Your health care decisions: don’t worry your pretty little head over them

by Carolyn Thomas     @HeartSisters

My mother, like many women of her generation, would never dream of telling her doctor that she wants a second medical opinion, even if she suspected that her doctor’s treatment or advice was lacking. This means that, if he were negligent or incompetent or even downright dangerous – which he’s not, by the way –  my mother would rather die than get a second opinion. To ask for one would be rude and insulting to her physician, and that just would never happen.  Whatever her doctor says  goes unquestioned. He is the boss of her health care.

She’s not alone. Many patients choose to simply defer to their physicians, even when that physician is not providing comprehensive information about diagnosis or treatment options. As orthopedic surgeon Dr. Howard Luks described some of his colleagues:

“Time is short for doctors, they often have biases, and many assume patients don’t want the burden of overwhelming information.”

Before my own heart attack, I could have been one of those patients, too. When my doctor ordered lab tests for me, for example, I figured that if the results were bad, I would be phoned.  When I was prescribed drugs or procedures, I figured these were necessary – or my all-knowing physician wouldn’t have mentioned them to me. Otherwise, I was much too busy to think much about my medical decisions.

And now when I ask the women in my heart health audiences to raise their hands if they know their blood pressure numbers, it’s common to see at least 1/3 of the group who have absolutely no clue.  And when I ask them if they know their cholesterol numbers, the awareness level is even worse.

A survey of women over 40 done by The Federation of Medical Women of Canada (called the LIPSTICK Survey) reported that women spend more time thinking about their weight than they do about their hearts. Only 10 per cent of women surveyed, for example, knew their personal cardiac risk factors, versus 64 per cent who know how much they weighed in high school.

In fact, many people can’t answer even basic questions about their illnesses, according to research from the Foundation for Informed Medical Decision Making, a non-profit patient advocacy group.  

For example, a recent survey of patients conducted by the University of Michigan found that fewer than one in five was even asked by their physician about their preferences for medical care. Fewer than 50 per cent knew detailed information about their care that a truly informed patient would understand prior to making a treatment decision. The survey also found that physicians often neglected to tell their patients about the potential disadvantages of treatments or tests that they recommended.

Another study published in the journal Annals of Internal Medicine suggests that heart patients believe that coronary stents have far greater benefits than they actually do. The research found that over 80% of heart patients studied who had undergone balloon angioplasty with stainless steel stents implanted in their blocked coronary arteries believed that the procedure would cut their odds of having a future heart attack. But about the same proportion of the cardiologists who had either referred these patients for angioplasty or actually performed the procedures insisted to researchers that they had told their patients that stents would do nothing more than simply relieve chest pain.

Annette O’Connor, a researcher at the University of Ottawa who has long studied how best to help patients make informed decisions, adds:

 “A patient may think a treatment is going to provide a cure, when it might only lessen symptoms, for example, or that the risks are more or less serious than they actually are.”

At the opposite end of this knowledge-seeking spectrum are the ‘e-patients’ or ‘medical Googlers’, patients who are keenly aware of the importance of being informed participants in their own health care.

Doctors may be experts about the field of medicine, but you are the expert about YOU.

If your doctor says: “This is the test. This is the drug. This is the treatment.” – be sure to ask:

“What other options or consequences should I know about before we decide?”

You may need more time or more information before you’re able to decide.

And while doctor-bashing seems to be a national pastime for some people, when will patients start acting like grownups when it comes to being responsible for knowing about their own health? 

A Colorado study, for example, showed that the hospitalized patients surveyed (54 per cent female) were often clueless when asked about their medications, with almost all of them unable to name all their medications and many leaving out as many as a half dozen of the drugs they had been prescribed.

Every patient needs to be an informed partner in every health care decision, not just a passive, willing victim.

And there can be profound safety consequences for patients who are not well informed. Misunderstanding technical aspects of treatment or the relative risks and benefits of alternative options may mean that patients choose treatments with a greater risk of adverse consequences than they might otherwise have chosen, according to the Foundation for Informed Medical Decision Making:

“We believe that without adequate knowledge of the risks and benefits associated with all treatment options, patients may be exposed to risks or experience harm that they would choose to avoid if only they were informed.”

The Foundation’s website gives real-life examples of medical decisions that informed patients have made, including patients who:

  • decided not to have bypass surgery for coronary heart disease
  • made a decision about how diabetes would be managed
  • decided not to have repeat surgery for a back condition
  • chose mastectomy over lumpectomy for early stage breast cancer

Patients are not alone when it comes to making difficult decisions like these, however. Did you know that there are even tools to help patients make hard decisions like these?

For example, the Ottawa Personal Decision Guide from the Ottawa Hospital Research Institute, an affiliate of the University of Ottawa, is a patient decision aid that can help you make better decisions by providing information about options and outcomes, and also by clarifying your personal values.

Patient decision aids are designed to complement, rather than replace, counseling from your physician on just about any health or social decision.

The Foundation for Informed Medical Decision Making insists that it is the ethical right of all patients to be informed and involved in all health care decisions:

“We believe that patients should have the opportunity to learn about all relevant treatment options, and to engage in an active shared decision-making process in which they communicate their values and preferences to their health care providers.”

NOTE FROM CAROLYN:   I wrote more about the importance of patient participation in health decisions after a cardiac diagnosis in my book, A Woman’s Guide to Living with Heart Disease . You can ask for it at your local bookshop, or order it online (paperback, hardcover or e-book) at Amazon – or order it directly from my publisher, Johns Hopkins University Press (use the JHUPress code HTWN to save 30% off the cover price).

See also:

Say What? Do Patients Really Hear What Doctors Tell Them?

What Doctors Really Think About Women Who Are Medical Googlers

Reliable Health Info From the ‘Medically Unqualified’?

How a Heart Attack Turned Me into an “Information Flâneuse”

Are You the Quarterback of your Own Heart Health Team?




6 thoughts on “Your health care decisions: don’t worry your pretty little head over them

  1. Just want to say your article on health care decisions is clear and striking. Well with your permission allow me to subscribe rss feed to keep up to date with forthcoming post. Thanks a million and please keep up the accomplished work. Excuse my poor English. English is not my mother tongue.


  2. You might assume that this kind of attitude is mainly found in elderly patients, but there are so many of us younger women who seem to have the same lack of interest or awareness in our own health. You have inspired me to get down to business, keep track of my own test result numbers and exactly what’s going on inside my own body.

    THANKS for this!


  3. Good advice here. We ar so used to treating the “doctor as god” that many women give up all say in their own health care in favor of whatever the doctor says. We can’t afford to be shrinking violets when it comes to our health.

    Thanks – love your website.


  4. Hello and thank you for this most informative essay. I especially appreciated the link to the Foundation for Informed Medical Decision-Making, which I had never heard of, but now I think should be required reading for both physicians and patients.

    We need to be ‘grown up’, as you say, when it comes to taking care of health. Our bodies are our most valuable assets in life – OF COURSE we need to be well-informed and involved team players in all of our health care decisions.

    Well done – this is an important message, nicely presented. You have a new subscriber here for sure!!!


  5. Hi Carolyn,
    Thanks for drawing attention to the issue of women’s heart health and encouraging people to get a second opinion when they feel doubt about their doctor’s diagnosis. Would you be interested in doing an interview with us for heart health awareness month?

    Hope to hear from you.


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