Choosing Treatments
Contents
> Learning About the Problem
> Medical Tests
> Getting the Diagnosis
> Support
> Looking at the Options
> Making Decisions About Surgery
> Getting a Second Opinion
> Ambulatory Surgery Centers
> Sources of Additional Information
Research shows that millions of Americans receive treatments that are
unnecessary, costly, and even harmful to their health. On the other
hand, millions of Americans do not get the treatments they need.
Study after study has found that the use of certain treatments varies
widely-from region to region, State to State, and city to city. But
there are even large differences in the use of treatments within a
single health plan or hospital, or by a single doctor.
That is why it is very important to work closely with your doctor when
treatment decisions need to be made. Make sure your doctor knows your
questions, concerns, and preferences. Ask your doctor if the
treatments he or she recommends are based on the latest scientific
evidence.
Quick Check for Quality
When choosing a treatment, make sure you understand:
[x] What your diagnosis is.
[x] Whether treatment is really needed at this time.
[x] What your treatment options are.
[x] Whether the treatment options are based on the latest scientific
evidence.
[x] The benefits and risks of each treatment.
[x] The cost of each treatment.
If you understand and feel comfortable with your treatment plan, you
are more likely to do your part to make it work. And, research shows
that people who are actively involved in their own health care tend to
get better results.
Learning About the Problem
The first step in getting the right treatment is to tell your doctor
what's going on. This information might include:
Your symptoms: ________________________________________________________
When they first started: ______________________________________________
When they occur: ______________________________________________________
Are they getting better? Worse? ______________________________________
What makes them better? Worse? _______________________________________
Are they affecting eating, sleeping, or other activities? How?
________________________________________________________________________
Medicines you take: ___________________________________________________
Before a treatment decision is made, your doctor needs to make a
diagnosis. Medical tests are an important way to help your doctor
learn about the problem. It is important to make sure that any tests
your doctor suggests are appropriate for you.
Medical Tests
Doctors order blood tests, x-rays, and other tests to help diagnose
medical problems. Perhaps you do not know why you need a particular
test or you don't understand how it will help you. Here are some
questions to ask:
How is the test done? _________________________________________________
What kind of information will the test provide?
________________________________________________________________________
Is this test the only way to find out that information?
________________________________________________________________________
What are the benefits and risks of having this test?
________________________________________________________________________
How accurate is the test? _____________________________________________
What do I need to do to prepare for the test? (What you do or don't do
may affect the accuracy of the test results.)
________________________________________________________________________
Will the test be uncomfortable? ______________________________________
How long will it take to get the results, and how will I get them?
________________________________________________________________________
What's the next step after the test? _________________________________
One study found that anywhere from 10 percent to 30 percent of Pap
smear test results that were called "normal" were not. Errors such as
this can lead to a wrong or delayed diagnosis.
You want your tests to be done the right way, and you want accurate
results.
What can you do?
* For tests your doctor sends to a lab, ask which lab he or she
uses, and why. You may want to know that the doctor chooses a
certain lab because he or she has business ties to it. Or, the
health plan may require that the tests go there.
* Check to see that the lab is accredited by a group such as the
College of American Pathologists (800-323-4040) or the Joint
Commission on Accreditation of Healthcare Organizations (telephone
630-792-5800; Web site http://www.jcaho.org).
* If you need a mammogram, make sure the facility is approved by the
Food and Drug Administration. You can find out by checking the
certificate in the facility. Or, call 800-4-CANCER 9:00 a.m.-4:30
p.m. EST to find out the names and locations of certified
facilities near you.
What about the test results?
* Do not assume that no news is good news. If you do not hear from
your doctor, call to get your test results.
* If you and your doctor think the test results may not be right,
have the test done again.
Getting the Diagnosis
When your doctor has decided what your problem is, he or she will give
you a diagnosis. But you should know that reaching a diagnosis can be
hard. Sometimes it can take a long time. And sometimes it is hard to
find out exactly what is wrong.
Ask your doctor to explain what you have and how it might affect you
and your family.
What is the diagnosis?
________________________________________________________________________
What is my prognosis (outlook for the future)?
________________________________________________________________________
What changes, if any, will I need to make in my daily life?
