When my daughter was 5 months old, she developed a rash on her face. I watched it for a couple of days and noticed it was worsening, so I took her to a family physician in Hadley, Massachusetts.
“What do you think’s wrong?” Dr. Robert Weitzman asked.
I cuddled the baby on my lap, a little taken aback by the question.
“That’s what I came here to ask you,” I said.
He was quiet for a moment.
“I think you know,” Weitzman said.
And he was right. I was pretty sure that the baby had an infection caused by an overgrowth of some type of Staphylococcal bacteria. In other words, a staph infection, I said. He nodded in agreement.
“So, what do you think we should do?” he asked.
That time I burst out laughing.
“Aren’t you supposed to tell me?!” I asked.
“I think you know,” Weitzman said again.
We decided what to do together: Weitzman would write a prescription for oral antibiotics and I would go to the drug store to get a topical antibiotic. I could fill the prescription if I wanted to, just to have medicine on hand if we needed it. In the meantime, he felt comfortable waiting for another 24 to 48 hours, as long as the rash didn’t get angrier or oozier and the baby didn’t spike a fever or start acting lethargic.
“Just keep an eye on it,” Weitzman said.
If the rash worsened, or if my husband and I started to feel more worried, we could always start the treatment.
Shared Decision Making
I was a young mom then, and I didn’t know it at the time, but Weitzman and I had done what medical experts refer to as “shared decision making” (SDM). SDM, according to a team of Canadian researchers in a 2017 article in the medical journal Canadian Family Physician, “is a process whereby clinicians collaboratively help patients reach evidence-informed and value-congruent medical decisions.”Patient-Centered Care Matters
But having such a positive interaction with the doctor may be the exception, not the rule. When compared to patients in other countries, Americans tend to be among the most dissatisfied in the world with the quality of care we receive.At the heart of patient-centered care is an open and mutually respectful relationship with your health care providers. That means finding providers—including medical doctors, nurse practitioners, naturopaths, chiropractors, acupuncturists, homeopaths, and massage therapists—who are willing to listen to your concerns, ask and answer open-ended questions, and talk honestly about the pros and cons of the treatments they recommend.
“I appreciate when my patient is a partner with me in determining treatment strategies,” said Dr. Jeffrey I. Barke, a board-certified primary care physician based in Orange County, California. “I want my patient to push back and challenge and ask questions and not just expect me to do it all.”
Barke said in every aspect of medicine—whether the issue is back pain or treating a fast-growing cancer—there are always several possible treatment strategies.
“It’s important to come up with a strategy together,” Barke said.
However, that isn’t always easy to do.
How to Disagree (Politely) With Your Doctor
So how do you disagree respectfully to find the best way forward?1. Ask Open-Ended Questions
“Disagreement for disagreement’s sake is unproductive and hardly worth the effort,” said Dr. Rick Kirschner, bestselling co-author of “Dealing With People You Can’t Stand: How to Be Your Best With People at their Worst” and past president of the Naturopathic Medicine Institute. “But if getting support for a plan of action or introducing new information into a seemingly closed mind is the goal, one of the best ways to disagree is by asking information-rich, open-ended questions.”To do that without openly disagreeing, Kirschner suggested asking questions as if you are running information by your doctor to get their response.
“One question is not enough, so be prepared to ask follow-up questions, with the end goal of getting either a ‘hmm’ or ‘I don’t know’ response,” he said.
2. Prepare Some Questions in Advance (and Write Down Your Doctor’s Answers)
It’s easy to get tongue-tied when you go to the doctor. Often you’ve had a longer-than-hoped-for wait in the waiting room, the medical assistant may be acting rushed, and when the doctor finally comes in, it often seems as though they’re more interested in checking boxes off on the computer screen than they are in examining you.It’s important to let your doctor know you brought a list of questions. Write or use an app on your phone to record the answers. That way, if there’s something the doctor said that you didn’t understand—or perhaps you didn’t agree with—you can review it later when you’re not being rushed.
England Miano, a holistic health practitioner based in Florida’s Tampa Bay area, works with people who have severe medical issues and are often using both allopathic and more natural, holistic-centered care. Miano recommends asking direct questions.
“Get the information you need,” she said. “Don’t be contrary about their suggestions. But do go back and research what they say.”
Some of the questions you may want to ask include:
Why do you recommend this particular test, treatment, or protocol?
What are the side effects or downsides of doing this particular test, treatment, or protocol?
What kind of problems may arise if I choose not to do this particular test, treatment, or protocol?
What alternatives are you aware of for this particular test, treatment, or protocol?
What kind of patient outcomes have you had with this particular test, treatment, or protocol?
What happened with your patients who said, “No, thank you,” to this particular test, treatment, or protocol?
3. Bring Along a Friend, Loved One, or Patient Advocate
Finding someone to bring with you to your medical appointments may feel overwhelming, especially if you live alone or are widowed. But it’s really important, whenever possible, not to go to the doctor or to the hospital alone. Given current COVID-19 protocols in place in some health systems, you may have to fight to have an advocate by your side. If your doctor is seeing patients via telemedicine and your situation isn’t dire, consider making the appointment by phone or computer.4. Know What Your Doctor Doesn’t Know
Miano reminds her patients that highly skilled medical doctors are often very good at what they do, but they often don’t know much outside their special skill set.“Your surgeon may be excellent, but they also may know nothing about wound-healing and dressing changes or detoxing the anesthesia out of your system,” she said.
“Understand that they’re an expert at what they were taught, but that they were only taught allopathic options. They aren’t going to know that magnesium citrate can help with constipation or that niacin—which is just vitamin B3—is the No. 1 cure for high cholesterol and outscores every pharmaceutical medication ... [or that] high doses can be used to detox from drug addiction and are also a very effective cure for schizophrenia.”
5. Seek a 2nd (or 3rd) Opinion Before Deciding
If you feel that your doctor may not be recommending the best way forward, Barke advised getting a second or even a third opinion when there’s a significant underlying problem.“Get multiple opinions for significant treatment decisions,” Barke said. “I’m not talking if someone has a cold. I’m talking about if you need back surgery or shoulder surgery or you’ve been diagnosed with cancer. Go to at least two different doctors before you decide.”
Dr. Weitzman called in the prescription for the oral antibiotic, and I picked up the bright pink liquid at the pharmacy on the way home from the appointment. But I didn’t need to give it to the baby. Instead, I dabbed a little powdered goldenseal (a plant that has natural antibacterial properties) on the rash.
As the rash was drying out, before it went away for good, some of the skin on her cheeks and chin started to turn brown. It looked disturbingly like the baby had smeared chocolate on her face. But she remained her bubbly curious self the whole time. So there was no need for the medication, and no need to disagree with our doctor, either.
