Learning About Your Case
Last updated in July 2016
To make the best possible choice of hospital, you must learn as much as time allows about your case. This education is also essential for you to answer two other critical questions: What is really wrong with you and what is the best approach to treatment? In addition, whatever you learn will help you play an active role later on in monitoring your care.
If a doctor recommends hospitalization, here are a few questions for you to ask (often when we refer to “you,” we assume the “you” is a relative or friend who will take responsibility for a sick patient):
- What is the basis for the diagnosis? Are there other possible explanations for your symptoms? Might it make sense to do further tests or to wait awhile to get a surer diagnosis?
- What are the alternative ways of treating your problem? What are the pros and cons of each—the chances of various outcomes in terms of your life, lifestyle, and ability to function?
- How complicated is the treatment you will get? Does it require sophisticated medical staff or advanced equipment?
- What are the risks of complications? Will it be important to have close monitoring and quick access to sophisticated medical staff and equipment at all times?
- Is your required treatment one for which special training or frequent experience is important? Are there certain hospitals or specialists who have more skill, more experience, and higher success rates than others?
Good physicians will encourage you to ask such questions, will offer answers, and will steer you to sources for further research. Don’t be concerned about insulting your physician by asking questions. It helps to write out your questions as a reminder. It is a good idea for a patient to be accompanied by a family member or friend to help press for answers. Also, you or someone with you should take notes on the answers.
A good physician will also encourage you to seek a second opinion. Get one.
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. To find a doctor to use for a second opinion, consult the Doctors section of our site, where we list highly recommended physician specialists in 53 metropolitan areas who can give second opinions in most specialty fields. Also, if you read up on your type of case—especially if it is of a type that is being actively researched at certain medical centers—you may come upon names of leading specialists who might be available for advice. When two doctors from whom you get opinions disagree or are uncertain, you may want to seek additional opinions.
To keep down the cost and time required for a second opinion, have your first doctor send copies of your medical records to the second-opinion doctor. This is standard procedure and will be easier and easier as doctors move more to use of electronic medical records.
Medicare and most insurance plans will pay for second opinions, and in some circumstances plans may pay for third opinions. In some types of cases, insurance plans require second opinions.
Don’t assume that because yours is a straightforward, uncomplicated case there is nothing to learn and there are no decisions to be made. In most cases, there are choices.
This point is brought home by studies done by Dartmouth Medical School researchers and others, looking at variations in medical practice in common types of cases across similar geographic areas. For example, a study 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 are found in rates of back surgeries, 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 financial considerations (the need to generate fees) and not necessarily based on sound evidence of likely benefits to the patient. Even in a common type of case, you can’t assume that a physician’s recommendation is the best option for you.
Also, for many types of conditions, there are different treatment options with different likelihoods of health improvement, discomfort, harm to the patient, and even death; only you, when fully informed, can decide which kinds of risks and benefits you weigh most heavily.
You can also check out family health books and websites such as the Harvard Medical School Family Health Guide, the Mayo Clinic Family Health Book, The Merck Manual of Medical Information, and the American College of Physicians Complete Home Medical Guide.
For more information, take advantage of public libraries where you can consult consumer-oriented newsletters and medical textbooks. For more in-depth information, visit a medical school library, which will have both general textbooks, texts in specialty fields, and peer-reviewed medical journals containing articles on new developments not yet included in textbooks.
An online search or a medical school library may also lead you to support groups and organizations that regularly provide information on your type of medical problem. Search for something like "hip replacement forum" or "heart valve replacement forum."
A source of valuable insight on hospital risks and how to minimize them is Consumer Reports' SafePatientProject.
As you learn more about your treatment choices, you’ll also learn about hospital choices. If yours is a case that requires a high degree of specialization that is currently available only at a few medical centers, you will want to use one of these centers for treatment. If yours is a complicated, high-risk case, you will want to use a hospital with sophisticated capabilities to deal with complications. If your case is low-risk, you might choose to give substantial consideration to the pleasantness of the staff and facility and its convenience to your home, family, and friends.