Photo adapted from image by Eddie (cc)

Making Health Care Decisions With Your Provider

By OBOS Navigating Health Care Contributors | October 15, 2011

Discussing medical problems with a health care provider can be enormously satisfying or frustrating, or somewhere in between. When your health care provider has looked thoroughly at your health history and current symptoms, and you both discuss your values, priorities and concerns, your provider ideally will engage with you in shared decision making and help you make the best choice for you.

One woman recalls how her doctor supported her decision to give her body time to complete a miscarriage on its own:

When we couldn’t find the heartbeat at my 10-week prenatal appointment, I had an ultrasound and found out that I had miscarried. My doctor offered me medication or a D&C to complete the miscarriage, and also told me that I could wait and see if my body would do it on its own.

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I asked for a day or two to think about it and she told me to take my time. I read up on the pros and cons of each option and talked to my friend who was a midwife. I had had my son at home naturally and I really felt that I wanted to complete this pregnancy naturally, too, so I decided to wait.

But after two more weeks, still nothing had happened. By then the risks seemed to be increasing and I was having a difficult time emotionally being in this state of limbo. I decided on the D&C at that point. I think it would have been the wrong choice for me right after I found out I miscarried, but in the end it was the right one.

If you receive care at an academic medical center (hospitals and clinics attached to a medical school), you can use the American Medical Student Association PharmFree Scorecard to look up information about the center’s conflict of interest policies and industry relationships.

While there is much they can provide, doctors and other health care providers may be constrained by such factors as:

  • Financial incentives built into the system that reward the use of procedures and prescriptions over talk time and preventive care
  • Pressures or more subtle influence from drug company representatives to recommend certain medications or devices over others that may be more appropriate
  • “Standards of care” that have been shown to be the most effective for the most people but still may not be appropriate or desirable for certain individuals
  • Lack of time to keep up with all of the latest research or the skills necessary to evaluate research and tailor treatment to individual patient situations
  • Inability to recommend certain testing or preventive care if insurance won’t cover it
  • Fear of a lawsuit resulting from a missed diagnosis or a bad outcome, which can drive hospitals and providers to overuse tests and treatments
  • A mistrust of patients’ abilities to understand or make good use of complex information
  • Sexism, racism, homophobia, and class bias as a result of their training or upbringing
  • Lack of knowledge or negative attitudes toward prevention, self-care, less invasive procedures, non-medical alternatives, and complementary and alternative medicine

It is common to want to trust doctors or other health care providers completely and always accept their advice. While this can feel reassuring, you may ultimately receive better care by becoming more informed, asking more questions, and treating the relationship as a partnership with shared decision making.

Changing our relationships to care can require courage in the face of uncertainty and may not always be welcomed by providers, but it is a good step in obtaining the care that is most appropriate for each of us.

Another woman writes:

My son was only seven weeks old and breastfeeding heartily when I developed what I thought was just a really bad clogged duct. After two days of intense pain, my ob‑gyn performed an ultrasound and found an abscess. She very sympathetically told me I needed surgery and would have to stop breastfeeding immediately. She prescribed medication to dry up my milk supply and scheduled the surgery for the next day.

I was devastated by the idea of stopping breastfeeding. I called my friend, a pediatric nurse practitioner and lactation consultant, for sympathy, and she mentioned that she had heard of instances where a woman continued breastfeeding during and after the surgery. When my ob‑gyn called that night to check in, I asked if this was possible. She told me that it’s rarely done, because the risk of the incision becoming infected is high, but she listened when I expressed how important it was to me to continue nursing. In the end we agreed to try, because I felt willing to take the risk.

The recovery was pretty intense—in order for the milk not to cause an infection, the incision had to heal from the deepest part outward. A home nurse came twice a day to clean out and repack the wound to keep it from closing up, and each time she did so, milk would spray out from deep inside my breast! But my breast healed relatively quickly—and two years later my son is still happily nursing.

For more information on making health care decisions in collaboration with your provider, view this article and video on shared decision making from Informed Medical Decisions Foundation, and a list of recommended resources.