How to Communicate With Your Doctor

This is part 2 of 2 in my 'How to Communicate With Your Doctor' series, started in my previous post, 'How Doctors Think'.  This is a list of ideas and strategies to get the most out of your relationship with and your visits to your doctors.

1. In the weeks leading up to the appointment, keep a list of symptoms, questions and issues you want to discuss. Be specific. Organize and prioritize your list before the appointment. Plan to discuss 2-5 issues, depending on the complexity and time available.
2. Keep a list of all medications, supplements, vitamins, etc. including dosages and frequency. Include past medications, why you stopped them, and allergies and adverse reactions to medications. Also list any medications you need refilled.
3. If it is a new doctor, bring a summary of your medical history, and have any relevant test results and info sent from your previous or referring doctor.
4. Be open with your doctor. He can't help you if you aren't honest. Help your doctor help you by giving all the information he needs to give you the best treatment. If you don't plan to follow his instructions, say so, there may be alternatives more to your liking (less expensive, less time consuming, more convenient, etc.)
5. If you are uncomfortable talking about an issue, write it down. Give it to the doctor to read. Remember that your doctor is trained about all body parts and how to treat them.
6. Give your doctor a copy of your list of questions, issues, etc., and keep a copy for yourself.
7. Look for a doctor whose 'bed side manner' is compatible with you. Some people like a doctor who takes charge, others prefer more of a team approach.
8. Ask questions if you don't understand. Speak up if you don't like what the doctor suggests. Ask for alternatives, and take time if you need to make a decision. Ask for a referral for a second opinion before agreeing to surgery or other intrusive or expensive procedures.
9. Repeat back what the doctor has told you to make sure you got it right. Write down instructions. If you have difficulty with thinking clearly, take someone with you who can help make sure you get what you need.
10. Make sure you fully understand your diagnosis and treatment before you leave, as well as what the next step is. If the doctor has left, ask the nurse.
11. Always get copies of test results for your own file, and to share with your other doctors.
12. Find out if your doctor offers email communication between visits.
13. When describing pain, tell: where, how intense (on a scale of 1-10), if it is constant, occasional, intermittent, etc., what it feels like (tingling, throbbing, stabbing, achy, etc.), what makes it better or worse, and how it affects your life.
14. If tests are suggested or ordered, ask what the test will show, method, preparation, what is involved, when to expect results, whether they will call with the results or if you need to call, and insurance coverage. When you get the results, ask for an easy to understand explanation.
15. For a new medication, ask the name, purpose, how, when and for how long to take it, possible side effects, which ones to be concerned about, and what to do if they occur. Is there anything to avoid while you’re on it, such as certain foods, drinks, or other medications or driving? When should it take effect and the cost. Have one doctor take charge of all your meds to minimize chance of interactions. If a medication is not working for you, or you can't tolerate the side effects, talk to your doctor. Don't stop it or change the dosage on your own.
16. If you want to try complementary or alternative treatments, talk to your doctor about it. Present articles and information, discuss pros and cons and possible interactions with current treatments. If you get a doctor's prescription, your insurance may cover it.
17. Educate yourself about your illness. Though your doctor is the expert, he should not be expected to know absolutely everything about every ailment. Keep up with the latest research on treatments, bring in literature to educate your doctor. Some doctors don't like this, find one who does. They are more likely to treat you as a partner rather than just a patient.
18. You have limited time with the doctor. Focus on medical related issues. Other questions, such as directions to a testing center, or the time of your next appointment, or where you should park your car, can be asked of others on the doctor's staff.

If anyone has other ideas to add to this list, please post a comment at the end of this blog post by clicking on the word 'comments'.

Patient/Doctor Relationship

Dr Rob recently posted an interesting Letter to Patients with Chronic Illness.  In it, he talks about how doctors are scared by us because they like to fix people, and we can't be fixed.  They get frustrated by our conditions, and are uncomfortable with how much we know about our illness (often more than they do).  He gives 7 pointers on how we can help our doctor give us the care we need.  I think he is very insightful and honest about a topic not often broached.  His post is well worth reading, as are the comments following it (I read the first few, there are too many to read them all).

The comments I read were angry, an emotion I did not experience when I read his post.  They were angry that, as insightful as his post is, it missed a major aspect.  The doctor is frustrated that he can't fix us?  How do they think we feel?  They are frustrated for the 10-15 minutes they are with us and focusing on our case.  We brought the chronic illness in with us, we have to carry it back out, and are lugging it around 24/7.  I think these readers missed the point of Dr Rob's post.  He is giving a look at what may be going on in a doctor's head, so we can be prepared for working with them.  The fact that we, as the patient, may be more frustrated than they are is irrelevant here.

One of  Dr Rob's pointers is not to put up with jerks.  There are doctors who think of themselves as gods, and when they discover they can't fix us, they assume it is our fault.  If a doctor won't listen to you, or makes you feel belittled, look for another doctor.  Remember that a doctor who comes across as a jerk to one patient may be a perfect fit with someone else.  The opposite is also true.  A doctor who works well with your friend may not impress you at all.  It is important to look for doctors you can work well with over time.  With chronic illness, there are often many issues to balance and juggle, and it takes time to develop a good working relationship.

Your doctor isn't God.  If he thinks he is, run quickly towards the exit (put your clothes back on first).  On  the other hand, your doctor isn't a dog you can train to follow your commands.  I think Dr Rob's main point was that doctors are humans, just like their patients.  We all make mistakes, we all have emotions, we each come to the table (or exam room) with different skills and knowledge.  The key is for both sides to be respectful, to listen to the other side, and work together as a team, using  the skills and knowledge we each bring.