How to Talk to Your Doctor

Questions to ask about tests, screenings, and scans

Use the Done On and Your Levels column in this table as a handy way to track the care you receive from your physician. The first checklist helps you determine whether your doctor is providing the basic preventive health care and screenings recommended by national and professional guidelines. Certain exams and tests are applicable only to men or to women. People with symptoms, risk factors, or chronic diseases may need to be tested sooner, more often, or more extensively than indicated below. The bottom table lists the minimum treatment goals for common chronic conditions: diabetes, high cholesterol levels, and hypertension. If you don't meet those goals, find out what you can do.

Test or procedure	To detect or prevent	How often	Done on
Physical exam
Abdomen	Enlarged liver or spleen, aortic aneurysm	Every few years, especially in men after 50
Breasts	Breast cancer	Every 1 to 2 years, starting at 40
Heart	Murmur, irregular heartbeat	Every visit
Height and weight	Overweight; also osteoporosis in postmenopausal women	Every visit
Neck	Thyroid nodules and narrowed carotid arteries	Every few years, especially after 60
Pelvic	Cancer and other problems in bladder, ovaries, rectum, uterus, vagina	Annually until age 30, then every 2 to 3 years
Rectal	Colorectal and prostate cancer	Every 1 to 2 years, starting at 40
Testicles and groin	Inguinal hernia and cancer	Every few years, especially between 20 and 35
Immunizations
Hepatitis B	Hepatitis B, a liver disease	Once by age 20
Influenza	The flu	Annually, especially after 50
Pneumococcal	Pneumonia	Once at 65
Tetanus booster	Tetanus	Every 10 years
Varicella	Chicken pox	Anyone who hasn’t had chicken pox
Screening tests: Definitely or probably needed
Blood pressure	Hypertension	Every visit
Bone densitometry	Osteoporosis	Every 2 to 3 years after menopause; at least once after 65 in men
Colonoscopy or sigmoidoscopy plus fecal occult blood test (FOBT)	Colon and rectal cancer	Starting at 50, colonoscopy every 10 years or sigmoidoscopy every 5 years plus FOBT annually
Complete lipid profile	High LDL-cholesterol or triglyceride levels, or low HDL level	Every 5 years starting at 20
Eye exam	Glaucoma, macular degeneration, and other vision problems	Every 3 to 5 years before 45 and every 1 to 3 years after that
Fasting plasma glucose (FPG)	Diabetes and the metabolic syndrome	Every 3 years starting at 45
Mammography	Breast cancer	Every 1 to 2 years, starting at 40
Pap smear and human papillomavirus (HPV) testing	Cervical cancer (Pap smear) and virus that causes it (HPV test)	Annual Pap smear through age 30, then Pap smear alone or combined with HPV test every 2 to 3 years; can usually stop testing after hysterectomy or age 65
Thyroid-stimulating hormone (TSH)	Thyroid disease	Every 5 years starting at 35
Condition	Measurement	Goal	Your levels
Tracking treatment for common conditions
Diabetes	HbA1c, protein in blood that reflects average blood-glucose levels over three-month period	Under 6.5 percent
High cholesterol levels /	Low-density lipoprotein (LDL), or “bad” cholesterol	Under 70 mg/dl if you have diabetes or history of coronary artery disease; under 100 mg/dl if you have moderate-high risk of heart attack; under 130 mg/dl if you have moderate risk of heart attack; under 160 mg/dl if you are at low risk of heart attack
Hypertension	Systolic, or upper, blood pressure and diastolic, or lower, blood pressure	Systolic 120 mm/Hg or lower, diastolic 80 mm/Hg or lower

Thirty-four percent of a national sample of 300 primary-care physicians surveyed by the Consumer Reports National Research Center in August 2007 said their patients "very frequently" or "quite often" requested unnecessary or duplicative medical tests. And 66 percent said they had acceded to at least one such request within the previous month.

"We have a real cultural infatuation with the latest treatments and the latest technologies," said David Blumenthal, M.D., director of the Institute for Health Policy at Massachusetts General Hospital. "This is a fact of life in the U.S."

Ask which treatments have been shown by research to be best for your condition.

What you can do. Designate one doctor, typically your primary-care physician, to coordinate your care.


Missing Evidence

Consumers are especially vulnerable to promotional persuasion in health care, because they assume that the medical treatments their doctors recommend are necessary and effective. They are frequently mistaken.
"About 80 percent of what we do in medicine today is not backed up by solid evidence--a clinical trial that proves it's really superior to other therapies," says Lee Newcomer, M.D., senior vice president for oncology at United Healthcare.


Questions to Ask About Testing

• Why is this test necessary? What will it tell us that we don't already know?
• Will the results significantly alter any treatment plans?
• When will the results be ready? Should I call you for them, or will you call me?