Note: The content here is not a substitute for professional medical advice, diagnosis, or treatment.
Benefits of Being An Informed Patient
Sometimes I’ve received medical advice that wasn’t the best. In this section, I’ll share a few examples to illustrate why being informed as a patient can be valuable.
Exercise Stress Testing
There is a test in cardiology called a stress test, where the patient walks on a treadmill to make the heart work harder, while an electrocardiogram (ECG) monitors the heart’s electrical activity. The goal is to look for signs of coronary artery disease (CAD). The idea is that when the heart works harder, a narrowed coronary artery caused by CAD may not be able to supply enough blood to meet the heart’s increased demand and this can be detected by the test. This test is often recommended when a patient has chest pain that may be related to the heart.
I have done such test myself. And on one of the visits, cardiologist also mentioned I could have done it routinely if I liked.
Now, here comes the problem. As far as I am concerned, routine stress tests are not recommended already for more than a decade (assuming you don't have strong risk factors or symptoms):
The U.S. Preventive Services Task Force, an independent panel that makes recommendations to doctors, urges physicians not to routinely offer exercise stress testing to people without symptoms or strong risk factors for CAD. Physician groups like the American College of Cardiology support this recommendation.
One of the reasons likely is the following. As noted stress testing can be helpful to detect narrowing in one or more coronary arteries. However, it detects those cases, when there is 70% or more narrowing. Heart attacks on the other hand often happen when smaller narrowings (less than 70%) rupture and form a clot. So doing routine stress tests could give you a false sense of security.
Another reason why doing unneeded stress tests can be harmful is that this test (like many tests) can give false positives (this happens roughly in 10% of cases). When this test gives false positive result, patient usually has to perform an invasive procedure called coronarography, which comes with its own risks.
But If someone has heart-related chest pain from a significant blockage, a stress test can be more useful - because the test is more likely to detect the problem.
Gallbladder Polyps
Once I went for a repeat abdominal ultrasound for a gallbladder polyp because I was interested in certain features of the polyp. However, I found out the doctor performing the scan was not willing to assess those features. Anyway, they mentioned that if there is a polyp I should consider a cholecystectomy (removal of gallbladder). Now usually the doctor performing the scan is not the one to recommend treatment, but I am mentioning this case, because they voiced their opinion anyway. I told them that polyps of size less than 4mm are considered very low risk and cholecystectomy is not advised in those cases based on the guidelines (unless there are some other risk factors) - on which he responded that size did not matter that much and seemed somewhat skeptical of the guidelines.
Limitations of Being an Informed Patient
While being informed allows us to participate actively in our healthcare, it also has its challenges. Medical knowledge is complex and constantly evolving, and without full clinical context, we may misinterpret information or become unnecessarily worried.
Final Thoughts
To sum up, being informed is important, but it does not mean we should disregard a doctor’s advice without due consideration. That’s why it is usually best to maintain open, respectful communication with healthcare providers and to discuss any questions or concerns directly with them.