A visit to the doctor these days is a
sprint, not a marathon.With luck,
you’ve got about 22 minutes from start to finish,
maybe a couple more if your doctor is a woman.
You begin with a
disadvantage – you’re sitting down, half-naked, sick
and scared. The doctor is vertical, dressed,
presumably healthy, definitely the top dog. This
event is winnable – but winning means finishing
together, with a health plan you come up with
jointly.
To get the max
from a minimal doctor visit, you have to screw up
your nerve and ask, front and center, about the two
or three things that worry you most, not the 20
other things you’re vaguely concerned about. Don’t
blither on about your latest cold if it’s your heart
arrhythmia, your depression, your drinking, your
spouse’s abuse or your sleep troubles that are the
real problem.
If you are
seeing a new doctor, or even a familiar one whom you
haven’t seen in a while, take a minute to remind the
doctor of important things in your medical history
or your life – how long ago you had your heart
attack, for instance, or whether you’ve just gotten
divorced. If your medical history is complicated,
bring your medical records with you to save the
doctor tracking them down.
“Don’t assume
that your doctor knows your whole medical history,”
said Sherrie Kaplan, a social psychologist and
associate dean for clinical policy and health
services research at the University of California,
Irvine, School of Medicine. This is especially true
if your medical clinic has a high turnover or you
see multiple doctors for different conditions.
To help you and
your doctor focus on the important things, write
down your questions and bring a list of all the
medications, prescription, over-the-counter and
herbal, that you take, said Dr. Donald Berwick,
president and CEO of the Institute for Healthcare
Improvement, based in Cambridge, MA. (You can also
put all your medications in a bag and bring them
with you.)
To be sure, some
doctors shudder when a patient walks in with a long
list of questions, said Dr. Barbara Korsch, director
of patient-doctor communication at Children’s
Hospital in Los Angeles.. But if you’re worried
about being too pushy, keep the list in your pocket
or purse, then check it mid-way through the visit to
be sure you’ve mentioned everything important.
For their part,
doctors should not be afraid to look at their
watches and then say something like, “I have about
10 minutes left. How would you like to spend this
time?” said Korsch. You can also ask how much time
the doctor has for you.
If you’re really
sick or your disease is hard to understand, take
notes and bring someone with you to listen and help
ask questions, suggested Dr. John Flynn [cq],
clinical director of the division of general
internal medicine at Johns Hopkins Medicine. “It
always helps to have another set of ears,” he said.
And another
mouth. When husbands and wives go to the doctor
together for the husband’s checkup, said Kaplan, a
common scenario is that the husband will answer,
“No,” when the doctor asks about chest pain, leaving
it to the wife to add something like, “Are you
kidding? You sat across from me two days ago, turned
gray and started sweating!”
On the other
hand, if you’re concerned about spousal abuse or
your spouse’s drinking or other problem, bring
someone else with you if you can. If your spouse
insists on coming, try to signal the doctor that you
need a private word.
If the doctor’s
answers to your questions are likely to be
complicated, you might consider bringing a tape
recorder with you - though some doctors may be
squeamish about this.
The key to
successful patient-doctor communication is what
Kaplan of UC/Irvine called “planned patienthood.”
Kaplan has been analyzing audiotapes of
patient-doctor visits for decades to see what works
and what doesn’t for good communication.
In general, she
has found, women are much better than men at asking
questions and being assertive with doctors. “Men, on
average, ask zero questions. Women, on average, ask
six,” said Kaplan, who attributed this to the fact
that women get more practice dealing with doctors,
both from going earlier in life for reproductive
issues and from taking kids to pediatricians.
Kaplan has
developed a program of “coached care” to help
patients get more from doctor visits. While patients
are still in the waiting room, her research team
goes over their medical records with them and helps
them formulate questions for the doctor. The team
then audiotapes the doctor visit.
Kaplan, in her
study of five chronic diseases, has found that the
patients who get coached care actually do better on
physiological measures of improvement (such as
better control of diabetes) or in daily function
(such as being able to move around despite
arthritis) than those who don’t get help preparing
for the visit.
Short of formal
“coached care” training, Kaplan said, the best thing
for patients to do to get ready for a doctor visit
is “rehearsal.” This means practicing, out loud if
necessary or role playing with a friend or family
member, what you want to ask.
Whatever you do,
don’t wait until the “doorknob” moment – when you’re
dressed, feeling more adult and heading out the door
– to ask the most important question. And before you
do head out that door, make sure you’ve got a follow
up plan in place.
If you have
questions you didn’t get to, ask the doctor if he or
she will accept a few questions by email or by
phone. If you have too many questions for that, ask
to schedule a follow-up appointment in a week or
two.
Judy Foreman’s column appears every other week. Past
columns are available on
www.myhealthsense.com.
