6 things your dr isn't telling you

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No news isn't good news when it comes to these six issues. Here's what your doctor may keep mum about -- and what you can do to get the care you need.

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It's probably happened to you at least once: You head out to the parking lot after your doctor's appointment, unlock your car door and suddenly remember something you wanted to ask your doctor. You mentally calculate the time until your next appointment -- can you wait that long? Should you call? While you're pondering in the parking lot, your doctor may be having the same experience in his office hallway. Maybe there was something he meant to tell you. Maybe there's a question he forgot to ask. Maybe one of your comments has suddenly clicked in his mind.

Surprised? You shouldn't be. A new study shows that doctors may forget, decide to forgo or just don't know to do much of what patients need in a typical visit. The study, published last fall in the New England Journal of Medicine, found that doctors in the United States take only half the recommended steps in treating patients with arthritis and other common conditions, including diabetes and lower back pain. In some cases, especially when it comes to conditions involving chronic pain, doctors take barely 10 percent of the recommended steps.

What's missing? Sometimes it's actual treatments, tests doctors might have ordered or medications they might have prescribed. Most often, though, it's things that go unsaid -- lifestyle counseling, information about risk factors and other subtler points. In some cases, time is an issue and doctors usually focus on acute concerns -- the pain or infection for which you made the appointment -- leaving only a few minutes each visit for preventive care. So, doctors may pick and choose preventive care measures based on time and need and stay silent about the rest. Doctors may also avoid potentially sensitive but risk-related issues, such as age and weight, unless patients bring them up first. And doctors may rely on their patients to address subjective concerns, like depression and pain, rather than probe their patients for them.

"Doctors are oriented toward doing rather than toward teaching," says Isadore Rosenfeld, MD, professor of medicine at Cornell University School of Medical Sciences, N.Y., explaining that it's now more cost-effective for a doctor to give a patient a shot to temporarily stop the pain of an inflamed knee than to spend time counseling that patient on the diet and exercise strategies that could help long-term.

At best, this snapshot of doctor office interactions is disconcerting; at worst, it's frightening. You can worry or fume over the possibility you're receiving substandard care, or you can do something about it. Speak up. It's not enough anymore to show up for your appointments and trust your doctor to take care of the rest. It's your job to stay informed about your condition and to ask your doctor about anything you don't understand. Think of your doctor's appointment as a business meeting - go in prepared so you'll come out with the information you need. The American College of Rheumatology Web site (www.rheumatology.org) lists treatment guidelines for rheumatoid arthritis (RA), osteoarthritis (OA), lupus and other arthritis-related conditions, so you can bring your own checklist into appointments.

We scanned studies and reports and spoke with some of the top experts in the field to find out what your doctor might not be saying. "Patients need to make every minute of their appointment count," says Dr. Rosenfeld. "Sit down with your doctor, and say, 'Before we go on, let me tell you what I'm worried about.'" Here's what you may not hear -- and why it matters:

1 "Your weight, your eating habits and even how much sleep you get can impact your health."

2 "Your state of mind matters."

3 "You need to know what to expect in the future."

4 "Your medications may interact with each other."

5 "Getting a second opinion can make a big difference."

6 "Chronic pain is not a fact of life because you have arthritis."

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