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Getting the Most from your Doctors Visit – Getting your Doctor to Listen to You

By Patti Wood  MA CSP Body Language Speaker, Author and Communication Coach

Many years ago, I went to a doctor and got a few prescriptions. I consider myself a pretty competent communicator, but when I called the doctor’s office a few days later saying I was still sick I discovered that I had not picked up one of the prescriptions from the pharmacy. The doctor had written two on one prescriptions sheet and the third prescription on a second sheet, and the drug store had handed me two prescriptions so I didn’t know there was a problem. I did not remember the doctor saying I should get three prescriptions filled and the pharmacy had inadvertently not filled out the third prescription. Thank goodness it was a sinus medication and not something to keep my heart pumping. The only fallout was dealing a few extras days with a stopped up nose. But it made me more aware of how I communicated with my doctors.

Last week my 87 year old mother went to the doctor yet again complaining about her long time fatigue. My mother is a vivacious and happy person and loves to please others. When my sister has gone to doctors appointments with her and she has seen my mother transform from a hobbling ill women to a sparkling dynamo as she talked to the doctor. It took two years for her to be diagnosed with Sleep Apnea. Gee, I wonder why they didn’t think she had a problem. Now she has this new issue and again can not get a doctor to listen to her.

Have you had problems getting a doctor to listen and take time with you? Even when we are healthy when you’re in a cold exam room, under florescent lights, wearing a paper dress, it may make you a little less communicative. Here are tips to get the most our of your hospital vests

Prepare-

  • If your getting ready for an annual exam or doctors visit start to jot down or type notes on how your feeling. Add to these notes a list of all the vitamins and supplements your taking, your general diet and exercise plan.
  • If you’re going in because you’re ill, figure out exactly what you want from the visit. Do you want a name for your illness? Do you want treatment plan options listed and explained? Do you want a different medication? Do you want help with side effects from what you’re taking already? Do you want to be out of pain, do you want to see a specialist?
  • Fold up your notes and stick it in your wallet or sync it to your PDA you are bringing with you. If you are dealing with a chronic or serious illness and you found new research on the internet you can bring that with you to remind you of a question you may have about it, but don’t expect the doctor to have the time to read it. (If you can do so graciously email the article to the office before your visit.)

When filling out paperwork-

Print clearly so everyone in the office can read your writing and if it is really sloppy ask if you can staple your typed notes to their paper work

Greet everyone in the office in a warm friendly manner-

You do not have to be a dynamo like my mother, but be gracious and you’re more likely to get better care. If you are on a timeline make sure that the office staff knows. It is ok to politely check in with them every 15 minutes or so. Yes that is bugging them, but believe it or not the front desk people can forget that you are there.

At the beginning of the visit, tell the doctor you have questions-

This way they know they have to take time with you. Write down your questions, and give a copy to the doctor so you both can go through the list together.

When the doctor speaks to you-

Write down his or her recommendations and instructions.

Don’t be hesitant about asking a doctor to repeat themselves-

Ask them to explain themselves in simpler terms or answer further questions. If you have a digital recorder, bring it with you and use it.

Get the doctor to sit down with you and make eye contact-

Visits were you have eye to eye contact with a physician last longer. If they come in staring at your chart, keep small talking with them till you feel you have rapport... If there is not place for them to sit, at least say, “I need a moment longer with you, so they may lean for a moment and relax into a conversation.

Bring family members with you-

This too has been shown to extend the length of the appointment and you have additional people asking questions for you and you can even assign a note taker!

If anyone in your family is a doctor make sure you mention it-

I know this sounds like name dropping but it has a strangely dramatic effect on a physicians behavior, it is like saying you’re related to God, The President and Angelina Jolie. I always try to mention that my brother in law is a doctor. “I may say my brother in laws waiting room doesn’t have magazines as good as yours” “Or my brother in law has this same computer in his examining room.” Doctors consider themselves family and they are more likely to take care of their own. My sister was having hip pain and went to see her doctor, the physician told her to go home and turn on the heating pad. Then she told him her husband the doctor had suggested she come to him and he asked her more questions diagnosed an ailment and got her on a treatment plan that had her out of pain in 24 hours.

