華陀再世
一個中國醫學生(CMG)在美國的生活。。。
一些看醫生時該問的問題（Some suggested questions to ask the doctor at a checkup）:
• 我的診斷是什麽（What is my diagnosis）?
• 我的治療方案有幾種（What are my treatment options）? 每個方案的好處是什麽（What are the benefits of each option）? 有什麽副作用（What are the side effects）?
• 我將需要什麽化驗（Will I need a test）? 這個化驗是查什麽的（What is the test for）? 化驗結果將會告訴我什麽（What will the results tell me）?
• 你開的處方藥有什麽作用（What will the medicine you are prescribing do）? 我將如何用這藥（How do I take it）? 有什麽副作用嗎（Are there any side effects）?
• 我為什麽需要做外科手術（Why do I need surgery）? 還有其他方法可以來治療我的狀況嗎（Are there other ways to treat my condition）? 你常做這樣的手術嗎（How often do you perform this surgery）?
• 我必須改變我的日常習慣嗎（Do I need to change my daily routine）?
People often fail to ask their doctors questions that could lead to fewer medical errors and better outcomes—and doctors don't routinely encourage them to do so. That's despite years of efforts to improve doctor-patient communication.
Part of the problem is the intimidation factor that comes with the doctor's white coat. Also to blame are mounting time pressures that mean less physician or nurse interaction with patients, according to the federal Agency for Healthcare Research and Quality.
On Tuesday, the agency is launching a new campaign to promote a solution that seems obvious but often doesn't happen: getting patients to ask questions. The aim is to get patients to prioritize their top concerns and questions before a medical encounter—and to get doctors to prompt patient questions in order to provide better care. "Americans want more time with their doctors, but what hasn't sunk in is the importance of using the time you have with your doctor wisely," says Carolyn Clancy, the agency's director.
Even though he had suffered multiple heart attacks and struggled with congestive heart failure and diabetes, Bill Lee never had much of a dialogue with his doctors. "Doctors are the experts, so who was I to challenge them and what they were telling me?" says Mr. Lee, 55 years old, who is featured in a video that is part of the new campaign.
He took medications without asking what they were for, sat for hours in waiting rooms and then felt rushed through appointments. It wasn't until a doctor told him he would keep having heart attacks and there was nothing more to be done that he says he realized he needed to start asking questions about his care.
For consumers, the agency is offering new online tools on its website, including an interactive "Question Builder." Patients talking to the doctor about a proposed surgery, for example, are prompted to ask how long it will take to recover. The site offers tips on what to do before, during and after medical visits, such as calling the doctor if there are any side effects. Videos feature doctors discussing the importance of preparing for medical visits with a prioritized list of questions. Patients talk about how asking questions helped them get better care.
Also, the agency is launching its first ad campaign targeting doctors, with donated space in publications, including the New England Journal of Medicine, that reach two million clinicians. The ads urge doctors to ask patients about their health priorities, because "a simple question can reveal as much as a test." Doctors can also print or order free forms to help patients prioritize their top three questions.
Mr. Lee, who manages a database for the state of Maryland, had his first of 10 heart attacks in 2004, with three in the first year alone. He says he believes he would be dead today if he had accepted the prognosis of the doctor who told him there was nothing more to be done. He ended up at the University of Maryland Medical Center in 2007, where he has survived three more heart attacks and is cared for by a team that includes a cardiologist and a nurse practitioner.
Mr. Lee says he began preparing a list of the most important questions for each medical visit. When he was placed on a more aggressive course of medications to help strengthen his heart—he takes 21 pills in the morning and 19 at night—he asked what each was for, how it worked and whether he would have to take the drug for the rest of his life.
Because his cholesterol was at a good level, he asked why he needed a cholesterol-lowering drug. His doctor explained it was an important therapy for patients after heart attacks, so he agreed to take it and read the information he was provided. "In the past I probably would have just said, 'OK, fine,' and I wouldn't read the pamphlet," Mr. Lee says. "Now I realize this is my body, and if I don't ask what I need to know, nobody's going to fill me in."
Erika Feller, his cardiologist and medical director of the heart-transplant unit at the hospital, says Mr. Lee was a possible candidate for a transplant at one point, "but due to his hard work and our hard work he's been able to avoid that and stay out of the hospital." She acknowledges that time constraints are an issue and physicians aren't always great at translating medical issues for patients, particularly when they have to manage complex regimens such as Mr. Lee's. The hospital administers self-tests to patients to make sure they understand things like their diagnosis and their medications.
Of course, patients may feel intimidated asking medical professionals tough questions, especially if the response is brusque or even chilly. And it's usually more effective to ask questions politely, rather than in a contentious way. "Bill isn't shy but he's not a pain in the neck. He asks great questions and he is always appropriate," says Jane Kapustin, the nurse practitioner who treats Mr. Lee's diabetes.
The Wall Street Journal
The Informed Patient
- By Laura Landro Tuesday, September 20, 2011
