Getting the Best Care
Before undergoing surgery, consider the evidence that it is necessary, that no better options exist, and that the benefits are worth it. To do this, talk with your primary care (non-surgeon) doctor, a surgeon who might perform the surgery, and one or more independent surgeons for second opinions. Any good surgeon will encourage you to get independent second opinions. Our surgeon ratings on this website will help you find good surgeons to consult.
To find non-surgeons for advice, you can use our specialist ratings. For example, you might want to consult a cardiologist before undergoing open heart surgery or a rheumatologist before hip surgery. Learning more about your case and consulting possible surgeons about it will help you evaluate not only your treatment options but also possible surgeons to perform the surgery.
To evaluate treatment options, read whatever level of medical information you are comfortable with–from online patient forums to general medical advice websites to medical journal articles. See Doing Your Own Medical Research for possible resources.
Make sure the doctor has a full copy of your health records.
Before visiting a surgeon or other doctor who will be advising or caring for you, ask the doctor's office staff to obtain copies of your records from your primary care doctor and other doctors you have seen. Doctors have the capability to transmit these records at least by paper or fax; many use electronic health record systems to transmit your records with lab and imaging results, medical history, and other information. It is a good sign if a doctor has moved to such a system–and best of all if the doctor has a system that automatically and coherently integrates your records from other doctors or hospitals into the electronic medical record he or she is compiling for you.
Make sure your doctor takes a thorough medical history.
If you feel your doctor has not asked about matters that might be important in diagnosing or treating you, volunteer the information. For example, if both of your parents had colon cancer, if your dad had a heart attack at age 40, if you recently had a bout of kidney stones, or if you periodically feel very depressed, let the doctor know.
Find out about tests your doctor proposes.
Ask your doctor what tests he or she will perform. Ask why those specific tests and not others. If you are concerned about particular medical problems, ask if there are relevant tests and why they do or don't make sense for you. Ask what each test will tell you that you don't already know, how reliable it is, the risks and costs, and whether the results might make any real difference in treatment plans.
There's a lot of debate in the medical field about which routine tests are worth performing for which population groups, and how often. There are reasons not to perform tests: Some are unpleasant, some are costly, some pose risks of complications, and some might indicate that you have a problem you don't have–leading to costly, unpleasant, and possibly dangerous treatment. You should be given an opportunity to express your preferences regarding tests, based on information about each test's pros and cons.
Make sure you are told the results of exams and treatment.
During a doctor visit, ask when the results will be available and how you'll receive them. Some doctors tell you nothing unless there is a problem. That approach may leave you wondering long after your doctor has the answers. There's also the risk that phone messages will be lost and you won't realize that the doctor called with the results. If you know when a doctor is supposed to call or email you, you can initiate a call when the time passes.
Discuss the results of exams.
When you receive test results, ask the doctor to compare them to results from previous tests and find out about any possible changes you could make to improve results. Even if your cholesterol count or weight is within an acceptable range, for example, is it worse than it was? Enough worse to do something about?
Prepare for appointments.
Before a doctor visit–either a visit to a doctor's office or a visit by the doctor when you are in the hospital–get ready: Think about questions you want answered, symptoms you've had, and treatments you've been administering yourself or that other providers have been giving you.
Write down your questions and other relevant information so you don't forget to mention something. Bring the medications you're using with you to the doctor's office.
If the doctor seems to be rushing through your list of items, explain that discussing these matters is important to you and that it's important that the doctor give you enough time.
Take notes. You might want to bring along a friend to help you push through your questions and remember the doctor's responses. You might even ask if the doctor minds if you record your discussion on your phone. And more and more forward-thinking doctors have adopted the "OpenNotes" concept, which means they will give you the full notes of your visit so you can refer to, and possibly make corrections to, the doctor's written record of the visit.
Describe symptoms in detail.
Does the problem occur only after you've just eaten, after you've exercised heavily, when you've been standing for a long time, only when you urinate? What does it feel like? When did you first notice the problem? Your description is a window on what's going on inside–often a better window than all the examining and testing the doctor can do.
If you suspect you might have a particular medical condition, tell the doctor. This will give the doctor a chance to investigate those concerns or assure you that they are unfounded.
Find out about getting answers by phone or email.
Many questions require a visit to the doctor or tests. But some can be resolved based on what you can communicate by phone or email. Also, a phone call can often help you determine whether a doctor's visit is needed–and how soon.
Ask your doctor if there is a nurse who can handle your questions. And ask about the best time to reach the doctor by phone.
Request a full explanation of your diagnosis, treatment options, and outlook for recovery.
When your doctor has had time to evaluate your case, request a full explanation of what he or she has discovered, your choices, and what you can expect.
What isn't working right? What caused it? What can be done about it now? If it's curable, what can you do differently to avoid a recurrence–for example, change the way you eat, exercise, sleep, or sit; change your job; wear a brace?
How certain is the doctor of the diagnosis? What are the other possibilities? What more can be done to confirm the diagnosis? At what cost and what risk?
What are the treatment options? For example, if you are considering total joint replacement versus arthroscopy, what is the evidence that one or the other will address your problem and be the best treatment option? What are the risks and costs? What are the possible benefits in terms of your lifestyle and ability to function? How will you know if the treatment is working? What will you need to report to the doctor?
One of your fundamental rights as a patient is the right to informed consent. If you agree to a treatment–using drugs, knives, or other instruments–that you would not have chosen had you better understood your options, the doctor's actions amount to an assault. That's why responsible doctors understand the importance of trying to answer all your questions.
