Doctor visits are a weird social dynamic. You sit in the exam room a little nervous, fidgeting and waiting with anticipation for the doctor to come through the door. You know what you want to talk about, but once they step in and start talking, your mind goes blank. The next fifteen minutes are a blur. As they rush out the door saying their good-byes and recommendations for follow-up, you wonder what just happened.
It's a fact of life that sooner or later we need to talk with doctors about our health. Sometimes for an immediate injury or illness and other times to establish long-term care. Whatever the reason, it’s imperative that we take the lead in the interaction in order to get the best care. That starts with having productive conversations.
Difficult Conversations with Doctors
Talking to doctors can be a little unnerving. There’s this unacknowledged authority imbalance between a physician and a patient. The doctor presents himself or herself as the expert, and the patient can’t help but feel vulnerable because of his own lack of knowledge. The patient may be eager for prompt relief or information, so he chooses not to second-guess the doctor’s caliber. Instead, he just hopes the doctor is competent and can be trusted.
With such uncertainty and no means to address it, many patients end up feeling intimidated, self-conscious, and insecure in their exchanges with doctors. This leads to “white coat of silence”—a situation in which patients fail to vocalize their concerns or questions due to intimidation or embarrassment. With little response from patients, doctors then mistakenly assume the patient’s silence signals agreement and understanding of care.
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Doctors Aren’t Perfect
But even if a patient demonstrates some assertiveness, doctors may fail to give the patient adequate time and space to communicate. A study in the the “Annals of Internal Medicine” found patients were not given the opportunity to complete their opening statement of concerns in 77 percent of visits. In 69 percent of visits, the physician interrupted the patient's statement and immediately directed questions toward a specific concern.
Doctors are real people with real flaws. Just because they’re smart doesn’t mean they’re perfect communicators (and for that matter, neither are we). They likely went into medicine for the right reasons and possess a genuine desire to help people. But that aspiration is constantly undermined by today’s health care environment. In numerous ways, doctors are feeling frustrated by conditions that are interfering with the practice of good medicine.
Understanding a Doctor’s Point of View
As we shouldn’t judge a book by its cover, we ought not to judge a doctor by the few minutes we’re in their company. Instead, first consider some of the stress and frustration that goes into being a doctor today. View the medical ecosystem from their point of view. You will come to appreciate the constraints and limitations they face in a typical day and how these issues have been central to the trend of declining care.
Doctors negotiate discounted insurance payments in exchange for being a part of the insurance company’s wide network. This brings patients to the practice but at reduced rates. Doctors then feel pressure to see more patients than they’d like in order to make up in volume what they lose in insurance payments. This is forcing them to pack their schedules and be strictly regimented with how long they spend with each patient.
Patients turn to the Internet for medical information and then share their assessment with the doctor—even sometimes requesting prescriptions they’ve heard of but know nothing about. Imagine if someone showed up to your job and presumed to do it better? By doing this, a patient is usurping the expertise of the doctor’s knowledge. A doctor didn’t spend umpteen years in medical school to be overruled by the Internet.
Electronic Medical Record Mandates
Many doctors are now forced to keep electronic medical records. It's more efficient and accurate for doctors to type their notes in real time during the appointment, but doing so creates a hindrance to establishing rapport. Plus, it’s an exhausting repetitive exercise. For every patient he or she sees, a doctor has to quickly make the patient feel comfortable while talking, listening, processing, diagnosing, and typing all at the same time.
Potential Reputation Damage
Patients are becoming less collaborative and more demanding. Programmed by today’s promises of instant gratification, some patients expect immediate definitive answers that may not be so cut-and-dry. When these patients don’t get the answers they want, they may broadcast their displeasure for the world to see. Doctors already under enormous pressure will acquiesce where they can to protect their reputations. But remember, this puts a doctor in a precarious and unfair position. They have a lot to lose, including their license.
Show Kindness But Take Ownership
With this small sampling of some of the challenges doctors face daily, there’s no wonder that their bedside manner can seem lacking at times. Instead of being frustrated and aggravated, try to extend a little empathy, respect, and kindness toward them. Show some gratitude to remind them of why they became a doctor in the first place.
Keep in mind, despite this dysfunction doctors really want the best outcomes for their patients. They want to partner with you, but this means you cannot count on doctors to take full responsibility for your health care. Instead, you need to take the lead. That means advocating for yourself and setting standards for the kind of care you require. A good place to set these expectations is within the confines of the doctor’s appointment.
