Are You Taking An Active Role In Your Health Care?
Doug Amis knew he had to make a change. He had survived a quadruple heart bypass 20 years earlier, but his cholesterol and blood sugar numbers were heading in a dangerous direction. His doctor’s advice about diet and exercise didn’t seem to be helping. “I was not educated in this area and I was relying on my doctor, who was also uneducated about it,” says Amis, a 69-year-old from Danville, California.
Amis began researching treatment and eating a plant-based diet. Then he got a new doctor and spoke up at their first meeting. “I said, ‘This is the direction I want to go in, and here are the books I’ve been reading. Is it something you agree with?’” Amis remembers.
Seven years later, Amis is an active participant in managing his health. And he’s not alone.
A study published in late 2017 in the Annals of Family Medicine found that about 85 percent of people ages 65 to 84 preferred taking an active role in their health care decisions. The study was based on survey responses, and doesn’t prove the trend. But the numbers are similar to what Dr. Pankaj Vij sees among his patients. “People are very aware, and often they have done a lot of research and reading before they come in to see us,” says Vij, an internal medicine specialist with Kaiser Permanente in Pleasanton, California. He says the rise of the internet has played a role in that.
A Shift in Approach
In the past, the doctor was the purveyor of all knowledge, and patients did as they were told. This was known as the paternalistic approach. And there are still times when the doctor needs to call the shots without much consultation with the patient, such as an emergency surgery.
But increasingly, patients are expected to actively participate in making treatment decisions, to learn as much as possible about their health and to be responsible for helping to manage their conditions.
It’s all part of patient-centered health care and shared decision-making, models that focus on collaboration between a clinician and patient to craft treatment that addresses what’s important to the patient.
It’s fueled in part by a drive to improve patient satisfaction and health outcomes. Some studies even link shared decision-making with reduced medical costs by avoiding unnecessary surgeries and other procedures.
Not everyone is able to take an active role in his or her health. The Annals of Family Medicine study noted that 1 in 7 older adults preferred taking a passive role in health care decisions, especially if they had several chronic conditions. “Yes, if you’re 95 and can’t hear well and are dependent on others for day-to-day care, then probably you’ll be in a group leaving the decision-making to the adult child or caregiver,” Vij says.
But Vij also says some people simply choose not to take the lead in their health care, assuming the doctor will manage everything. That plan can have pitfalls:
- You may not get the care you want. Your doctor may prescribe one treatment for a problem – such as a prescription painkiller for back pain – when you’d rather have another treatment, such as physical therapy.
- You may get care you don’t need. A study published online in October 2017 by JAMA Internal Medicine found high rates of unnecessary diagnostic testing and imaging in 2016, such as CT scans for non-life-threatening breathing trouble and routine ultrasounds of the carotid arteries (in the neck) in patients who haven’t had a stroke. These tests can be expensive and may cause unnecessary anxiety.
An Active Role
Taking the reins of your health requires many steps. It should start with understanding your condition and the goal of treatment, according to Dr. Michael Perskin, a geriatrician at NYU Langone Health. “It’s not enough to know that you have high blood pressure and need to reduce it,” Perskin notes. “What you’re really trying to do is reduce the incidence of strokes and heart attacks. Find out why you’re doing a particular treatment and what you can expect.”
Equally important, you need to follow your treatment plan. That may mean taking medication, exercising, having surgery or eating a specific diet. If you can’t follow the plan, report it to your doctor’s office. There may be an alternative treatment.
There are many other ways you can take a more active role in your health care:
- Look up health information. Use the websites of trusted news sources, large research institutions or government resources such as the National Institutes of Health. Compare the information to ensure it’s consistent from source to source, and bring it to your doctor to be sure you’re on the same page.
- Prepare for a doctor visit. “Write down symptoms you’re having, how long you’ve had them, what makes them better, what remedies you’ve tried,” Vij suggests. That will help the doctor make a better diagnosis.
- Bring your medications to the doctor. “Don’t just bring me a list. I need to see the bottles and have you tell me what you’re taking and when,” Vij explains. “And don’t forget to bring supplements. Sometimes they can interact with medications.”
- Ask questions and share concerns. “Sometimes people are intimidated,” Vij says. “But be upfront with what you’re worried about. Maybe there’s something confusing about a treatment plan. Or maybe you want a certain test. Don’t be afraid to ask.”
- Develop a relationship with your doctor. “You have to tell your doctor what makes life worth living for you,” Perskin points out. “It helps the doctor understand the kind of advice you need to make a decision about your treatment.”
- Report symptoms. Call your doctor’s office if you develop new symptoms. These may affect your treatment.
- Track your health. Write down anything you’re doing that affects health, such as what you’re eating and when you’re taking pills, exercising or sleeping. Bring the journal to your doctor visits in case you need to refer to it.
For Amis, being proactive has improved his condition. “My last blood sugar test was almost normal,” he says. He’s still on a quest to learn more about his health. He’s also learned how to cook (most recently, stir-fried vegetables and tofu over rice), and he’s created a website to share health information.
But taking a proactive role may simply mean making the health care decision you feel most comfortable with, even if the decision is to avoid treatment. “Just remember that you need to make that decision in context,” Perskin advises. “When the stakes are higher, you need to seek more expert opinions.”
In other words, assemble a team to manage your health. And if possible, experts say, do your best to be the star player.
This blog was originally published in U.S. News and World Report.