Building from my previous blog post, in
which I offered suggestions for choosing your health care team, today I look at
a related issue: communicating effectively with your doctor* (*which could mean
your physician, nurse practitioner, or anyone else you are seeing for medical
advice and help).
Too many patients and too little time
Today’s doctors are in a big hurry. In many
cases, doctors are contractually bound to limit the amount of time they spend
with each patient (typically ranging from 10 to 15 minutes) for the
purpose of meeting total caseload quotas. Doctors who do not see the number of
contractually stipulated patients can be penalized financially or in other
ways. Although this system has been criticized heavily from all sides (not
least of all, by the doctors themselves), it is the reality under which many
health care providers are now seeing patients.
Get clear in your own mind
If you have only 10-15 minutes with your
doctor, you need to be thoughtful and organized about your time. You also need
to realize that it is as much—or arguably more—your job, as opposed to your
doctor’s job, to ensure that you get what you need from your appointment.
You must plan in advance. First, define
what you really want from the appointment. If you are seeing your doctor for a
rash, for example, you might want to know whether it’s contagious; or
alternatively, you might want a prescription to stop the itching; or maybe you
really just want piece of mind that it’s not bed bugs from your recent trip to
Paris. The point is: get clear in your own mind what will make the appointment
a ‘success’ for you.
Write it down
It never fails to amaze me how often smart,
capable people fail to go to their doctor with a written list of issues and
questions. (They also fail to bring pen and paper or any type of a recording
device, to take note of what is discussed and recommended. But that is a
different topic.) With a written list, you will be less likely to become
distracted and more likely to get what you want from the appointment.
Communicate succinctly and effectively
Once you are clear about why you are at the
doctor’s office, communicate your goals clearly and repeatedly, before and
during your appointment. The essential formula is: “I am here for X issue or
problem, and I would like your help via Y action.” Tell the medical assistant
or nurse who brings you into the exam room, and repeat it to the doctor. If you
plan in advance, it should take you no more than 10 seconds to communicate this
information.
For example: “I am here today about this
rash. I would like to know if it’s contagious.” Or, “I have been more short of
breath lately, and I’d like the doctor to go over my medications and see if
there is anything else that can be done to address my asthma.” Practice in advance.
Dealing with multiple issues in one visit
If you have multiple issues you want to
address within a single appointment, you might consider starting by saying
something like, “I have four things on my list to discuss with you. I am not
sure you will have time for all of them. The things I want to cover, in my
personal order of priority, are a) a new rash on my chest, b) my ongoing knee
pain, c) my ongoing neck pain, and d) new shortness of breath since yesterday.”
Be realistic
You must be realistic about what can be
covered within the allotted time. If you don’t know how much time is available
for your appointment, ask in advance or while there. Prioritize your list and
if necessary, schedule a follow-up appointment to deal with topics that could
not be covered fully.
In some cases, your priorities will not
match the priorities of your doctor. For example, it is highly likely that any
doctor hearing the list outlined in the scenario above would deal first and foremost
with your new shortness of breath. That’s because shortness of breath is
potentially a life-threatening condition and might indicate a major medical
event in progress, such as a heart attack or a blood clot. In situations like
these, you need to trust that your doctor is using his/her expertise to
reprioritize your list for your overall health.
Finally, it is important to understand that
competent doctors practice within the scope of evidence-based medicine, even if
that means denying you something you think you want. Good-quality doctors, for
example, will not prescribe an advanced imaging test for acute, uncomplicated
low back pain, nor will they prescribe an antibiotic for a presumably viral
infection. They should, however, explain to you the reasons why this is the
case.
In summary, getting what you want from your
doctor’s visit is up to you. Plan in
advance, write it down, and communicate clearly.
Resources
Before Your Appointment: Questions Are the Answer. Agency for Healthcare Research and Quality. http://www.ahrq.gov/patients-consumers/patient-involvement/ask-your-doctor/questions-before-appointment.html
How Can You Get the Most Out of Your
Doctor's Appointment? Center for Advancing Health. http://www.cfah.org/prepared-patient/communicate-with-your-doctors/getting-the-most-out-of-doctors-appointment
