What to Ask When Your Doctor Prescribes a Drug
9 important questions recommended by the author of "Health Your Self"
Editor’s note: In her excellent new, useful book, “Health Your Self,” health journalist Janice M. Horowitz, explains what really drives your health care and how to take charge. This excerpt arms you with essential questions to ask the next time your physician prescribes a drug.
Our experience of medicine is maddening — and hidden factors are always at play in the background that compromise our care. But when you're in the thick of things, sitting with a doctor and eager to be the good patient, you're likely to nod, agree and go along when your physician says: "Just take these pills each morning."
If your doctor hasn't asked you about what other medications and supplements you are taking, then ask them to ask you.
Instead, you need to perk up, pierce through the curtain that's obscuring what's really going on and start asking questions. When you're asking them, make it clear that you're not trying to be an aggressive patient. Be polite. Doctors are people, too, and will treat you better if you're, well, nice.
9 Questions to Ask About a New Prescription
These nine questions are not always easy to ask, but ask you must. And don't forget to jot down the answers.
How real is the benefit of the drug? As an example, if a medication cuts the risk of an early death by 20%, but your risk is only 10% to begin with, the medication will drop your risk only by two percentage points, bringing your absolute risk down to 8%. That's the number you want to pay attention to. Is it worth taking a medication — cost, potential side effects and all — just to move the needle by two percentage points?
What are the side effects? Once you know, you can consider whether the possibility of enduring them is worth whatever benefit you might see. Same goes for how this drug will interact with anything else you're taking, including supplements. If your doctor hasn't asked you about what other medications and vitamins you are on, then ask them to ask you.
Will this be a "lifer" drug? That's one you'll need to take for years, and usually for the rest of your life, such as blood pressure or cholesterol-lowering medications. If it will be a lifer drug, a red flag should go up.
Explain that you don't want to take any medication for the long-term based wholly on the result of one blood test or another one-time measure of your health. Blood test results vary depending on the time of day the blood is drawn, if you ate beforehand, what you ate and how much sleep you got. Blood pressure readings can vary similarly. Also, MRIs, CT scans and other imaging tests can be interpreted differently depending on who is reading them.
Ask for a repeat blood test or repeat blood pressure readings, at a different time of day or under different conditions. And ask for other doctors to review your imaging results or the results of any report that pushes you into treatment.
If you'll need to be taking the drug for years, can you wait before making a decision about it? You never know if a change in diet or some other non-drug remedy might work instead. For lifers, you usually don't have to leap into a decision. High cholesterol, moderately high blood pressure and weak bones, for example, are not emergencies.
What are the results of long-term studies for this medication? That's particularly important for lifer drugs. By long-term, I mean the coveted 20-year study. In other words, as long as you hope to live while taking the drug. Hard to come by, but ask nonetheless.
If you're being prescribed a lifer drug or near-lifer drug, how might it interact with medications you are likely to take in the future? For instance you may end up with drugs that lower high cholesterol, a prospect that increases as you age. Ask if it's possible to make these kinds of projections now so you can factor the future into your current decision making.
Older drugs have been used on a large population pool, versus a new drug that's likely to have been tested in a study that doesn't always reflect the lifestyles and predispositions of the rest of the population.
What would happen if you needed to go off the drug sometime down the line? It's possible that after taking a drug for years, you develop intolerable side effects.
If a man is taking testosterone supplements, for example, after a while his body comes to rely on the medication for its supply of the hormone and may stop producing its own. If he discontinues taking the testosterone, he might be unable to produce any of his own, leaving him bereft of the male hormone altogether.
Can I take an older version of a medication rather than the new, hot drug? Older drugs are often the better choice. They have been used on a large population pool, sometimes on millions of people and in daily life, versus a new drug that's likely to have been tested on just a few thousand and under strict conditions in a study that doesn't always reflect the varied lifestyles and predispositions of the rest of the population, you included.
How much experience do you have prescribing this medication to older people like me at the dose being suggested for me? The doctor may be prescribing something studied on patients who are a lot younger than you and may not have the same health conditions. If you have diabetes, for example, ask if any of the subjects in the studies for the drug did, too.
Remember: when it comes to taking a prescription, it's all about you.