Dr. Besser's Notebook: Creating a Doctor-Patient Partnership

Last he said he wanted to screen me for prostate cancer. I had recently reported on the new guidelines for prostate cancer screening put out by the American Cancer Society. They recommended that doctors and patients have a conversation about risks and benefits of screening with all men when they hit age 50 and with higher risk men at an earlier age. The decision to screen should not be automatic but instead should come from weighing an individual's personal risk of developing prostate cancer as well as their perception of the benefits of early detection. I had done my research, explored my family history, and was ready for our conversation.

Well, having challenged him on aspirin and vitamins, I had run out of steam. He felt very strongly that screening was beneficial. I was unconvinced that in my case it was.

"Wouldn't you want to know if you had prostate cancer?" he said.

"I would if I also knew from the screening test whether it was a bad cancer."

As an epidemiologist, I knew that with no family history of prostate cancer, a positive test for me was most likely a false alarm.

He said he had a urology group he used that was very good with robotic surgery and had low complication rates. He had followed many men with PSA values above normal without operating initially.

I understood his approach and considered it reasonable, yet was unconvinced that, for me, I wanted the test.

He completed his thorough physical exam, ordered an electrocardiogram, and some blood work, including the PSA test for prostate cancer. I got dressed, thanked him for his time, and headed home. As I drove, I thought about this more. It's my body. If I can't express my wishes, how can I expect my patients to do the same? I liked this doctor and did not want to find another one. Better to risk offending him and taking a step towards having the type of relationship I believe everyone should have with their doctor.

After pulling into the driveway I took out my doctor's business card and called the office.

"Doctor's offices, may I help you?"

"Yes, please. I was just seen a few minutes ago. I would like to cancel a test."

For tips on how to help you develop an open relationship with your doctor, see "Are Doctors Recommending Too Many Tests?"

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"Do you have any tips on how to make it easier to communicate with your doctor?" Share your thoughts on the comment board!

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