Go carefully through your treatment options and instruction-

I have adapted the following questions from recommendations from Lawren H. Daltroy, Dr.P.H. for people with arthritis.

  • What is the treatment for exactly or what will this treatment do?
  • How long will it take to work? A few days? Three months? 
  • How often do I have to take it? With food or without? 
  • Will it cause problems with my other medications? 
  • How long will you have to take it? A month? Indefinitely? 
  • Are there any likely drawbacks? Side effects, cost?
  • What have other patients experienced? What have they done to cope?
  •  What if it doesn’t work?

Doctors are often in a hurry, and they can not read your mind. Take responsibility for your health and follow their tips and eat an apple every day.

Produce a tape recorder, and say, “You don’t mind if I record this, doctor? My family will want to hear what you have to say.” This is the ultimate weapon against the lackadaisical counselor!

This is so smart! Not only will it make your doctor sit up and take you seriously, you have their advice on tape, just in case you forget it.

Thanks Dr. Hildreth, you have shared some really great advice.

Doctors diagnose a patient within the first 18 seconds of speaking with them-

Dr. Jerome Groopman, a staff writer with The New Yorker and author of the newly published book "How Doctors Think." The book outlines how doctors often misdiagnose because of their emotions. Sometimes they view a truly sick person with many ailments simply as a complainer, Groopman writes. On the other hand, a doctor can misdiagnose a serious illness in an outwardly healthy patient because of positive feelings, he says.

Despite its criticism of the medical profession, Groopman says the book has been well received by the medical community.

"That's because misdiagnosis is a big issue in medicine," he said. "For the first time, this book helps people understand why we come to the right diagnosis, but also why we go astray. The other thing is that the worst errors in the book are my own. It's not a preachy self-righteous book. I make myself quite vulnerable."

According to Groopman, to be an effective consumer of medical services, patients need to realize there are two categories of physician thinking.

"A physician's emotions can colour his or her thinking and actions," he said. "Patients need to know how to pick up on negative and positive feelings."

"A physician's emotions can colour his or her thinking and actions."

— Dr. Jerome Groopman

It's also important for them to convey exactly what the symptoms are. Sometimes doctors make an attribution error because they may think it has to do with an existing condition, which often happens with menopausal women.

In Groopman's book he cites the case of a woman going through menopause who felt she had explosions going through her body.

"She saw four doctors, and when she got to the fifth doctor, he told her, she was high-strung and in the middle of menopause, but she felt explosions that were different and that something truly was wrong. That kind of language causes the physician to listen. It turned out she had a tumor producing adrenalin, which caused the explosion feeling.

Groopman also says if a patient genuinely feels the symptom is different from anything they've ever felt, to red flag it — ask the doctor to take it seriously, not to stereotype and make an attribution error. If you think a doctor is not listening, search out a second or third opinion.

Personal experience

Groopman himself endured poor medical advice over a three-year period when he attempted to obtain treatment for a painful wrist. The first doctor gave him a diagnosis of a condition Groopman discovered didn't exist when he checked it out on the internet. He then received four different opinions from six different surgeons.

"What I needed was someone who was thinking, not just dismissing me and saying 'I'll figure it out when I cut you open.' I needed someone who could explain to me what was wrong so that it made sense to me."

*Citation: Daltroy LH. "Getting the Most from a Visit to the Doctor" Harvard School of Public Health: Health Literacy Website. 2001.

Available at: http://www.hsph.harvard.edu/ healthliteracy/talk_drvisit.html.

Here is the Full Article:

“Getting the Most from a Visit to the Doctor”
by Lawren H. Daltroy, Dr.P.H.

All of us go to the doctor at one time or another. Considering how important these visits can be, it is surprising that we don't get any training for them. Visits often just seem to happen, and afterwards we find ourselves saying, "Oh! I forgot to ask about...! I wonder what the doctor meant by…!” Knowing what we want out of a visit, preparing for it, and following some simple steps can help us get the most out of our visits.


