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Speaking up can be hard

There are few relationships with a greater power differential than doctor and patient. Traditionally, the doctor is perceived as having all the knowledge as well as the power of life and death.

There also is a tremendous amount of vulnerability when you visit a doctor. There may be physical discomfort or even significant pain, which precipitates the trip to the doctor or the hospital. Uncertainty, anxiety and outright fear are not uncommon emotions.

In most cases, you will be asked to take off your clothes and wear a flimsy gown that is open in the back. You may have to wait quite a while for the doctor to examine you. It takes a tremendous amount of confidence to maintain your poise in such situations.

When a busy doctor comes bustling in the door of the exam room, it can be very hard to speak up and ask whether he has washed his hands. Phyllis related the following story:

"I am president of a publishing company and have no problem being assertive with authors, colleagues and vendors. When I saw my doctor recently, I was pleased to note that she washed her hands carefully before starting the exam. But I noticed that she did not bother to clean the stethoscope she wore around her neck.

"I asked my doctor how often she cleaned her stethoscope, and she admitted that she probably only did it about once or twice a week. She commenced to listen to my heart and lungs with that same stethoscope, and I didn't have the nerve to ask her to clean it. I can only guess how many germs were on it. Doubtless some were passed to me from previous patients, and my germs were likely passed on to dozens of other patients.

"I didn't get sick, but I was surprised at my inability to speak up and ask her to clean the bell of her stethoscope. I wonder if other people have as much difficulty being assertive with a doctor as I did."

We suspect that Phyllis is not unusual. People who are anxious or stressed about their health may easily become tongue-tied. If the doctor delivers a scary diagnosis like diabetes, heart disease or cancer, it is likely that patients won't hear much after that kind of bad news. The brain shuts down like a car that has run out of gas.

That's why it is so crucial to prepare for a doctor's visit or a hospital stay in advance. Take a prioritized list of your top health concerns. Bring an assertive friend or family member to act as your advocate. If you choke up and can't speak up for yourself, this person can ask questions and talk for you.

We have several Top 10 lists of questions and tips to avoid diagnostic mistakes, hospital errors, adverse drug reactions and interactions in our book "Top Screwups Doctors Make and How to Avoid Them." It is available in libraries, bookstores and online at

As difficult as it may be for patients to speak up, nothing can be more important for their health. Each year, hundreds of thousands of people die because of misdiagnoses, hospital-acquired infections, drug disasters and treatment failures. Asking key questions and requiring answers can help control the epidemic of health care harm.