Study after study has found that the use of certain treatments varies widely—from region to region, state to state, and city to city. But there are even large differences in the use of treatments within a single health plan or hospital, or by a single doctor.

That is why it is very important to work closely with your doctor when treatment decisions need to be made. Make sure your doctor knows your questions, concerns, and preferences. Ask your doctor if the treatments he or she recommends are based on the latest scientific evidence.

When choosing a treatment, make sure you understand:

1. What your diagnosis is.
2. Whether treatment is really needed at this time.
3. What your treatment options are.
4. Whether the treatment options are based on the latest scientific evidence.
5. The benefits and risks of each treatment.
6. The cost of each treatment.
7. If you understand and feel comfortable with your treatment plan, you are more likely to do your part to make it work. Research shows that people who are actively involved in their own health care tend to get better results.

The first step in getting the right treatment is to tell your doctor what's going on. Below is a list of information that may be important to your care.

Your symptoms

1. When they first started
2. When they occur
3. Are they getting better? Worse? What makes them better? Worse? Are they affecting eating, sleeping, or other activities? How?

Medicines you take

Before a treatment decision is made, your doctor needs to make a diagnosis. Medical tests are an important way to help your doctor learn about the problem. It is important to make sure that any tests your doctor suggests are appropriate for you.

Medical Tests

Doctors order blood tests, x-rays, and other tests to help diagnose medical problems. Perhaps you do not know why you need a particular test or you don't understand how it will help you. Here are some questions to ask:

•  How is the test done?
•  What kind of information will the test provide?
•  Is this test the only way to find out that information?
•  What are the benefits and risks of having this test?
•  How accurate is the test?
•  What do I need to do to prepare for the test? (What you do or don't do may affect the accuracy of the test results.)
•  Will the test be uncomfortable?
•  How long will it take to get the results, and how will I get them?
•  What's the next step after the test?

For tests your doctor sends to a lab, ask which lab he or she uses, and why. You may want to know that the doctor chooses a certain lab because he or she has business ties to it. Or, the health plan may require that the tests go there.

Check to see if the lab is accredited by a group such as the College of American Pathologists (800-323-4040) or The Joint Commission (telephone 630-792-5800; Web site http://www.jointcommission.org ).

If you need a mammogram, make sure the facility is approved by the Food and Drug Administration. You can find out by checking the certificate in the facility. Or, call 800-4-CANCER 9:00 a.m.-4:30 p.m. EST to find out the names and locations of certified facilities near you.

Do not assume that no news is good news. If you do not hear from your doctor, call to get your test results.

If you and your doctor think the test results may not be right, ask your doctor about having the test done again.

Getting the Diagnosis

When your doctor has decided what your problem is, he or she will give you a diagnosis. But you should know that reaching a diagnosis can be hard. Sometimes it can take a long time. And sometimes it is hard to find out exactly what is wrong.

Ask your doctor to explain what you have and how it might affect you and your family.

What is the diagnosis?

What is my prognosis (outlook for the future)?
What changes, if any, will I need to make in my daily life?
Is there a chance that someone else in my family might get the same condition?
Will I need special help at home for my condition? If so, what type of help?

Ask for materials you can take home. You also might want to find out if there are any support groups for people with your condition.

"Self-help" groups offer support to people with disabilities, cancer, and many other health problems. The groups are made up of people who have "been there" and who share experiences and information.

Call the American Self-Help Clearinghouse for information on national groups. It also can refer you to any State or local self-help clearinghouses in your area. If you want to start your own self-help group, the Clearinghouse has information to help you at its Web site: http://www.mentalhelp.net/selfhelp/ .

The next step is for you and your doctor to look at your treatment options. Your doctor may recommend one or more of the following:

Behavior change (for example: eating a healthier diet, getting more exercise, quitting smoking).
Prescription medicine.
Non-prescription ("over-the-counter") medicines.
Surgery.
Rehabilitation (such as physical therapy).
Other treatments (for example, chiropractic services, massage, or acupuncture).
"Watchful waiting." (You and your doctor keep track of your symptoms and watch for any changes. If there are changes, then treatment might be the next step.)
Not all treatments have been proven by research studies to work-or to be the best treatment for what you have. "Clinical practice guidelines" can help doctors and patients make the right treatment choices for some conditions. Some of these guidelines are based on scientific evidence about which treatments work for certain conditions and which do not. Ask your doctor if there are evidence-based guidelines on treatments for your condition.

Ask about any books or special materials that can help you decide which treatment is best for you. For example, "shared decisionmaking programs" use video, audio, and computer graphics to help patients make decisions based on science and on their own values and preferences. Self-help groups, patient organizations (such as the American Cancer Society and the American Diabetes Association), the Internet, and your library are other sources of information.

All treatments have benefits and risks. To learn more about them you may want to ask your doctor:

•  What is the recommended treatment? Are there other choices?
•  What are the chances the treatment will work?
•  What are the expected results? When will I see them?
•  What are the risks?
•  What are the benefits?
•  Are there any side effects? (Most treatments have them.) What can be done about them?
•  Is the treatment painful? How can the pain be controlled?
•  What happens if I choose to have no treatment at all?
•  How much does the treatment cost? Will my health plan pay?

Once you have the answers to these questions, you might want to make a chart of "Benefits and Risks" or "Pros and Cons" to help you decide if the treatment is right for you. Here is a sample chart:

Benefits (Pros)

•  Treatment has worked well for others with my condition.
•  The medicine only needs to be taken once a day.
•  No major side effects are expected.

