Improving Patient-Doctor Communication

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Improving Patient-Doctor Communication

by Lee s*

ImmuneSupport.com

06-02-2008

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The reluctance of many patients to confide fully in their physicians

is a serious concern, with responsibilities on both sides.

A survey was recently conducted by ProHealth asking the question: " Do

you feel safe talking truthfully about your illness or symptoms with

your doctor? " If the answer was " no, " respondents were asked, " Why

not? "

Fifty-seven percent of those who responded said they did not feel

safe – a startling, albeit not entirely surprising, statistic. More

than half of those answering the survey said they do not feel safe

enough to be honest with their doctors about their illness. On the

positive side, 43% are comfortable and feel safe being truthful with

their doctors. But when you consider the fact that we are literally

entrusting our lives to our doctors, the inability of so many to be

honest with them is a serious concern.

Reasons We May Not Feel Safe

Following are the top 10 reasons patients gave for why they do not

feel safe communicating truthfully with their doctor (in order of

frequency):

Doctor doesn't listen or care.

Doctor attributes symptoms to depression or other psychological

problems.

Doctor doesn't understand or believe in my illness.

Doctor doesn't believe me.

Patient fears being labeled a complainer or hypochondriac.

Doctor trivializes my symptoms.

Patient fears being labeled a drug seeker.

Too many symptoms; doctor doesn't want to deal with them all.

Doctor is judgmental.

Patient fears being " marked " by insurance companies.

Other reasons mentioned are that: patient fears that medications will

be taken away, doctor tries to give too many medications, doctor is

tired of hearing complaints, patient is in denial about illness,

patient fears more tests being done, patient is embarrassed, patient

feels there is a lack of confidentiality.

Things That Will Help Make the Most of MD Communications

Although the responsibility for most of these complaints appears to

fall into the laps of the doctors, there are things we as patients

can do to help improve communication with our doctors.

1. Educate yourself. Long before you walk into the doctor's office,

learn all you can about your illness. A good doctor usually respects

and appreciates patients who have enough self-respect to educate

themselves. If you are getting your information from the Internet,

make sure you stick to reputable sources. Chat rooms and forums are

great places to get support, but you can't believe everything you

read on them.

2. Prepare for your appointment. Your doctor has a limited amount of

time to give each patient, so anything you can do to organize your

information will be appreciated. Make the following lists before

every appointment and take them with you.

• Medications – List all medications you are currently taking. This

list should include: prescription drugs, over-the-counter

medications, supplements, herbal remedies, inhalers, and medicinal

creams or gels.

• Symptoms – List all symptoms you experience on a regular basis.

Describe the symptom clearly but try to keep it as brief as possible.

Note when the symptom began, how frequently it occurs, and how it

affects your life. If you list pain as one of your symptoms, describe

the type of pain (that is, throbbing, aching, stabbing, sharp), the

location of the pain, how long it lasts, and its severity (using the

pain scale of 0 to 10 with 0 being no pain and 10 being the worst

pain you can imagine). Note: Avoid the temptation to say your pain

level is 50 on a scale of 0 to 10. Although your intention is to have

the severity of your pain taken seriously, it will have the exact

opposite effect. If you exaggerate your pain level, your doctor will

assume you're exaggerating everything else as well.

• Questions – Write down all of your questions in order of

importance. Don't depend on your memory. Doctor visits can be

stressful and you're likely to forget something if you haven't

written it down. By asking the most important questions first, you

ensure those questions will be answered even if the appointment has

to be cut short due to time constraints.

Ideally your lists should be typed so your doctor doesn't have to

spend time trying to interpret your handwriting. Take two copies of

each list to your appointment – one for you and one for your doctor

to refer to during the appointment and then include in your file.

3. Think about how you speak. When talking to your doctor, be

specific; don't use generalities. For instance, instead of

saying, " My legs hurt when I stand, " try saying something

like, " Whenever I stand for more than five minutes, I get a sharp

pain that goes all the way down the back of my legs. " The second

statement will give your doctor a much better idea of what you are

experiencing and what might be causing it.

The tone and timbre of your voice is another important aspect of

speaking to your doctor. The more calm and rational your voice

sounds, the more likely your doctor will take you seriously. Try to

avoid the two extremes: the whiney patient and the adversarial

patient…

• Don't whimper or whine. Sometimes people who are chronically ill

will develop the habit of speaking in a whimpering, whiney voice

without even realizing it. Unfortunately, no one likes to listen to

whining. If you have children, you know how irritating it can be when

they whine. Instead of causing you to want to do what they are

asking, it only makes you want to get away from them. When adults

whine, we tend to consider them less credible. If you have any doubts

as to whether or not you sound whiney, ask a family member or friend

who will be honest with you. Practice explaining your symptoms in a

calm, rational voice.

• Take the chip off your shoulder. If you've had negative experiences

with doctors before, you may find it difficult to walk into a

doctor's office without having an adversarial attitude – and that

attitude will reveal itself in your voice. Taking a " You'd better do

what I want or else " approach will only cause your doctor to become

defensive and label you a troublemaker. Although you have the right

to be listened to and treated with respect, you can't demand respect.

The more antagonistic your attitude, the less likely it is that

doctor will listen to you or take you seriously. Try to give your

doctor the benefit of the doubt and communicate in a calm rational

tone.

4. Have realistic expectations. If you have a chronic illness

(especially one like ME/CFS or FM), expecting your doctor to give you

a prescription or two that will relieve all of your symptoms is

unrealistic. It usually takes a great deal of trial and error to

figure out a combination of treatments that will help you. It is

realistic to expect your doctor to communicate honestly with you and

work as a team with you in an atmosphere of mutual respect and

cooperation.

5. Think like a consumer. Remember, as a patient, you are also a

consumer. You are paying your doctor to provide a service. Would you

continue to go to a hairstylist or barber who refuses to cut your

hair as you ask? Would you keep returning to an auto mechanic who

insists nothing is wrong with your car, even though it doesn't run?

We demand to receive the services we pay for in other areas of our

lives, but often accept less than adequate service when it comes to

our healthcare.

Evaluating the Result

The responsibility for developing an atmosphere in which you feel it

is safe to be truthful with your doctor is shared by both doctor and

patient. You can only be accountable for your part of the

communication. If you've given it your best effort, applying the

principles discussed here, and still feel your doctor is not taking

your concerns seriously, then it's probably time to find another

doctor. (See " 10 Signs It's Time to Find a New Doctor. " )

___

* Lee s is the Expert Patient, specializing in

Fibromyalgia and Chronic Fatigue Syndrome, for HealthCentral's

ChronicPainConnection