Ask about referrals to specialists.
If your doctor refers you to a specialist, ask why a specialist is needed and why he or she chose that particular one. What is known about that specialist's expertise and experience with your type of case? Is this the only specialist of this type that your doctor can refer you to under your health plan? Ask the doctor to compare his or her recommended specialist to our list of doctors who were most often recommended by other doctors.
What should you expect the specialist to do? How will your referring doctor remain involved in your care?
If you are not referred to a specialist, ask why not. What extra expertise could a specialist bring to the case?
Remember that some health plans have physician compensation schemes that penalize–or reward–a doctor for making referrals to specialists. Ask any doctor making a referral whether such a compensation scheme or other pressures are constraining his or her choice of referral options.
Ask about medication.
If medication is recommended, ask why that particular medication. What are its benefits? How soon will it take effect? What are possible side effects, and what should you do if you experience them? How should you take the medication–for example, with meals, at bedtime? Can you take it even though you're taking other medications? What should you do if you forget to take a dose? Will the medication limit your capacity to drive, work, or do other activities?
You may find it useful to consult a drug reference guide. Consumer Reports' Best Buy Drugs covers thousands of brand-name and generic drugs.
There are also free websites that provide extensive information on drugs-what they are for, possible side effects, interactions, etc. A useful site is MedLinePlus.
Ask about hospitalization.
If hospitalization is not recommended, ask why not. Hospitals are expensive and health plans are interested in cutting costs. If your plan pays its doctors less when their patients are hospitalized, make sure the financial disincentives are not producing inadequate care.
On the other hand, if hospitalization is recommended, ask why. Could the case be handled on an outpatient basis?
Hospitals are dangerous places. Some authoritative studies have concluded that preventable medical errors may kill more than 200,000 patients each year in the U.S., making this the third-leading cause of death–more than auto accidents and anything other than cancer and heart disease. And there are many additional cases where hospital or doctor negligence slows recovery or leads to short– or long–term disability. What's more, even where there are no errors, infections and other problems can occur.
Also, be sure to ask why a particular hospital was chosen. Is it the only hospital to which your doctor is allowed to refer under arrangements with your health plan?
How complicated is your case? Does it require sophisticated hospital staff or advanced equipment? What are the risks of complications? Will it be important to have close monitoring and quick access to medical staff and equipment at all times? If the case is complicated, a major teaching hospital might be best.
Does your treatment require special training or frequent experience? Does staff at certain hospitals have more skill, more experience, or higher success rates than others with this treatment? In many types of cases–such as open heart surgery–research has shown that hospitals that treat a greater number of patients generally produce better results.
Our ratings of hospitals are based on our comparison of death and adverse outcome rates for major types of cases; doctors' ratings of hospitals in areas such as high-risk adult surgery, low-risk adult surgery, high-risk child surgery, complex medical care for adults, and maternity care; assessments of whether hospitals fail to provide proper tests and procedures; and patient ratings; and also on Show hospitals performed on key patient safety measures, as reported by The Leapfrog Group.
Get a second opinion.
If your doctor recommends hospitalization or other treatment that will be expensive, risky, or burdensome, get a second opinion. In such cases, good doctors encourage second opinions, and most plans are glad to pay, since the second opinion may lead to a recommendation of less care–and lower cost.
If your doctor recommends against certain types of care that you know are available, or if you are not confident about your doctor's conclusions or satisfied with the progress of your case, get a second opinion to consider more or different care. In a traditional insurance plan or preferred provider organization (PPO), you can arrange for a second opinion on your own and the plan will generally pay for it. In an HMO, your doctor may have to refer you for the second opinion in order for the plan to pay. Since the second opinion might lead to more care, there may be some resistance to authorizing it. If you think a second opinion is justified, insist on one. If the first and second opinions are in conflict, or for some other reason you're still not confident about the conclusions, insist on a third opinion.
If possible, get your second opinion from an entirely independent doctor. If a surgeon who has recommended surgery refers you to another surgeon for a second opinion, it will be difficult for the second doctor to recommend against the advice (and the economic interests) of the first. Our ratings of surgeons or lists of most-recommended doctors will help you identify a doctor to consult for a second opinion. Read up on your type of case–especially if it is a type actively researched at certain medical centers–to find leading specialists who might be available for advice.
You'll have more flexibility in choosing an independent doctor if you are in a traditional insurance plan or PPO than if you are in an HMO. In an HMO, your primary care doctor is likely to refer you to another participating doctor with whom he or she has regular contact.
Don't assume that because your case is straightforward and uncomplicated that there is nothing to learn and no decisions to be made. In most cases, there are choices.
This point is brought home by studies conducted by Dartmouth Medical School researchers and others who have examined variations in medical practice in common types of cases across similar geographic areas. One of these studies, for example, found that about 75 percent of the elderly men in one Maine town had undergone prostate surgery, compared with fewer than 25 percent of men the same age in an adjacent town. Similar variations have been found in rates of hysterectomies, caesarean sections, and other common procedures. Significantly, studies generally find no evidence that such medical practice differences result in differences in the health status of the affected populations.
The implication is that big differences in the ways patients are treated result from differences in the beliefs and customs of different physicians in different communities–possibly influenced by the need to generate fees and not necessarily based on sound evidence of likely benefits to the patient. Even in common types of cases, don't assume that a physician's standard recommendation is the best option for you.
Complain if necessary.
If you have a dispute with a doctor, you may be able to resolve it in a discussion with the doctor. If that fails, you can file a formal complaint. We provide a list of state medical boards that hear such complaints.