Before your Visit:

Step 1: Know what you want. Most visits for arthritis are not emergencies, so you will have time to prepare. You may want one or more of the following: 

  • A diagnosis. "A name for my condition."
  • A prognosis. 'What will happen? What will this mean for me?" 
  • Reassurance. 'Just tell me this won't get worse, and I can cope." 
  • A new treatment so your symptoms will go away or stay under control.
  • An end to a treatment that does not help or is causing problems.
  • Help with practical problems, like keeping your job, taking care of your family, and keeping up with exercise and a social life.
  • Help with feelings, fatigue, or depression. “I need to talk to someone who understands and can help.”

Be honest about what you want from a visit. Arthritis can affect all parts of your life. However, many people feel that they need a physical I complaint to justify a visit. If you are really going to see the doctor because you are having trouble taking care of your family or are feeling tired and blue, let the doctor know this. Otherwise the doctor may concentrate on your physical complaint and never address your other concerns.

Step 2: Make a list. Write down what you want from your visit. Ask your family for good questions. Sometimes the people around us see what we need more clearly than we do ourselves. Family members may want information to reassure themselves or so they can help.

Put your most important questions first. You may need more than one visit if you have a long list.

Step 3: Practice asking your questions. Asking questions doesn't seem hard, so why practice? Practice helps us to act. Practice makes us focus, clarifies our thinking, helps us remember, and gives us courage. Studies have shown that patients who practice first ask more questions and get more of the information that they need. Practice is as simple as telling someone else what you want to ask the doctor Listen to yourself as you practice asking a question. Is it clear? Does the other person understand what you want? If not, ask the question a different way. It will pay off.

Step 4: Gather any information about your health that the doctor might need. This includes names and doses of your medicines. It could be a list of your symptoms, test results, or a letter from another doctor. This is especially important for a first visit to a new doctor. The more complete your information is, the sooner your doctor can help.

Step 5: Bring a family member or a friend. For many of us, a visit to the doctor raises anxiety. We’re worried about a new symptom, about the meaning of a diagnosis. It is hard to think clearly and remember things when we're anxious and feeling ill. Another person can help remember things you have forgotten. He or she may hear things that you miss or write things down if you are busy or self-conscious. Make it clear before the visit, however, that your ally is there to support YOU and should stay out of the conversation unless invited.


During your Visit:

Step 6: Ask your questions. Most patients ask only a few questions during a visit. The result? Most patients get information than they want, and doctors think that patients understand more than they usually do. If you don't ask questions, your doctor may assume that you understand, or that you do not care to know more. He or she cannot guess what your concerns are. Most doctors appreciate patients who ask good questions.

What is a good question? A good question is specific, timely, and well thought out. A good question gets results. Here are some tips for asking good questions.

  • Be specific. If you ask, 'How am I doing?" you may hear 'Not too bad.' If you want to know how serious your arthritis is or how long a treatment must be taken, then ask that.
  • Be direct. Do not hint. Your doctor cannot guess what you want.
  • Be timely and thoughtful. Tell your doctor at the beginning of your visit that you have some questions.  Ask when to bring them up. This gives you both a chance to organize your time together.  If you let the doctor know at the beginning that you have several questions, you are more likely to get them addressed.  In many visits the doctor starts asking about the first problem mentioned, and the patient does not have time to bring up other important problems. 
  • Get an answer. A good question gets a clear answer. If your doctor doesn't answer, or if the answer is not clear, ask again.  Ask for details or simpler I words if that is a problem. 
    What gets in the way of asking questions?  Most people, including many physicians, find it hard to ask questions when they are patients. Common reasons include the following:
  • Forgetfulness. Time is limited, and you may be anxious. This is why you brought your list! Ask new questions right away when you think of them.
  • Embarrassment. Because arthritis affects such things as going to the bathroom, having sex, or feeding yourself, you have good reasons to talk about such concerns. Becoming comfortable with your physician may take time. Your doctor's job is to help you live day to day with a chronic disease.
  • Medical jargon. Many medical words are technical. However, your doctor might not realize you don't understand them, because he or she is so used to using them. Ask if you can repeat something in your own words to be sure you understand. 
  • The doctor is too busy. Doctors get interrupted and sometimes act rushed. However, your time is as important as the next patients’. Asking your important questions first can help you and your doctor organize your visit. Also, you can ask for booklets, a follow-up appointment, or a chance to talk with another caregiver, such as a nurse or therapist.
  • Feeling intimidated. You have a right to answers to your questions, even if the answer is "We don't know yet, until we do more tests." 
  • Fear of the answers. Fearing the worst is natural, but the worst is rarely true. Most problems in arthritis are manageable. The best way to reduce your fears is to look for solutions and take action. 
  • Feeling that "my question is not important." Anything important to you is worth mentioning.