Getting the Most From Your Doctor Visit
Barring that the visit with your doctor isn’t under emergency conditions, you can optimize a doctor visit if you prepare. By doing so, your thinking will be clear and you will better define what successful outcomes look like. Here are some suggestions for preparing adequately.
Consider asking a good friend or loved one to accompany you to the visit. They can provide moral support even if they stay in the waiting room. They can then hear the debrief afterward to help you remember the appointment details and care regimen.
Write down your medical history. Be as detailed as you can. This is something you can keep with you over the years and add to over time. If there’s family history you’re not sure of, ask relatives for more information. This can help identify genetic risk factors.
Decide what you’d like to discuss with your doctor. Share your biggest concerns up front to keep the conversation focused. But be truthful and forthright about all that’s affecting you, including relevant details from your medical history. Together you can decide how to tackle secondary concerns.
Create a concise list of what you want to talk about. Share facts but also the story or conditions behind them. The physician can then focus on asking more detailed questions to hone in on your issues.
Prepare questions you'd like to ask. Consider what questions you ought to ask before you leave the appointment. While new information may come up during the visit, you can adapt your questions depending on how the discussion unfolds.
During the Doctor Visit
Because you have prepared, you will have a better chance of having an efficient and productive discussion with your doctor. After exchanging pleasantries, ask if you can record the appointment citing that you don’t wish to forget what will be discussed. If that isn’t possible, tell (don’t ask) the doctor you will be taking notes to remember the conversation accurately.
Be proactive in sharing why you’ve made the appointment. If he or she cuts you off prematurely (which probably isn’t intentional), insist that you finish your thoughts first. Have your list with you so you don’t forget anything.
This is what I’m here to talk with you about.
These are my issues.
Here are my symptoms.
This is when it started.
This is how it feels.
This is what I have done so far to address it.
These are my broader concerns because of previous illness and/or family history.
After the examination is completed and a course of treatment is discussed, be sure to have all your questions answered. Examples include the following:
What can I do to safely alleviate the pain?
Can you help me better understand the two treatment options?
What’s the recovery timeline for something like this?
Will this illness have any long-term implications for my health?
If at any point the doctor’s responses or explanations don’t seem clear to you, ask for clarification. It won’t be any more clear after the appointment, so ask while you have his or her undivided attention.
To clear up confusion, request that he say his answers in another way. Doctors are guilty of knowing too much. Meaning, they forget that you, the patient, don’t know what they know. This is an unconscious bias. To get the clarification you need, ask them to explain it in simpler terms or alternatively show you a diagram or draw you a picture.
At the end of your appointment, recap what’s been discussed and any decisions that have been made. Remember, though, you have ultimate decision-making power about your own health care.
Often there are several follow-ups. Be sure you understand every step and the order in which things must be done. Repeat back what you think you heard, and let the physician clear up any misunderstanding. To make this easier, write it all down for later reference.
First, I need to get an X-ray. Next, I need to get a blood draw. The results of both will be ready in 48 hours. I should start the prescription right away, and I will make a follow-up appointment in six weeks. But I should call you, the doctor, if the symptoms don’t get better in a week.
After the Doctor’s Appointment
At the conclusion of your appointment, be sure all your questions are answered and your notes are legible and understandable for later reference. Also, ask how you can communicate outside appointment times. In many medical practices, post-appointment communication is done through a secure portal.
Once you’re home, you may have additional questions that you didn't think of during the appointment. Write them down as soon as you remember them. Communicate your questions clearly and concisely through the portal.
Follow up proactively if the doctor or her office doesn't respond in the time parameters they promised. Stay on them to ensure your case stays front and center with your doctor. Be the squeaky wheel.
The health care industry is unfortunately flawed. But within that system, there are many people whose hearts are in the right place. While they will try to offer you the best care in a dysfunctional system, it’s imperative for you, as the patient, to accept that the best outcome for your health care will depend on your advocacy and ownership of it.
One of the best ways that can be accomplished is through clear communication. Be respectful yet assertive, and then demand unambiguous clarification from your doctor. Laying this solid foundation will give you the empowerment you need to work the system to your advantage instead of simply being a victim of it.
Create a medical journal to record your medical history including any family conditions. Take it with you the next time you have a doctor’s appointment, and use it to document your discussion in real time. This can be a good way to preserve your health history over the long term with accurate notes.
What other ideas do you have for making a doctor’s visit more productive? If you are a doctor, what would you recommend?
Please let us know in the comments below.