________________________________________________________________________
Is there a chance that someone else in my family might get the
same condition?
________________________________________________________________________
Will I need special help at home for my condition?
If so, what type of help?
________________________________________________________________________
Ask for materials you can take home. You also might want to find out
if there are any support groups for people with your condition.
Support
"Self-help" groups offer support to people with disabilities, cancer,
and many other health problems. The groups are made up of people who
have "been there" and who share experiences and information.
Call the American Self-Help Clearinghouse for information on national
groups. It also can refer you to any State or local self-help
clearinghouses in your area. If you want to start your own self-help
group, the Clearinghouse has information to help you at its Web site:
http://www.mentalhelp.net/selfhelp/
Looking at the Options
The next step is for you and your doctor to look at your treatment
options. Your doctor may recommend one or more of the following:
* Behavior change (for example: eating a healthier diet, getting
more exercise, quitting smoking).
* Prescription medicine.
* Non-prescription ("over-the-counter") medicines.
* Surgery.
* Rehabilitation (such as physical therapy).
* Other treatments (for example, chiropractic services, massage, or
acupuncture).
* "Watchful waiting." (You and your doctor keep track of your
symptoms and watch for any changes. If there are changes, then
treatment might be the next step.)
Not all treatments have been proven by research studies to work-or to
be the best treatment for what you have. "Clinical practice
guidelines" can help doctors and patients make the right treatment
choices for some conditions. Some of these guidelines are based on
scientific evidence about which treatments work for certain conditions
and which do not. Ask your doctor if there are evidence-based
guidelines on treatments for your condition.
Ask about any books or special materials that can help you decide
which treatment is best for you. For example, "shared decisionmaking
programs" use video, audio, and computer graphics to help patients
make decisions based on science and on their own values and
preferences. Self-help groups, patient organizations (such as the
American Cancer Society and the American Diabetes Association), the
Internet, and your library are other sources of information.
All treatments have benefits and risks. To learn more about them you
may want to ask your doctor:
What is the recommended treatment? Are there other choices?
________________________________________________________________________
What are the chances the treatment will work?
________________________________________________________________________
What are the expected results? When will I see them?
________________________________________________________________________
What are the risks? __________________________________________________
What are the benefits? _______________________________________________
Are there any side effects? (Most treatments have them.)
What can be done about them?
________________________________________________________________________
Is the treatment painful? How can the pain be controlled?
________________________________________________________________________
What happens if I choose to have no treatment at all?
________________________________________________________________________
How much does the treatment cost? Will my health plan pay?
________________________________________________________________________
Once you have the answers to these questions, you might want to make a
chart of "Benefits and Risks" or "Pros and Cons" to help you decide if
the treatment is right for you. Here is a sample chart:
Benefits (Pros) Risks (Cons)
______________________________________________________________________
* Treatment has worked well for * Some minor side effects
others with my condition. (rash, stomach upset)
could be troubling.
* The medicine only needs to be * The medicine is costly.
taken once a day.
* No major side effects are
expected.
What Can You Do to Help the Treatment Work?
* Ask about anything you do not understand.
* Follow the doctor's directions. If you have a problem with the
directions, tell the doctor-the sooner, the better.
* If you have made any changes in the treatment plan, tell the
doctor.
* If you feel worse, have new symptoms, or have side effects from
the treatment, call your doctor.
Making Decisions About Surgery
Some surgery has to be done right away. But most surgery is not an
emergency. That means you have time to talk with your doctor and
decide what is best for you.
No surgery, not even minor surgery, is risk-free. To decide if a
procedure is right for you, learn about it and its possible benefits
and risks. Research shows that patients who know the facts about
surgery and other treatments can better work with their doctors to
make decisions based on science and on what the patient prefers. The
result? A more satisfied patient.
Here are some questions you may want to ask your doctor or surgeon:
Do I really need this surgery? Is there some other way to treat
my condition?
______________________________________________________________________
What will happen if I wait until later to have surgery? Or never
have it at all?
______________________________________________________________________
How often does this type of surgery help my kind of problem? How much
does it help?
______________________________________________________________________
Where will the surgery be performed?
