decisions. Begin your search for a second opinion by contacting local chapters of medical associations that specialize in your condition—say, the American Diabetes Association or the Lupus Foundation of America. They can help connect you with specialists who practice in your area. What should you do if your first two doctors don't agree? Get a third opinion.
Can we go over these questions today?
Some physicians whip through appointments in the time it takes to get a car washed, but their need for speed isn't the only thing causing quick visits. There's also a phenomenon known as white-coat silence, which refers to patients' tendency to clam up in the presence of a doctor. A 2012 study in the journal Health Affairs found that one reason people don't ask questions is that they fear being seen as difficult. Yet a lack of communication could lead doctors to mistake your silence for comprehension when they explain test results or procedures.
Be prepared: List all the questions you'd like to ask, and make two copies—one for you and one for your doctor. That way you won't forget important queries, and your doctor will know what information you want to cover. I also suggest bringing a backup: Ask a family member or close friend to go with you to an appointment. Not only will this person serve as a second set of eyes and ears, but she may have questions you would never think to ask.
Two-thirds of patient visits end with the doctor pulling out the prescription pad, according to the Institute for Safe Medication Practices. It's no wonder, then, that more than 10 percent of Americans are currently taking five or more medications. That's a lot of pills to keep straight. According to the Food and Drug Administration, medication errors (like receiving the wrong dose or taking drugs that don't mix) cause at least one death each day and account for about 1.3 million injuries a year—a truly alarming figure, considering that such casualties are largely preventable.
Be prepared: If you're taking it, take it with you. Just writing down the names of medications leaves too much room for error; one misspelled word or misplaced decimal point changes everything. Instead, gather up pill bottles (over-the-counter and supplements included) and bring them to your appointment. Another option: Snap pictures of Rx labels with your camera phone. This will provide your doctor with valuable information in case she wants to put you on a new medication. And don't forget to take advantage of one of your greatest health resources—your pharmacist. She's in the best position to sound the alarm on potentially dangerous drug interactions.
Is there another option?
So let's assume you've received the right diagnosis. The final potential land mine: treatment. For many conditions, there are several alternatives for care, often ranging from the conservative (wait and see) to the aggressive (surgery), and each approach comes with its own risks and benefits. But recent research suggests that doctors don't always do a good job of informing you of all your choices. And that can lead to what's known as preference misdiagnosis—when your doctor makes an assumption about which treatment you'll want and, as a result, presents you with only a narrow range of options. One study in The Journal of the American Medical Association found that when women with abnormal menstrual bleeding were given information on treatment options and asked about their preferences, they were more than 20 percent less likely to choose a hysterectomy than those not asked about their preferences.
Be prepared: Before signing off on any treatment plan, request information about all available options. Then have a frank discussion with your doctor about what's important: Would you prefer to take an array of medications daily if you could avoid surgery? Or would you rather go under the knife if it meant never taking pills again? One choice may not be better than the other; what does matter is finding the path that best fits your life.
Mehmet Oz, MD, is the host of The Dr. Oz Show (weekdays; check local listings).