When the physician-patient relationship is already underway, I usually try to talk to the physician by phone. Of course, you need patient permission to do this. On several occasions I have accompanied the patient to the appointment, or if unable to be there, had them telephone me at the beginning of their medical encounter, so that I could listen to the evaluation and hear the doctor’s conclusions. You will learn a lot about their clinical thinking, and you will avoid getting incorrect information via second- or third-hand communication. Usually, the physician is both open and capable and I am reassured, but sometimes the physician will be defensive or dismissive and it becomes difficult to sort out ego from competence. This is a nuance that I am still learning.

When dealing with physicians making potentially questionable medical decisions, the best strategy is to ask them to explain their reasoning. Often, they will hear their own logical errors and will self-correct. I was in the wilderness with only satellite phone access when my wife called to relate that my 3-year-old granddaughter was in the pediatrician’s office for the third time with five days of fever and a diagnosis of influenza despite two negative rapid-flu tests. My wife said she was going to demand “more tests,” but I told her to ask the doctor to do “more thinking.” She asked him, “How many times have you seen a child with influenza who had fever for five days with no respiratory symptoms and two negative flu tests?” He answered, “Never,” promptly concluded that he had ignored some potential important diagnoses, and sent her to the children’s hospital for some focused testing. My granddaughter was admitted and successfully treated for Kawasaki disease.

You Can Always Demur

After all, it may not be your specialty, you may be retired, or have other good reasons not to get involved.

As physicians, we have specialized knowledge and perspective that laypeople lack. Most medical care in the United States is good, but there is significant variation in quality. With the right approach, you can put your expertise to work to help someone close to you navigate the complexities of the medical system and get the best care possible.

Dr. Schwam was previously the director of quality assurance for the emergency department at Sturdy Memorial Hospital in Attleboro, Mass., an attending physician at Rhode Island Hospital in Providence, R.I., and a clinical assistant professor of emergency medicine at the Warren Alpert Medical School of Brown University in Providence, R.I. He is now retired, but still lectures on clinical decision making and medical malpractice.