How to Become an Empowered Patient

Female empowered patient on her laptop

How can you become an empowered patient and work with your doctor to make the right choices and access the best treatment for your menopausal symptoms?

Be Pro-Active in Managing Your Health

Professor David Haslam, chairman of the National Institute of Health and Care Excellence (NICE) suggests that you become more pro-active about managing your health. In an interview with The Telegraph he said British patients should become more assertive and see themselves as “equal partners” with their doctors, with legal rights.

He also said that patients should become more knowledgeable about their health conditions, and tell their doctors if they believed they were missing out on treatment which could help them. He stressed that he was not suggesting that patients should be confrontational but that they should be able to assert what they wanted.

Work in Partnership with your GP

I couldn’t agree more. If you know what you want, you can ask for it. I think it’s important to see yourself on an equal footing with your GP. Not only is this empowering for you but it means that you and your GP can discuss treatments and work together in partnership to find the hospital or medication that is best for you and which you are both happy with.

With the internet, patients are now more informed and empowered than ever before. But, just because you’ve read it on the internet, doesn’t mean it’s the right choice for you.

I’ve heard anecdotes of GPs hearts sinking when yet another patient storms into their consulting room armed with a load of print-outs from the Daily Mail Online and a list of demands for treatment.

There’s a lot of conflicting knowledge out there which is why we need our doctors to provide us with up-to-date information about our condition and the treatments available so we can make informed choices.

What if You’re a Menopausal Woman?

If you’re a menopausal woman, your doctor may lack the training to provide you with the best information and care. In my article UK Doctors Need Better Education about the Menopause I discuss this issue as well as the fear that still exists around prescribing HRT for menopausal women. And that’s before we even get onto the controversial subject of being prescribed testosterone.

But it’s important to remember that you have a legal right to certain drugs. According to Professor Haslam,

“When products have been approved for use by the NHS by NICE, patients have a legal right to those drugs – as long as they are clinically appropriate. The take-up should be much higher than it currently is.”

That means you have a right to bioidentical hormones that have been manufactured by pharmaceutical companies rather than a compounding pharmacy.

These bioidentical hormones are available on the NHS but not all doctors are aware of them or are keen to prescribe them. Brand names include Estrogel, Estraderm, Evorel and Hormonin. Progesterone is available in pill form as Utrogestan.

Unfortunately you have no right to testosterone treatment as it is no longer licenced for women. Some enlightened doctors are prepared to prescribe it for those patients with very low levels but most are not willing to prescribe off-licence.

If you find yourself in that situation, the best thing you can do is ask for a referral to a menopause clinic or a Gynae-Endocrine consultant.

How to Become an Empowered Patient

Menopausal or not, there are things you can do to become an empowered patient and work with your doctor to make the right choices and access the best treatment for your condition.

I find it best to approach GP consultations as a cross between a friendly chat and a business meeting. At no point do you want to appear arrogant or confrontational, but you want to make it clear that you’re not helpless and are there to work with the GP to solve your health issue.

Think of You and Your GP as a Team

Think of you and your GP as head of a team – Team You. Together you are responsible for facilitating the best possible health care for you. That may involve sending you off to see hospital consultants, nurses, physiotherapists and other medical specialists, but ultimately you’ll keep on coming back to your GP for general monitoring and any new health issues.

Find a Doctor you Feel Comfortable With

The first step in any relationship is feeling comfortable in each other’s company. Some people we like, some we don’t. Many people, myself included, feel tense in the doctor’s office, especially if we think we may not be listened to. You need to feel comfortable and relaxed with your doctor, to trust them, and most importantly, be able to open up and discuss any problems or symptoms you’re experiencing honestly. A good relationship is all about good communication, so find a doctor you can talk to.