Step 7: Take part in decisions about your care. Make sure your doctor knows your goals (see that list!). The doctor's goals may be to reduce inflammation and pain slow disease progress. Yours may be to keep working or to be able to pick up your grandchildren. Share your goals with the doctor, to make sure that the treatments meet your needs.

Find out your options. Your doctor will suggest treatments and tests based on his or her experience and knowledge of you. Ask your doctor to discuss the pros and cons. Get information from other health professionals, books, and the Internet.

Find out benefits and drawbacks for each option, for yourself and your family. All treatments are not alike. If more than one might work for you, then your preferences become important. What are the side effects, costs, and likelihood of success for each treatment? Will you need a ride to the clinic every week for one treatment, only once a month for another?

Consider which options are modifiable. Even if options are limited, you may be able to change them to suit you better. Perhaps you can take fewer doses of a drug or substitute one exercise for another. Even small changes can make a treatment more acceptable. You are more likely to stick with a program that suits you.

Don't rush. For most problems in arthritis, you have time to think about changes. If you are unsure about trying a new treatment, ask your doctor what will happen if you do nothing new for a while longer. You may have more time for most decisions than you think.

Step 8: Know your diagnosis, the purpose of each treatment, and how to follow it. There are over 100 kinds of arthritis and rheumatic conditions. If you don't know which one you have, you may easily read about the wrong condition and think it applies to you.

You'll want to know the following: 

  • What is this treatment's purpose? Is it for pain? For swelling? 
  • How long will it take to work? A few days? Three months? 
  • How often do you have to take it? With food or without? 
  • Will it cause problems with your other medications? 
  • How long will you have to take it? A month? Indefinitely? 
  • Are there any likely drawbacks? These include symptoms like stomach upset, but also cost and inconvenience to you and your family. 
  • Are there ways to overcome drawbacks? Having a plan can help you overcome obstacles, and your doctor may know of things other patients have done to cope.
  • What if the treatment isn't working? Many arthritis medicines work for some people but not for others. Or one might work for you for a while and then stop doing so. If so, tell the doctor, so you can work out your next steps together. Don't stop a treatment without telling your doctor what you are doing and why.

Step 9: Get it in writing. People forget half of what a doctor tells them within five minutes. If you get information about your diagnosis and treatments in writing, you will be less likely to forget and make a mistake that might hurt you. Ask the doctor for booklets about your condition and treatments. 


After your Visit:

Step 10: Review your notes. Read your notes, and write down anything else you can remember. Date the notes and save them, to help you later.

Step 11: Phone your doctor if necessary. If you forgot to ask the doctor something, don't be shy. Call and ask your question. Your doctor would prefer that you get it right! If you have a problem with your treatment, call your doctor. He or she may want to make adjustments or see you again.


Summing up:

You have the right to full information about your health and medical treatments. Make a list of concerns before your visit, and practice asking your questions clearly. In the office, present your most important questions early. Be specific and direct. You can help your doctor help you by providing clear information and by sharing your goals and concerns. Find out the pros and cons of each option. Participate in decision making; you will be more likely to stick with a treatment you helped design. Make sure you know your diagnosis, the purpose of each treatment, and how to follow it. Get it in writing to help you remember. Finally, if you forget something, call back and ask. Doctors are human and they vary in their ability to communicate. It is up to both of you to make your conversation work well.

Lawren H. Daltroy is Associate Director of the RBB Arthritis Research Center at Brigham & Women's Hospital in Boston, Associate Professor in Medicine, Harvard Medical School, and Associate Professor of Health and Social Behavior, Harvard School of Public Health.

Copyright © 2007 Patti Wood All Rights Reserved

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