Saturday, May 4, 2013

How to Tell Your Medical Provider “No.”

While we’re more at ease telling the car mechanic that the oil doesn’t need to be changed or the tires will last for another 1,000 miles, most of us find it a bit more difficult to say “no thanks” to our health provider. It seems that every time you pick up the paper there is another article saying that a particular test isn’t necessary or a much-touted treatment doesn’t work. This week alone, the New York Times had two articles on this very topic-Looser Guidelines on Prostate Screening” and Jane Brody’s investigation, “Questioning the Pelvic Exam.”  While these articles are very helpful in saying what you don’t need or should avoid, they don’t tell you how to say ‘no’ to your medical provider.

I’ve had several reminders this week of the importance of learning how to do so.

One friend had an unnecessary pelvic exam, which resulted in months of  tests, biopsies and expenses, to say nothing of the emotional toll it took on her. She’s fine.  In addition, my husband was scheduled for a test that didn’t make sense to either of us.

Before he went to the specialist’s office, he researched the test he was scheduled to have and the rationale for it. He didn’t think he needed it, but still he thought the doctor might have a explanation that he should hear. Like most of us, even though he felt he was fine, the provider’s referral and ordering of a test made him uneasy. In addition to his research,  he also practiced what he would say depending on the information the specialist provided. Most importantly, he had a game plan and he took me to the appointment as his advocate.

I was impressed by his approach, and thought this is a good strategy to follow. So below are some simple steps to take if you need to, “just say no!” 

Step I: Be clear in your own mind why you don’t want a particular test, procedure or treatment.
Do your research and validate why you need to decline. The reasons can be varied-not being able to afford it; tried it previously and had side effects; will not impact course of treatment etc. are all valid reasons.

If you have a gut level reaction that the test, treatment or procedure isn’t necessary or not something you want to do, check out ChoosingWisely.  This is an initiative by the ABIM Foundation, which encourages patients, doctors and other health providers to think and talk about medical tests, and procedures that may be unnecessary and in some instance can cause harm. Many different specialist organizations e.g. American Academy of Pediatrics participate in this project. They have clear and easy to understand information about what’s appropriate. They can make it easier for you to say no.

Step II: Prepare for your appointment
You’ve done the research and you are clear the path you want to take. Line someone up to be your advocate and practice how you will discuss this with your medical provider. Pick a code word or signal that will let your advocate know that if you use it, it means you’re having a hard time saying ‘no,’ but that’s what you really want. Once given, that’s a signal for the advocate to become more assertive during the visit.

Step III: At the appointment-Be respectful but clear
Keep in mind that your medical provider is not the enemy. They’ve gone through a great deal of schooling and continuing education to get to the position they are in. They want the best for you. That noted, they aren’t you and they don’t have to live with the choices you need to make. Ultimately, you are in charge of your health care.

Listen to what your provider has to say. If you find that does change your opinion, fine. If you believe you need to say ‘No,’ do so.  Just because you are saying no, doesn’t make you’re a bad patient.

Additional Resources
Patient Angst: When you just have to say “No” to the doctor by Dr. Annie Brewster. A doctor and a patient with MS, she struggled over the decision to reject her own doctors’ advice. 

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