HOW TO TALK TO DOCTORS

Many people complain about the medical care they receive, especially from doctors but also from nurses and other health care professionals. The most common complaint is that doctors don’t spend time with patients, listening to their concerns, fears and discomforts. Even when a patient tries to take the initiative and talk to the doctor, he or she is often interrupted with specific questions from the doctor. The disconnect between doctors and patients is particularly pronounced in hospitals where a continuous stream of health professionals interact with patients and perform various tasks including blood tests and transporting patients to other places in the hospital for other diagnostic tests. Regardless of whether a doctor is seeing patients in his or her office, or in the hospital there is sometimes a disparity between the behavior of doctors and the needs of patients. Understanding the perspective of doctors can help people better navigate the health care system and receive the medical care they need.

When a doctor has contact with a patient, and a doctor/patient relationship is established, there are ethical as well as legal requirements that oversee the contact.
Doctors first and foremost want to do no harm, and secondly want to use their training and knowledge to relieve suffering and if possible cure disease. For many chronic medical conditions doctors cannot cure the condition but rather try to manage the disease so as to minimize patient discomfort and prevent the disease from getting worse. Of course doctors have many patients and have a limited time to spend with each patient.

Generally doctors think in a systematic way based on their training and experience.
Their first concern is what the patient is complaining about and whether the complaint represents a serious medical condition, or worse, a medical emergency, which if course would require immediate medical treatment. The next concern is the history of the complaint – or if there is more than one complaint – the history of all complaints. Often this information is contained in a medical record either in a handwritten chart or increasingly on a computer screen. This may explain why doctors talk to patients but look at the medical record instead of looking directly at them. In this context doctors want to know what treatments and medications have been prescribed currently or previously to treat the condition the patient is complaining about, and how effective they have been. Based on how much time a doctor has allotted to spend with the patient, he or she may be asked to return for a subsequent visit to attend to other medical conditions that are not urgent or emergencies.

From the patient perspective relief from pain or other distress is paramount, along with feeling that the doctor shows caring and respect. Visits to doctor’s offices are stressful for some people, especially those with health anxiety. When people are stressed and anxious they typically forget what is on their mind and may also have some difficulty listening to what other people are saying or asking. Generally the amount of time spent is less important than the quality of the interaction between doctor and patient. Patients may not always be able to know if the doctor’s diagnosis and treatment is accurate. What they do know is how the doctor talks to them and whether the doctor listens attentively. This is especially so for people who are anxious when they talk to doctors. Some doctors pay attention to these interpersonal variables but many do not. They are primarily interested in making an accurate assessment and prescribing an effective treatment plan. This difference in doctor behavior is partly explained by personality factors, but also can be explained by understanding that doctors are primarily concerned with making a correct diagnosis and not missing anything associated with the patient’s illness. This may explain why a doctor may interrupt a patient to ask additional questions.

In recent years patient satisfaction with medical care has become an important consideration for health care providers as well as organizations that evaluate the effectiveness of health care providers. There is increasing interest in finding out what doctors can do better with respect to maximizing patient satisfaction.
In addition, there is a lot patients can do to facilitate an effective medical encounter between doctor and patient. Recognizing that there is a limited amount of time, it is very helpful to use the time as efficiently as possible. Patients can start by writing down the questions or concerns they have for the doctor and letting the doctor know at the very beginning of the medical visit what those questions or concerns are. Most doctors will try to answer the questions as best they can at some point in the visit. Many patients don’t say anything until the doctor is finished and ready to move on to another patient. Although some doctors may ask patients if they have any questions, it is not surprising that when time is limited doctors may cut a patient short and defer further discussion to a subsequent visit.

Another thing patients can do to promote efficiency is to provide a list of medications, dosages, and dates of other treatment and illnesses. This information may be contained in the patient’s medical record but it is a good idea for patients to be aware of their own treatments and be able to communicate this information to the doctor, either verbally or in writing. It is often helpful to have another person accompany the patient both to provide information if necessary and to remember what the doctor said to the patient regarding diagnosis, and treatment. With or without another person being present, it can be very useful to listen carefully to what the doctor is saying and ask questions if something the doctor says is confusing or not fully understood. It can be helpful to write things down to remember better what the doctor said. Some patients may need a more knowledgeable and assertive family member or friend to advocate for their interests. Ideally both doctor and patient enter a collaborative relationship to promote the medical well being of the patient. The doctor contributes medical expertise and experience. Patients have the responsibility to provide information that can help the doctor do his or her job effectively. Perhaps the most important responsibility of patients is to be not only compliant with the doctor’s treatment plan, but also to live in a health promoting way. The most important question a patient can ask a doctor is “what can I do to better my own health”?