Ten years ago I visited a foot doctor, and he told me that I needed immediate surgery on both feet to treat bunions, which is not what I went to see him about. (A bunion is a bony lump on the side of the foot near the big toe.)
How can you decide whether to take advice like that or not? When considering a non-emergency medical treatment, a first step is to identify the activities that you care about being able to do. Then you can figure out if the proposed treatment is likely to improve your ability to do those things or not.
Some activities that I care about doing that involve my feet are walking, bicycling, hiking up mountains, driving a car, swimming, and sleeping. Bunions did not prevent me from doing any of those. Sometimes my feet hurt a little, and finding shoes that I can wear has always been a challenge. But bunions have never interfered with my life in any important way.
Surgery carries risks of infection and other complications. Further, it can take months to recover completely. I concluded that having the surgery was more likely to interfere with my ability to live my life than to improve it.
Everybody's situation is different. People who can't do the things they want to do because of severe pain from bunions could conclude that they'd be better off having the operation.
Thinking about medical treatments in terms of how they will affect your ability to do the things you care about may help you get better results from health care. The alternative is to think about medical treatments as unrelated to your day-to-day life - something you have to get because somebody else says so. Letting someone else make the decisions for you may not be ideal.
You probably would not let real estate agents decide what house you're going to live in for the next 10 years. Why not? The real estate agents are the experts. They probably know a lot more about houses than you do.
However, you are the one who knows if you want a mansion or a cabin, and if you want the master bedroom on the main floor or if you want it upstairs. You are the one who has to live in the house. It's your life.
The situation is similar in health care. Doctors are the experts. That said, if you've concluded that you do need treatment, you have a right to get information that allows you to compare treatment options and choose the one that is the best fit for you.
Researchers at Dartmouth have concluded that doctors often choose treatments based on what they want to deliver. A surgeon is likely to propose surgery, for example. The research also shows that solutions chosen by doctors often aren't a good fit with the patients' needs, priorities and values.
A study in the Journal of General Internal Medicine concluded that people have a real say in their treatment only about 9 percent of the time. People who simply follow doctors' orders typically are less satisfied with the results than are people who have a voice in the decision.
Twelve questions that you might ask about proposed treatments are:
- What will this treatment enable me to do that I can't do now (or that I may not be able to do in the future without this treatment)?
- How is success defined for this treatment? (e.g, reduces pain by 25 percent.)
- How many people out of 100 get that successful result?
- Will this treatment solve the problem forever, or will the problem come back and require more treatment later?
- What are common complications of this treatment?
- How many people out of 100 experience complications?
- What do patients like most about this treatment?
- What do patients dislike most about this treatment?
- How will this treatment interfere with my ability to live my normal life, and for how long? (For instance, having knee surgery might mean that you can't drive for a number of weeks.)
- How much pain am I likely to experience and for how long?
- What else will I have to do to get good results? (For example, joint surgery is typically not very successful without intensive physical therapy afterward.)
- What other treatments are available for this condition?
With answers to the above questions, you can compare your options and choose the treatment that best meets your needs. You can avoid treatment that is unlikely to improve your ability to lead your life. You can understand clearly the trade-offs you are making and the potential risks involved. Taking this approach can help you to get the great benefits health care can offer while avoiding unpleasant surprises.