"Do I really need this test?"
"Doctors often adhere to a better-safe-than-sorry philosophy, ordering tests just to protect themselves in the event of a lawsuit," says David Sandmire, M.D., coauthor of Medical Tests That Can Save Your Life. A full 16 percent of prostate-cancer screenings, for example, are unnecessary, say Harvard researchers. Since 80 percent of PSA results are false positives, thousands of men undergo needless biopsies each year. Another overused procedure: CT scans. The radiation from these tests causes an estimated 5,695 cancer cases a year, say British researchers.
"Where would you send your wife or children?"
Like our tax code and the judicial system, medicine is supposed to treat everyone equally, but it's clear that some people receive better treatment than others. "General practitioners who work within a particular system routinely refer patients to specialists within that health-care system," says Kevin Soden, M.D., coauthor of Special Treatment: How to Get the Same High-Quality Health Care Your Doctor Gets. "However, oftentimes the best surgeon is in a completely different facility on the other side of town, and you can bet that's where your doctor would send his family."
"How many surgeries do you perform each year?"
Nowhere is the saying "practice makes perfect" more applicable than in the operating room. Urologists who perform more than 40 prostatectomies a year, for example, experience 50 percent fewer complications than those who perform fewer than 40. The same goes for hospitals performing more than 200 coronary bypass surgeries a year, according to a report in the journal Circulation. Bottom line: Your health hinges on your surgeon's experience.
"Can I schedule my surgery for the morning?"
Arrive early and you'll get the undivided attention of an alert medical staff. A recent study of 90,000 surgeries by researchers at Duke University found that patients who had operations in the morning were four times less likely to have anesthesia complications—nausea, post-op pain, fluctuating blood pressure—than those who had them in the afternoon.
"If I get sick, will you see me in the hospital?"
In the past 10 years, the number of hospitalists—a new breed of physicians who specialize in inpatient care—has grown from a few hundred to nearly 20,000. "So if you require hospitalization, odds are your primary-care physician won't be at your bedside," says Evan Scott Levine, M.D., author of What Your Doctor Won't (or Can't) Tell You. "You'll be dealing with a new doctor who doesn't know you or your medical history." Make sure your GP makes hospital calls.
"Do you earn bonuses based on performance?"
Before you schedule a surgery, check the hospital's physician reward system. Insurance companies reimburse hospitals based on the type of treatment provided, not the length of your stay. As a result, "Many hospitals pay their physicians bonuses based on how quickly they move patients out the door," says Dr. Levine. "Quality of care is sacrificed in the interest of increasing patient turnover."
"When did you graduate from medical school?"
In an analysis of 62 studies, researchers at Harvard Medical School discovered that doctors who have been out of medical school for more than 20 years were up to 48 percent less likely to stay up-to-date on developments in their fields. They are equally likely to be unaware of current treatment guidelines, such as prescribing aspirin to treat angina (chest pain caused by decreased blood flow to the heart).
"What the hell does that say?"
No doctor would prescribe Zoloft for high cholesterol, but that's what you might end up with if your pharmacist can't read Zocor in your doctor's chicken scratch. Poor penmanship isn't just an old stereotype; it's responsible for up to 61 percent of medication errors and more than 1.5 million patient injuries per year, according to a recent report from the National Academies of Sciences' Institute of Medicine. "If you can't read a prescription, chances are your pharmacist can't either," says Dr. Soden. "Get your doctor to print out the name of the medication."
"Will you remove that wedding ring?"
When scientists at Rush University Medical Center in Chicago, analyzed the hands of 66 nurses, they found that those with wedding rings had 10 times more bacteria than those without. "Bacterial infections are the leading cause of death in American hospitals; about 98,000 people die from them each year," says Dr. Soden. "That means you can contract a secondary infection at the hospital."
"What else can I do to treat my condition?"
Recent studies suggest that diet and exercise are essential for treating and preventing everything from heart attacks to prostate cancer, yet only one in six doctors discusses how to use nutrition to prevent disease, according to a study in the American Journal of Clinical Nutrition. Researchers in Colorado, meanwhile, found that only 28 percent of doctors mention exercise to their patients. Many primary-care physicians work with dietitians and trainers who can help treat patients with lifestyle-influenced health problems, such as type 2 diabetes. So even if your doctor doesn't have answers regarding nutrition and exercise, he likely knows someone who does.
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