Risks (Cons)

•  Some minor side effects (rash, stomach upset) could be troubling.
•  The medicine is costly.

•  Ask about anything you do not understand.
•  Follow the doctor's directions. If you have a problem with the directions, tell the doctor—the sooner, the better.
•  If you have made any changes in the treatment plan, tell the doctor.
•  If you feel worse, have new symptoms, or have side effects from the treatment, call your doctor.

Some surgery has to be done right away. But most surgery is not an emergency. That means you have time to talk with your doctor and decide what is best for you.

No surgery, not even minor surgery, is risk-free. To decide if a procedure is right for you, learn about it and its possible benefits and risks. Research shows that patients who know the facts about surgery and other treatments can better work with their doctors to make decisions based on science and on what the patient prefers. The result? A more satisfied patient.

Here are some questions you may want to ask your doctor or surgeon:

1. Do I really need this surgery? Is there some other way to treat my condition?
2. What will happen if I wait until later to have surgery? Or never have it at all?
3. How often does this type of surgery help my kind of problem? How much does it help?
4. Where will the surgery be performed?
5. Does the surgeon, hospital, or surgery center have a lot of experience with this kind of procedure?
6. Is the surgeon experienced and qualified to perform the surgery?
7. What complications or side effects might I have?
8. What kind of pain might I have? How will it be treated?
9. How long will it take me to recover? Will I need help at home? What kind of help?
10. How much does the surgery cost?
11. Will my health plan pay?

A "second opinion" is when another doctor gives his or her views about what you have and how it should be treated. A second opinion can help you decide whether the surgery is right for you at this time. Your doctor and surgeon should welcome your request for a second opinion. Your health plan may even require one for some types of surgery.

You can ask your doctor, health plan, a local medical school, or local medical society for help in finding someone to give you a second opinion. But first check to see if your health plan covers second opinions.

Today more and more surgeries are done in places other than hospitals. These are "in and out" (ambulatory) surgery centers, where you may stay for a few hours or up to one night. If you plan to have surgery at such a center, call your health plan or visit the center to find out:

If your health plan will cover your care there.
If it is licensed. Then check to see if it is accredited by a group such as The Joint Commission (telephone 630-792-5800; Web site http://www.jointcommission.org) or the Accreditation Association for Ambulatory Healthcare (847-853-6060). The accreditation certificate should be posted in the facility.
How well trained and experienced the center's health care professionals are.
If the center is affiliated with a hospital. If it is not, find out how the center will handle any emergency that could happen during your visit.

Planning for your discharge should start when you arrive at the hospital. Patients who understand and follow directions about follow-up care are more likely to heal faster and less likely to require re-hospitalization. Participate in all decisions about your treatment. You are the center of the health care team.

While a nurse, social worker, or discharge planners are often involved in helping patients plan for follow-up care, there are many things that patients and their families can do that will make a real difference. Full recovery is dependent upon continuing to get needed support and services.

When patients play a more active role in the discharge process, they experience better health outcomes and they are also less likely to need to return to the hospital.

Find out about your condition – This includes knowing how soon you should feel better; setting reasonable expectations as to when you can resume everyday activities such as walking or preparing meals; knowing warning signs and symptoms to watch for; and enlisting the help of a family member or friend in your discharge from the hospital, as well as to look in on you once you leave the hospital if needed.

Find out about new medicines – It is important to request written directions about new medicines, possible side effects and how to take them. You should ask any questions you have before leaving the hospital.  It is also important to find out whether other medicines, vitamins and herbs that you already take could interfere with the new drugs and whether there are any specific foods or drinks that you should avoid. 

Find out about follow-up care –

•  Ask for written directions about taking care of your wounds, using special equipment, or doing any required exercises.
•  Will you need further tests after you leave the hospital and whom you should follow up with to get the results?
•  Do you need follow-up visits to your physician or to the hospital?
•  Do you need help to make transportation arrangements for these visits?
•  Do you need help to determine whether home care services will be necessary to support your recovery.

Sources of Additional Information

Be Informed: Questions to Ask Your Doctor Before You Have Surgery, A list and in-depth discussion. 12 pages. Free. Web site: http://www.ahrq.gov/consumer/surgery/surgery.htm

The National Guideline Clearinghouse™ makes clinical practice guidelines available to the public via the World Wide Web. The Clearinghouse was developed by AHCPR, the American Medical Association, and the American Association of Health Plans. Web site: http://www.guideline.gov

FDA Guide to Choosing Medical Treatments

Designed to help consumers avoid fraud and deception when choosing medical treatment. Use publication number (Reprint 95-1223) when ordering. 6 pages. Free.

Food and Drug Administration
Office of Consumer Inquiries: HFE-88
5600 Fishers Lane
Rockville, MD 20857
1-888-463-6332
Web site: http://www.fda.gov

Taking Part in Clinical Trials: What Cancer Patients Need to Know
This booklet by the National Cancer Institute describes how clinical trials work, and their possible benefits and drawbacks. 18 pages. Free.
Cancer Information Service:
1-800-4-CANCER (1-800-422-6237)
9 a.m.-4:30p.m. EST Also available on the Clinical Trials Web site:
http://cancertrials.nci.nih.gov

The American College of Surgeons
Office of Public Information
633 N. Saint Clair St.
Chicago IL 60611
312-202-5391
http://www.facs.org

Information about women's health, men's health, and treatments for arthritis, diabetes, and other conditions is available from the Health Pages' online magazine.
http://www.thehealthpages.com

healthfinder®
Provides a gateway to reliable consumer health information from the Federal Government and other organizations.
Web site: http://www.healthfinder.gov