______________________________________________________________________
Does the surgeon, hospital, or surgery center have a lot of experience
with this kind of procedure?
______________________________________________________________________
Is the surgeon experienced and qualified to perform the surgery?
______________________________________________________________________
What complications or side effects might I have?
______________________________________________________________________
What kind of pain might I have? How will it be treated?
______________________________________________________________________
How long will it take me to recover? Will I need help at home?
What kind of help?
______________________________________________________________________
How much does the surgery cost?
______________________________________________________________________
Will my health plan pay?
______________________________________________________________________
Getting a Second Opinion
A "second opinion" is when another doctor gives his or her views about
what you have and how it should be treated. A second opinion can help
you decide whether the surgery is right for you at this time. Your
doctor and surgeon should welcome your request for a second opinion.
Your health plan may even require one for some types of surgery.
You can ask your doctor, health plan, a local medical school, or local
medical society for help in finding someone to give you a second
opinion. But first check to see if your health plan covers second
opinions.
Ambulatory Surgery Centers
Today more and more surgeries are done in places other than hospitals.
These are "in and out" (ambulatory) surgery centers, where you may
stay for a few hours or up to one night. If you plan to have surgery
at such a center, call your health plan or visit the center to find
out:
* If your health plan will cover your care there.
* If it is licensed. Then check to see if it is accredited by a
group such as the Joint Commission on Accreditation of Healthcare
Organizations (telephone 630-792-5800; Web site
http://www.jcaho.org) or the Accreditation Association for
Ambulatory Healthcare (847-676-9610). The accreditation
certificate should be posted in the facility.
* How well trained and experienced the center's health care
professionals are.
* If the center is affiliated with a hospital. If it is not, find
out how the center will handle any emergency that could happen
during your visit.
_________________________________________________________________
Sources of Additional Information
Be Informed: Questions to Ask Your Doctor Before You Have Surgery
A list and in-depth discussion. 12 pages. Free.
Web site: http://www.ahrq.gov/consumer/surgery.htm
The National Guideline Clearinghouse™ makes clinical practice
guidelines available to the public via the World Wide Web. The
Clearinghouse was developed by AHCPR, the American Medical
Association, and the American Association of Health Plans.
Web site: http://www.guideline.gov
FDA Guide to Choosing Medical Treatments
Designed to help consumers avoid fraud and deception when choosing
medical treatment. Use publication number (Reprint 95-1223) when
ordering. 6 pages. Free.
Food and Drug Administration
Office of Consumer Inquiries: HFE-88
5600 Fishers Lane
Rockville, MD 20857
(301) 443-3170
Web site: http://www.fda.gov
Taking Part in Clinical Trials: What Cancer Patients Need to Know
This booklet by the National Cancer Institute describes how clinical
trials work, and their possible benefits and drawbacks. 18 pages.
Free.
Cancer Information Service:
1-800-4-CANCER (1-800-422-6237)
9:00 a.m.-4:30p.m. EST.
Also available on the Clinical Trials Web site:
http://cancertrials.nci.nih.gov
When You Need an Operation
This brochure by the American College of Surgeons covers how to assess
a surgeon's qualifications, whether to seek a second opinion, and
informed consent and cost issues. It and 12 other informational
brochures are available free from:
The American College of Surgeons
Office of Public Information
633 N. Saint Clair St.
Chicago IL 60611
(312) (202) 5391
Web site: http://www.facs.org
Information about women's health, men's health, and treatments for
arthritis, diabetes, and other conditions is available from the Health
Pages' online magazine.
Web site: http://www.thehealthpages.com
healthfinder®
Provides a gateway to reliable consumer health information from the
Federal Government and other organizations.
Web site: http://www.healthfinder.gov
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_________________________________________________________________
Current as of July 2001
Send Questions & Comments to: info@ahrq.gov
_______________________________________________________________
Internet Citation:
Choosing Treatments. Your Guide to Choosing Quality Health Care. AHCPR
Publication No. 99-0012, July 2001. Agency for Healthcare Research
and Quality, Rockville, MD. http://www.ahrq.gov/consumer/qntascii/
qnttreat.htm
_______________________________________________________________
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