What changes need to be made?
If the pilot feels there might be a pressurization issue, why not don O2 masks and then ask for clearance to descend?
If the pilot felt it was an emergency, why not descend to FL100 and then TELL ATC what's going on?
I'm not sure what happened to the other thread on this topic...but somebody summed it up nicely:
ATCs job is to separate traffic; not read the pilot's mind. The pilot's job is to fly the aircraft, and deal with issues as they arise.