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Goldilocks Medical Care: Not Too Little, Not Too Much


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In my last two blog posts, I discussed the harms of a new epidemic: too much medical care. We also don't want the opposite, not enough care. In fact, much of the driving force leading to overdiagnosis and overtreatment is a fear of rationing.

So what can you do to ensure that you obtain just the right amount of care?

It isn't easy — if it were, if there were an algorithm that would give us the answer, then we wouldn't have the Goldilocks problem: Is it too little? Too much?

Here are five suggestions that may help:

First and foremost, work in partnership with your doctor. The most critical key to getting good medical care is a trusting relationship between you and your doctor. This is not to say you should never question your doctor, but rather, develop a relationship of mutual respect such that you are the expert when it comes to your body, and the doctor is the expert when it comes to medicine.

Second, make sure your doctor listens. Study after study shows that the patient history will reveal the diagnosis in 80% of the cases, without the need for any tests or further interventions. If your doctor orders tests instead of listening to your story, that could lead to unnecessary testing and potential misdiagnoses. You can help prevent this by telling a good story and making sure it's heard.

Third, ask about your diagnosis. Understanding what illness you have is key to figuring out what type of treatment should follow. Before you get any tests done, ask your doctor what he thinks you might have. This gives you some idea of what tests may be necessary and also focuses your doctor to remember the important tests and have a justification for tests ordered.

Fourth, ask about every test done. Every single test has risks, so make sure you understand why each test is done. Ask about the risks. Ask about how it would change your treatment recommendations: What happens if the test is negative? What happens if it's positive? And, importantly, what happens if no test is done at all? This helps you gauge how urgent (and also how necessary) a particular test is at this point in time.

Fifth, do your own research. This is particularly true when it comes to treatments. Look on the Internet and ask your friends and family. Be aware that not all information is equally credible, but at least this helps you formulate questions to ask your doctor. It might also help to do some research on your doctor and see if she has conflicts of interest that you may not be aware of — information about drug company affiliations, for example, can be found online. Write down your questions, and ask them.

None of these suggestions are foolproof, but these five steps can help begin the process for you and your doctor to work together to identify the right tests and treatments for you. If you have other thoughts or ideas that have worked for you, please share them in the comments below.

This post was originally published on Dr. Wen's blog, The Doctor Is Listening, on September 29, 2013.

More Blog Posts by Leana Wen

author bio

Leana S. Wen, M.D., is an attending emergency physician and Director of Patient-Centered Care Research at George Washington University. She is the author of the critically-acclaimed bookWhen Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests. For more information, visit her blog The Doctor is Listening, check out her website or follow her on twitter @DrLeanaWen.

Tags for this article:
Patient Engagement   Communicate with your Doctors   Participate in your Treatment   Inside Healthcare  

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