Thursday, August 5, 2010

How to Talk to Your Doctor - Simple Easy Steps

As a practicing primary care doctor, I continue to work incredibly hard on making my bedside manner even better so that patients feel heard.  The other reason is because as most doctors learned in medical school 90 percent of getting the right diagnosis comes from taking a good history from a patient.

Unfortunately with shorter doctor office visits and doctors interrupting patients within 23 seconds of starting, you need to know how to get your concerns across.  While I don't believe this is the responsibility of patients, the reality is not everyone has access to doctors with great bedside manner.

How to talk to your doctor is quite easy if you follow these simple steps.

Set the agenda.  Before you go into the doctor’s office, decide what you want to discuss.  Are you there for a physical and to receive preventive care and tests? Do you have new problem that needs a medical evaluation or an ongoing problem that requires follow-up or further treatment?  If you want to talk about four concerns, tell your doctor at the beginning of the visit that you want to talk about four items and list them, without going into too much detail at first. Be sure to indicate which one is the most important to you.

Bring up the most important concern you have first and not at the end of the visit as you are about to leave.  We find this extremely frustrating and maddening. This will help the doctor enormously as he determines how much time to spend on each problem and how to pace the office visit.  If you leave a surprise at the end of the visit, the doctor may not spend adequate time to address your issue.

Write up a list of problems and questions you wish to discuss and make the number manageable.  If at all possible, I recommend tackling no more than four concerns in your office visit, especially if the four are new problems never before evaluated by your doctor. The goal is not to cram in as many problems as possible in a visit, but rather to get the most out of the visit by getting an accurate diagnosis and treatment plan. The aim is quality, not quantity.

After setting the agenda, next go into detail into each problem with the 4 W's the When, What, Where, and Why.

Ask your doctor which problem he wants to tackle first. Alternatively, you can just begin by talking about each problem in depth.  Always tell your problem the same way you might tell a story. Start in chronological order. Give it a beginning, a middle, and an end. Understanding your problem is far easier to follow if you do it this way.  While this may seem obvious, you’d be surprised how many patients don’t start at the beginning. They talk about their symptoms in no particular order and blurt out whatever thoughts enter their heads.

To help you organize your thoughts, use the Four Ws — the when, what, where, and why. The Four Ws help enhance your story to make sure that important details aren’t overlooked. Your doctor may ask you to clarify or expand on details if you forget them. Organizing your thoughts logically using the Four Ws brings a level of sophistication and detail to the office visit that increases your chances of getting the right diagnosis.

Start with the when, the what, and the where.  Finish with the Why.

  • When did you first notice the problem? Describe how the problem has changed over time.
  • When does it seem to occur?
  • When was the last time you had the problem?

  • What activities, treatments, or behaviors seem to make the problem better, worse, or no different (this can include home therapies like taking over-the-counter medications, applying heat or ice, eating or not eating, going to the bathroom, movement, activity or lack of, etc., depending on the problem).
  • What does the problem feel like? How would you describe the pain (i.e. sharp, dull, burning, gnawing, pressure-like, tight, achy, constant, increasing, comes and goes).
  • What other problems or symptoms have you noticed?

  • Where did the problem start? Did it move over time, and if so, where?
  • Does the pain or condition move anywhere else in the body?

Finally, end with the why. The why is the reason you are at the doctor’s office. While you don’t have to provide this information, as it may be completely obvious, doctors may ask when it isn’t clear why. They also may not.  Reasons are personal and quite varied.

  • I want to make sure it isn’t anything serious, like cancer or a heart attack.
  • I wanted to make sure I don’t need to take antibiotics, change my behavior, or forego my vacation.
  • The problem is interfering with my lifestyle.
  • My wife/husband/family member is worried about my problem.

Once you finish describing your first problem, move on to the others using a similar format. Although it does take some time to think about how to fill in the details about a particular issue, the payoff is that your doctor will have plenty of information to work with. This will increase the chance of him providing you with the right diagnosis and treatment.

Avoid the urge to diagnose yourself and say things like “I have the flu.” Although it seems like convenient shorthand, doctors are very specific with terminology and what you mean could be completely different than what a doctor understands the term to mean. Going to medical school is like immersing yourself in a foreign country. In four years medical students learn an entirely different culture, language, and perspective on the world. Their new vocabulary provides them the precision, understanding, and tools to communicate with their peers.

Perhaps it isn’t surprising that many doctors have forgotten how to speak normally!

Instead of self-diagnosing, talk about your symptoms. This doesn’t mean you can’t ask questions like, “Do you think I have a pinched disc in my back?” or “Do you think I have pneumonia?” or say things like, “These symptoms remind me of the time I had pneumonia.” If you have had the problem in the past, go ahead and tell your doctor. Many times these comments are very helpful.Wise patients know that getting an accurate diagnosis requires that their doctors have all the information they need.

Set the agenda.  Describing your problems in a concise format, using the four Ws, means your doctor has all the information he needs to make an accurate diagnosis.  Better diagnosis may mean fewer visits, getting healthier sooner, and possibly less unnecessary testing and interventions saving you both time and money.

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