Samantha's doctor had tested her and told her that she "might have diabetes." He prescribed medicine for her to take to treat it.
She was exasperated. "The doctor won't give me a meter to test my blood sugar until after I start taking the medicine. I don't want to do it that way. He said I'm not in any danger; my blood sugar is only a little bit elevated. But he just wants me to start taking the medicine."
She continued, "I want to know what my blood sugar level is now. I want to see what it is since I've already started changing how I eat, and I'm getting more exercise. It was a real wake-up call when the doctor said I might have diabetes. But I don't want to take medicine if I don't need it!"
Samantha's doctor decided on a course of action without getting her buy-in. Research shows that this approach is common. Up to 91 percent of the time, doctors choose a treatment without giving patients a real voice in the decision.
Clarence H. Braddock III, et al., writing in JAMA (the Journal of the American Medical Association), suggested that patients could be considered to have meaningful involvement in their treatment choices only if seven elements are present when they talk with the doctor:
- The patient understands that it's reasonable for them to have a say in their treatment.
- The patient understands what the medical issue is. (In Samantha's case, the issue is that she might have diabetes.)
- The patient is told about the various choices available. (For example, a condition might be able to be treated with changes to diet and exercise, with several different types of drugs, or with surgery.)
- The patient understands clearly the pros and cons of each of the choices. The researchers note, "(Doctors) frequently discuss the pros of one option and the cons of another without fully exploring the pros and cons of each."
- The patient understands the uncertainties involved in the different treatments. (For example, a treatment might help 60 percent of the people who get it, but not help the other 40 percent.)
- The doctor figures out if the patient understands the above five elements. If the patient does not, the doctor provides clarification.
- The patient is asked for her preference after the above six steps are completed.
Based on Samantha's story, her meeting with her doctor had only one of those seven elements in it: she understands what the medical issue is. The doctor did not give her any choices about the path forward. He did not talk about the benefits and risks of different approaches. He clearly did not ask her what she preferred to do.
It is also worth noting that the doctor put up roadblocks for Samantha. She was eager to start taking action. He created the impression that she couldn't test her blood sugar level when she wanted to. She was supposed to wait for him to give her a glucose meter. He would provide it on his timeline, not hers.
He probably didn't mean to create obstacles. Nevertheless, he missed a chance to engage a patient who was ready to take steps to monitor her condition and to improve her health. Instead of feeling supported and encouraged, she felt angry. She saw the doctor not as a trusted adviser but as someone who prevented her from learning what was going on in her own body.
Devices to check blood sugar levels are readily available. They are sold in just about every drugstore in the country. You do not need a prescription to buy one. Samantha did not need to wait for the doctor, but she didn't know that.
No one would recommend that people skip seeing the doctor and try to manage a serious chronic disease on their own. However, if people want to monitor an aspect of their health on a daily basis, if reliable products are available to help them do so, and if they are able to follow the instructions that come with the device, it's hard to see why they shouldn't be permitted and even encouraged to track their numbers.
The resulting data can help them understand the effects of their lifestyle choices (big piece of chocolate cake + soda = high blood sugar reading). The information they gather allows them to make better choices and to have more informed conversations with their doctors.
What can you do to make sure that you have a voice in the decisions about what medical treatments you get? If the situation is not an emergency, seven steps you can take are:
- Remember that you have a right to choose your treatment.
- If you don't know what the medical issue is that your doctor plans to treat, ask.
- Find out what the reasonable treatment choices are.
- Collect information about the pros and cons of each treatment.
- Ask about the uncertainties of each choice.
- If you don't understand any of the above, keep asking questions until you do.
- Compare your choices, based on the above. Decide which one has the combination of pros and cons that suits you best, and tell your doctor which treatment approach you prefer.