You rely on your doctor to give you sound advice about your health. After all, he or she has gone through extensive training and likely has lots of experience treating people with conditions just like yours. But what if you don’t agree with the wisdom your doctor has to offer?
“That depends. Do you disagree with the doctor’s diagnosis or the doctor’s recommended treatment plan?” asks Dr. Michael Perskin a geriatrician at NYU Langone Health.
The Diagnosis
Doctors make diagnoses by considering many aspects of health, including a physical exam and factors such as:
— Symptoms
— Medical history (your age, gender, weight and past health conditions)
— Risk factors for disease (such as a high cholesterol, a risk factor for heart disease)
— Family medical history (for example, any links to cancer or diabetes)
— Medical test results
— Medical imaging
The doctor is an expert at interpreting the information and figuring out what it means.
Why would you disagree? It could be a gut feeling. Maybe you just know the heart palpitations you’re experiencing aren’t linked to stress, as your doctor has suggested. Or maybe you have a symptom like fatigue that could have many explanations, such as a sleep disorder, an underactive thyroid or depression.
[See: 10 Questions Doctors Wish Their Patients Would Ask.]
Perskin says patients often disagree with their doctor because they’ve made a self-diagnosis after reading something on the internet. “They come in with conclusions, not symptoms,” he explains.
Sometimes those endless Google searches can actually be a good thing for doctors. “That might be very helpful if I’m not an expert on a particular subject, like a rare heart condition. I’m not a cardiologist, so I’ll listen carefully,” Perskin explains.
It’s not helpful, Perskin notes, when patients take information from the internet out of context and want diagnostic tests that are inappropriate. “That’s when things get tricky. Now you’re negotiating over what should be done,” he says.
Perskin frequently hears from patients who want blood tests for Lyme disease because of news reports about ticks carrying the disease or patients who want MRIs because they have a little lower back pain.
“This creates tension in the relationship. And if the patient is negotiating with you, then in a sense they’re questioning your authority or ability to help them,” Perskin says. “It’s difficult.”
It can also be risky for health. For example: “A patient might insist on a CT scan of the belly because they think there’s something wrong with their gallbladder. But usually a sonogram is more accurate,” Perskin says.
[See: Who’s Who at Your Doctor’s Office.]
The Treatment
Doctors recommend treatments based on symptoms, conditions and health guidelines. But you may disagree with a recommended course of action because:
— You’ve heard about a medication’s side effects. For example, antidepressants are associated with sexual dysfunction. Long-term use of proton pump inhibitors for heartburn is associated with low levels of magnesium and vitamin B12 and an increased risk for hip fractures and potentially life-threatening infections such as pneumonia and Clostridium difficile, a digestive system infection.
— You don’t want to endure the treatment. For example, the standard treatment for obstructive sleep apnea (pauses in sleep caused by a blocked airway) is continuous positive airway pressure, or CPAP, which involves wearing a device that sends a constant flow of air down your throat while you sleep. A lot of patients feel it’s uncomfortable to wear the device all night.
— You don’t believe you need it. For example, you feel you can avoid knee replacement surgery by doing physical therapy and getting knee injections.
— You’re worried about complications. Maybe your doctor recommends that an enlarged prostate should be treated with surgery, which is associated with side effects such as incontinence and sexual dysfunction.
— You think another treatment would be more effective or safer. Perhaps your doctor has recommended proton pump inhibitors to treat heartburn, but you’d like to try to manage the condition with diet first.
Disagreeing with your doctor about treatment — and not following the plan — can be risky. If you have high blood pressure, for example, and don’t take the medication your doctor prescribes, that can lead to even higher blood pressure and an increased risk for a stroke. The same is true if you don’t use CPAP or another means of treatment (like a special mouth piece) for obstructive sleep apnea, which also increases the risk for stroke.
Finding a Compromise
Perskin says you can avoid a disagreement with your doctor by collaborating from the start. That means being upfront with your doctor, sharing your concerns and asking lots of questions. You can do this by:
— Writing down your symptoms and bringing a list to your doctor’s appointment. “Think about what makes it better or worse and what time of day it’s occurring,” Perskin advises.
— Keeping an open mind and leaving conclusions at home. Even if you feel the symptoms point toward one particular condition, remain flexible and see what the expert thinks first.
— Bringing a printout of health information from the internet that you want to share. Make sure it’s from a reliable source. “If it’s not a peer-reviewed medical study or the result of clinical guidelines, it’s not an appropriate resource,” Perskin says.
[Read: 12 Signs You Should Fire Your Doctor.]
The Second Opinion
If you still disagree with your doctor, you can always seek another doctor’s advice. “A good physician simply does not resent a patient wanting to get a second opinion,” says Dr. Steven Nissen, a cardiologist and chairman of the department of cardiovascular medicine at Cleveland Clinic.
Perskin says that getting a second opinion often confirms an initial diagnosis. “That’s good because you want the patient to be comfortable with the diagnosis and treatment plan. If they hear multiple voices in agreement, they’ll say, ‘Gee, I ought to listen to them.'”
But it doesn’t always work that way, both doctors point out. “When I see people for second opinions, it’s about 50-50 whether I agree with the treatment. That verifies that the patient’s concerns were legitimate,” Nissen says.
Getting conflicting opinions can be challenging for the patient. “At this stage in my career, most of what I see are second, third or even fourth opinions — people who’ve struggled and gotten contradictory advice,” Nissen says. He sometimes calls a patient’s doctor to talk about the differences in treatment approaches.
But ultimately, your treatment is your decision.
So how do you break it to your doctor that you want outside advice? “Be straight up,” Nissen says “Look someone in the eye and say, ‘I’ve greatly appreciated your care over the years, but this is a big decision and I’m not sure about it. Is there someone you can recommend who can see me to give me an independent opinion?'”
What if you still can’t agree or the doctor won’t cooperate? “The question is — is it a big point or a small point you disagree on, and do you want to continue with the doctor?” Perskin asks.
“Health care is not here to serve the physician,” Nissen says. “It’s here to serve the patient.”
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What to Do When You Disagree With Your Doctor originally appeared on usnews.com