Talk about One Issue per Appointment

GPs in Britain are expected to see and effectively treat a new patient every 10 minutes. This is almost impossible to achieve, which is why we often spend a long time in GP surgery waiting rooms. Make the most of your ten minutes by only dealing with one issue. That way your doctor will be less stressed about running over time and also be able to focus on the issue at hand. Some GP practices allow you to make a double appointment for 20 minutes if you know that you have a lot to discuss, so it may be worth your while doing that if you think you need extra time.

Be Prepared for Your Appointment

My mind often goes blank in the doctor’s office. These days I go prepared with a list of symptoms, diary dates of when they started and frequency, and a list of questions I want to ask.

If you’re seeing a new doctor for the first time, it’s also a good idea to either take along all your current medication or make a list of all the medication you’re taking daily, including the dosage. If you’re taking any complementary therapies you must include these too.

If it’s a follow-up appointment I make sure I look through my diary beforehand and make a note of how I’ve been feeling since the last appointment, any side-effects of the medication I’m on and so on. I also make a note of what I want the outcome of the appointment to be; it could be a repeat prescription, a blood test, a referral to a hospital clinic or a diagnosis.

NHS Choices has a very useful list of questions to ask your doctor in order to make the most of your appointment.

Take Notes

Take a notebook and pen with you to your appointment so that you can make notes. If you’re stressed or hearing upsetting news it’s very difficult to take everything in, so it helps to have it written down. If you’re too upset, ask the doctor to write down the name of the condition you’ve just been diagnosed with.

I also find it good practice to write notes on what happened and what was said in the consultation as soon as I get home. That way, I can keep track of my condition and it makes it easier to remember my progress when I prepare for a follow-up appointment.

Be Knowledgeable

You may have read about an illness or treatment that applies to you in the Daily Mail, but your doctor may not accept this as a reliable medical resource. Your GP probably doesn’t have much time to read the British Medical Journal or other medical journals, but they may appreciate it if you can provide them with an up to date medical reference to back up your claim for bioidentical hormone therapy or testosterone or any other treatment you think may benefit you.

If you are menopausal, it’s a good idea to look on the websites of The British Menopause Society or The North American Menopause Society.

The U.S. National Library of Medicine is an excellent resource for medical research papers.

For general advice of health conditions and treatments, NHS Choices is an excellent website designed for the patient.

You Can Choose

The more you know about your condition, you more you’ll be able to discuss treatment options with your doctor and make the right choice for you. Instead of being passive, and expecting the doctor to tell you what to do, being an empowered patient means you can take control of your health care.

Go for it!

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2 Responses to How to Become an Empowered Patient

  1. Charlotte September 21, 2015 at 5:28 pm #

    Hi Angie

    Thanks so much for flying the flag for women in early onset menopause! I have just been diagnosed as definitively menopausal at the age of 41, but with retrospect have experienced hormonal disruption since my early thirties. It has all come as quite a shock although I’m grateful to have some validation for all the symptoms over the years.

    My GP is relatively enlighted for a middle aged man (!) and is happy to prescribe me bioidentical HRT at my suggestion. Apparently Evorel patches contain norethisterone (is this correct? I thought they were estradiol only) so as I don’t want synthetic progesterone he is now recommending Elleste-Solo MX with Utrogestan.

    I’m unsure whether I’ll need testosterone although my libido has been nonexistent for a few years. Will probably try the above protocol first and see how I respond.

    Thanks again – I feel a bit cheated out of my thirties but am aiming to be proactive and positive in the hope I will see the real me return before too long…


    • Angie Macdonald September 24, 2015 at 5:23 pm #

      Hi Charlotte. Sorry to hear that you’ve also had hormonal disruption from such a young age. Glad to hear you’re getting the treatment you need and you have an enlightened GP. Fantastic! As far as I’m aware the Evorel conti patches contain estradiol and norethisterone, but the plain Evorel patches are estradiol only (these are the ones I’m on). If you are distressed by having no libido it might be worthwhile having a blood test to test your androgen levels and asking for testosterone. But some women find that having the extra oestrogen restores their libido and enjoyment of sex, so see how you go. You’re doing the right thing by being proactive and positive. Things are bound to improve.

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