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"Both you and the medical professional you work with have something important to contribute. The doctor is the medical expert, but you are the expert on your body and condition...."
David Sobel, MD, Director of Patient Education, Kaiser Permanente, Northern California

If you or someone you know has been diagnosed with heart disease, you are not alone. Coronary Artery Disease is the most common chronic disease in America. It is a complex disease process that is still not thoroughly understood. There are a range of theories as to its cause and a variety of approaches to treatment. There is no cure but, in the last decade, effective treatments have become widely available that allow many patients to manage the disease, eliminate symptoms and even sometimes reverse progression of arteriosclerosis.


Angioplasty inventor, Dr. Gruentzig, with patient

Because this is a complex disease that is affected by lifestyle choices, stress and other factors, active participation of the patient in managing his/her own health can have a profound impact. Your choices and actions as a patient can be essential to your recovery; this is an opportunity for patient and physician to work together as partners.

Your first step as a patient is to establish comfortable, effective communication with your physician. This is not always easy to do. Most of us are used to a traditional doctor-patient relationship where decisions are left to the physician, who is an authority figure and expert.

Certainly, your cardiologist is the medical expert. But you are one of the experts in your own care. Every patient is unique: physiologically, genetically, emotionally, and intellectually. You have vital information about your symptoms, your body, your needs and your preferences.

Doctors are busy and patients often feel they are imposing on the physician by asking questions. In some cardiology practices, a nurse educator or other professional will meet with you to answer many of your questions. When you talk with the cardiologist or nurse educator you may be worried about your condition or nervous about procedures. You may be concerned about bothering the doctor or sounding stupid. But it's your heart and you're the one undergoing treatment -- the doctor is there to assist you.

There are a number of tools you can use to facilitate effective communication so that you understand, choose and receive the best possible health care.

1) Prepare in advance
Doctors are usually on a very tight schedule. Sit down before your appointment and make a list of concerns, symptoms and/or questions. Think about your symptoms: when do they occur, how do they start, do they change over time, are they affected by anything you do. Prepare a concise description of your symptoms to share with your physician.

Make a list of brief, specific questions. When you go to your appointment bring along any tests you may have had and be prepared to report on any treatment that has been given in the past.

2) Research
If you have been diagnosed with heart disease, seek out resources like this web site. Learn appropriate medical terminology and a bit about standard treatments. You'll feel better equipped to ask questions.

3) Bring a support person along
It can help to have a second set of ears, especially when you are feeling anxious, so it may be a good idea to bring a spouse, relative or good friend to your appointment. It can also be helpful to tape-record the conversion to review later -- you might bring a recorder and ask if your health provider is comfortable with your taping the session to help you remember. It's difficult to absorb a lot of information in a short time, especially when under stress: a recent study showed that most patients forget as much as 80 percent of what their doctors tell them once they leave the office.(source: Journal of the Royal Society of Medicine, May 2003)

4) Speak up
Mention your most important concerns at the beginning of the visit. Ask the doctor to explain what you don't understand. Don't hesitate to ask for clarification if you are confused. The doctor might be able to recommend additional reading or schedule a visit with a health educator.

5) Repeat
It can be helpful to summarize briefly the key points from your discussion -- your understanding of the diagnosis, prognosis, treatment options, etc. This way the doctor can clarify any misunderstanding.

6) Make a follow-up plan
Be clear what the next step is. Make sure a plan is in place to get test results and proceed with whatever decisions need to be made.

Seeking a second opinion -- Asking for a second opinion is a routine and acceptable request. If you feel you would like confirmation, it can be useful to present the issue in terms of your needs: "I would like to gather as much information as possible in order to make an educated decision. I'm not totally comfortable with this treatment. I think it would help me to get another opinion. Can you suggest someone I could consult?"

Ultimately, you are the healthcare consumer. The more educated you are, the more choices you will have. If your physician does not offer treatment that you feel might be right for you, it is your prerogative to seek out alternatives. In medicine there is often no one right answer. Try to partner with your doctor to examine your options and determine the approach to treatment that will meet your particular needs.

Before making your own list of questions we recommend you read the FAQ's on this site and review some of the articles, particularly Angioplasty 101. These materials should answer some of your concerns.

We also have compiled a list of specific questions you might ask your cardiologist or health educator. You probably won't have time in one session to bring up all of your concerns, but select some questions of particular importance to you.

 

"An informed patient is a patient who not only understands what is being done to him or her, but is one who can and should participate in the decision-making process. I mean not everything we do as physicians is cut and dried. There are risks and benefits in many of the decisions we make and I think most physicians relish the opportunity to have an informed patient participate in that decision-making process.".
-- Dr. Gregg W. Stone,
Columbia University Medical Center, New York

"When I first started here, almost 25 years ago, it was, you know, respect the doctor. Don't ask him questions. He knows what's right. And that whole process has changed. And that's the right thing. It's an informational age. It's appropriate for patients to know what's going on, and I don't expect patients to be able to be their own physician, but they can ask serious and reasonable questions -- and they demand and should get reasonable answers."
-- Dr. Stephen J. Green,
North Shore
University Hospital,
Manhasset, New York


related stories:

• What's a Patient To Do?

• Angioplasty 101



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