Doctors communicating with patients -what's the right amount of information?
I was a little annoyed at my doctor's office recently - just a little. I was having some odd symptoms and, being a little neurotic, I had done a bunch of reading on Graves disease (which my sister had) and perimenopause and went in to have my hormones checked. My doctor, being an agreeable person, agreed with me that these were reasonable things to look at and sent me away with the appropriate lab slip (or maybe they drew the blood themselves, I can't remember now). He finished up with "No news is good news," which is what he always says - it means I don't have to call in, because if the test is negative, they won't call, but if it's positive, they will.
Now, I never trust that system to work, so I always call anyway. But this time, the person who answered the phone, after pulling out my chart, said "Everything's fine." I had to prompt her for more information, and for that, she had to ask the tech to call me with the actual results. The tech then said, "Everything's fine; the tests were negative."
Negative for...? Actually, the tests I had were supposed to report a hormone level that was part of a range. Presumably, different parts of the range had different meanings. I said, "Can you be a little more specific?"
"Your thyroid hormones were normal, and your estrogen levels were normal." Normal for whom? In what context? Any uncertainty? I gave up and made another doctor's appointment. Not having met my deductible for the year, I was paying good money for those tests. The sum of what I got from the doc was more reassurance that everything was fine. Maybe I was overintellectualizing what to him were just negative results, but never did anyone offer to go over the actual numbers with me, and their meaning in terms of the possible range of values, and whether there was any uncertainty in the tests. I asked a few more questions about perimenopause, and got a couple of useful answers, but, in addition, there was still no further light shed on my symptoms, and in the end they mostly went away and I decided not to worry about it. So I didn't have Graves disease, nor was I perimenopausal, at least according to those tests.
So even though I was, in the end, somewhat reassured, sometimes I'd just like to understand what's going on, and possibly armed with information to make choices. Is that unreasonable?
In this month's issue of GoodBehavior, Jessie Gruman, Executive Director of the Center for the Advancement of Health addresses this very topic.
In this new world of "personal responsibility" and perplexing health care choices, the accurate communication of the risk of treatments and tests is going to be as important as any new vaccine or miracle drug. Even if message-communication improves, message-comprehension may not.Was my doctor assuming I wouldn't understand the complexity of a message, did he feel inadequate to try to explain, did he not have enough information (or knowledge) himself, was he pressed for time?
As a patient, I need to have a choice between knowing the bare minimum and then asking my doctor to recommend an action and having the full range of trade-offs out on the table and subject to discussion until I am comfortable with my choice.
Ultimately it's a tricky dance between two humans. Finding the right balance is hard. I don't want to have to change doctors every time someone doesn't communicate quite the way I'd like, but I also don't want to have to always push, repeatedly, to get the information I need. And to be honest I don't always know what I need to know.