The most important question a patient can ask is, “What’s the evidence this treatment is going to work?”

One of the most powerful tools you have as a patient is a question. A well-asked question can help you determine if your doctor’s advice is on target for your needs. It also can be essential for avoiding inappropriate care—care that can waste your time and money or worse, may harm instead of heal.

In fact, questioning your doctor’s recommendation for back surgery, an MRI test, or a prescription medication before treatment begins can be just as sensible as questioning the advice of a car mechanic before repairs begin.

A Matter of Preference
Asking questions doesn’t mean lacking trust—it’s necessary to trust your doctor. It just means you’re looking out for your own best interests when seeking health care for you or your family. In reality, a fair number of the treatments prescribed these days are open for debate.

“Only about 10 percent of all medical care is really evidence-based,” explains Alan Zelicoff, M.D., author of More Harm Than Good: What Your Doctor May Not Tell You About Common Treatments and Procedures.

Evidence-based treatment is care that’s highly recommended under a given set of circumstances, based on a solid body of research.

For example, there’s plenty of evidence that mammograms are a good choice for women ages 50 and older. There’s strong research, too, supporting the use of aspirin and beta-blocker medication right after a heart attack to reduce the risk for heart tissue damage or death.

“These are things we know make sense and are beneficial, while also being cost-effective,” says Zelicoff.

But what about the other 90 percent of care that’s not backed by clear evidence? You may be surprised to learn that most prescribed treatments are, in the end, determined mainly by your own personal preference, your doctor’s personal preference, or market forces, such as the number of hospital beds or physicians in a given community.

Patients in some parts of the country are up to five times more likely to be hospitalized for certain common medical conditions than patients in other parts of the country, research shows. If all care were based on solid evidence, differences like these wouldn’t exist. More care isn’t necessarily better and actually can sometimes lead to worse outcomes.

After adjusting for variables, patient outcomes are worse in areas where the intensity of care is higher, says Zelicoff.

“Interestingly, patients are far less likely to be hospitalized for treatment when they know the right questions to ask, get the right answers, and use that knowledge to engage with their doctors in shared decision-making,” he says.

Good Questions
In an emergency—such as a serious case of pneumonia, a possible heart attack, or a broken bone—you may need to rely entirely on the immediate good judgment of the experts treating you. But if there’s a cushion of time before treatment begins, there’s time to learn more about your treatment choices.

Therefore, whenever your doctor points you toward specific treatments, good questions to ask include:

• What other options are available?
• What are the possible risks and benefits of each option?
• What would happen if we did nothing?

It’s only when you have these answers that you and your doctor together can make the choice that’s right for you.

Questionable Care
Some medical tests and procedures should come with a red flag attached. It’s not that they’re wrong for every patient; they’re simply questionable for most. For example:

• An MRI screening for back pain. Magnetic resonance imaging is so sensitive, it often reveals suspiciouslooking deformities that pose no health threat.

  Nearly all people as they age have some kind of deformity that will show up in the spine, with or without symptoms, Zelicoff notes.

  The problem is that suspicious MRI results often lead doctors to recommend biopsies or other invasive procedures that could themselves lead to long-term negative effects. If your doctor offers good evidence that you should have an MRI, then the possible benefit may be worth any risks that may result from the procedure.

• Stent insertion for cardiovascular disease. Many cardiologists favor inserting stents in diseased arteries to help keep them open and avoid blockages that could lead to heart attack or stroke. But for now, there’s evidence these inserted stents don’t improve outcomes in many heart patients who have received them, Zelicoff says.

  “Much of medicine depends on the patient’s preference,” he adds. “Unfortunately, many patients undergo treatments without knowing there are other options.”

  The only way to find out about those options, often, is to ask—and asking is up to you.

Weigh Your Treatment Options
As a patient, it’s your right to expect services that are appropriate, respectful, reasonably priced, covered by insurance, safe, and up to date.

As soon as your doctor diagoses the problem, treatment options can be weighed. The Agency for Healthcare Research and Quality recommends you take these steps:

• Make time with your doctor to explore your choices, determine what’s best for you, and make important decisions about your health. This type of careful reflection is especially important if you are diagnosed with cancer or another serious condition.
• Do your homework. Seek information from credible sources that’s based on the latest scientific findings.
• Get support from others. Talk with family, friends, and people who have been through a situation similar to yours. These people can help you cope better and make informed decisions.
• Keep lines of communication open with your doctor. This means not only asking good questions, but also providing full information to your doctor about your symptoms, needs, and preferences.
• Consider getting a second opinion if treatment may be risky or expensive, or if you have any doubts about your care options.
• Work with your doctor to decide on a treatment plan. The better a plan meets your personal needs and preferences, the more likely it is you’ll stick with it— and get the results you want.

Polly Turner spoke with Alan Zelicoff, M.D., author of More Harm Than Good: What Your Doctor May Not Tell You About Common Treatments and Procedures, Amacom, 2008, $24.

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