The old saying is 'Doctor knows best'. But times are changing and we're slowly moving into an era where the appointment room is a place for a two-way discussion and use of knowledge from both sides. No longer do doctors use a 'one size fits all' approach and informed patients are willing to ask more questions than ever before...well, that's the idea. But it seems it isn't quite yet the reality.

Think back to your last doctor's appointment. Did you ask any burning questions that you had during the consultation? Did you express any concerns that sprung to mind? Had you researched your symptoms beforehand and thought it may have been something different to what your doctor said, yet you felt obliged to remain quiet? If so, you're certainly not alone. According to new research from Bupa Health Pulse 2012, Britons are more likely than other nationalities to hold back from challenging their doctor or medical professional because they 'don't feel comfortable' questioning them.

Bupa's annual, international Health Pulse survey looks at people's attitudes towards their health and healthcare across 13 countries around the world. Because shared decision making is in the process of becoming part of mainstream clinical practice, this year, we explored how people are engaging with medical professionals and accessing health information and services, with the hope of identifying barriers to allowing patients to become more engaged in managing their own healthcare.

Of note, the international survey revealed that people in Egypt and Saudi Arabia feel most confident questioning their doctor, with 75% of people willing to do so. This compared to just 53% of Brits willing to challenge or question their doctor about health matters.

The reserve that this survey has exposed surrounding those in need of healthcare is a worrying one. Whether it's in Britain or elsewhere, a percentage of patients are genuinely limiting their choices and access to appropriate treatment and care because they simply don't feel comfortable to challenge their doctor about advice or treatment options.

The world has changed rapidly, and with ever increasing access to information, the average patient of today will have more knowledge than in previous generations. Being comfortable about asking for more details about a condition, a test or treatment is invaluable - not only does it involve you in decisions about your healthcare, but there is evidence to suggest that if you actively take part in managing your health and care, you will have better outcomes than people who don't. And better health outcomes result in both higher patient satisfaction and reduced use of health services.

The same survey also revealed that it's people who feel least positive about their health and those who admit to having a poor diet who engage the least with their doctor - an expected but troublesome trend. This is most likely due to a lack of confidence, lower levels of education, or a lower socio-economic bracket, and it's here where doctors have an obligation to play a part by prompting questions and encouraging discussion.

By necessity, doctors appointments are often short - the average in the UK is somewhere between seven and 10 minutes. All the more reason for patients to be prepared for their appointment, and to feel empowered and able to ask questions within that time. Patient-doctor time is precious, so being able to discuss alternative treatments, or to fully understand the risks and benefits of a procedure, will only be possible if there is an active conversation from both sides. This is still a challenge for many people, including doctors, and much work is still needed to embed shared decision making into health systems. The new mantra in healthcare should certainly be 'no decision about me, without me'.

This lack of confidence with doctors may also be fuelling a rise in the amount of people using the internet to research symptoms, address concerns and discover remedies. In 2010, Bupa Health Pulse survey found that 73% of people in Britain used the internet to search for advice about their health and medical conditions - this has now risen to 82% (2012), which isn't really surprising considering the resources, ease and anonymity of the internet.

Although there's a lot of trusted information out there, and doing some background research yourself can help you make better decisions about your healthcare, the internet should never replace your doctor. The healthcare cyber space can be inaccurate, misleading and even frightening if you don't use the right sources - in fact, our survey revealed only half of those using the internet for health purposes said that they always check the source of the information to ensure it's credible.

Remember, a doctor's advice, or personal communication with a health professional, is incredibly valuable. Don't be afraid to challenge your doctor or to ask questions, and always say if you don't understand something that you're told. To get the most out of your appointment, it pays to do some preparation beforehand and to think about the questions you want to ask. The health consumer (or patient if you like) should always have the right to choose treatments and healthcare that suits their lifestyle, preferences and beliefs. Being informed, confident and engaged in what medical treatment you're undergoing will, in both the short and long term, lead to better outcomes.

Follow Dr Sneh Khemka on Twitter: www.twitter.com/drsneh