How to Communicate Effectively With Your Physician

Most Americans do not know how to communicate effectively and efficiently with their doctors, and this is through no fault of their own. After all, the average citizen cannot be expected to know the complicated scientific principles it took their doctor many years of intensive training to learn. Yet, the gap in communication between patient and physician often leads to missed diagnoses, excessive testing, and ultimately, prolonged suffering and increased cost for the patient.
Patients don't typically walk into their physician's office and say things like, "Doctor, I'm sure I have an overactive thyroid gland, and after researching the various treatment options, I have decided that I should be treated with radioactive iodine. Please make the necessary arrangements as soon as possible." If it were that simple perhaps 'MD' really would stand for 'Mountain Doctor' (as Granny Clampett claimed) and Jethro Bodine could have been a brain surgeon with a grade school education.
In reality, physicians are trained to listen to the patient's symptoms and then work backwards by asking pointed questions and doing a targeted physical examination, all the while mentally devising a list of possible causes of the problem. Based on his suspicions, he may then order tests to confirm or rule out specific diseases. The stronger the doctor's suspicion of a particular illness, the fewer tests he will need to order to confirm it. In other words, if you can explain your problem in a clear and detailed manner to your physician, you can do a tremendous amount to streamline your care and help your doctor diagnose your problem in a timely manner. This will save you time, money, and perhaps even your life!
The thrust of this course is to give you an overview of how to communicate with doctors in a way that will accomplish these goals. This is no easy task. We all tell our stories in a way that is natural for us, while physicians try to sort thru the medically irrelevant issues and pull out the important facts.
Each month we will explore a different skill that will help you become an empowered, effective health care consumer. Put in simpler terms, to help you become a patient who is an effective health care partner, and not just a health care follower.

Lesson #1
Prepare in Advance

It is important to understand some of the key points that will help your doctor diagnose your illness before your visit begins. Typically, patients mentally pull together their story while they sit half-dressed in an often cold examining room. Not only are they often nervous and physically uncomfortable, they don't know what to expect and often worry about the worst case scenario. All of these factors work together to hinder the way they explain their problems to the doctor. In such a stressful situation, some of the most important facts frequently slip our minds. Meanwhile, the doctor, who is often feeling very pressed for time, may become impatient with the round about story and interject with specific, relevant questions about the problem at hand. As a result, patients often feel offended at being interrupted while physicians, who mean no harm, are torn between listening to every word (whether or not it is clinically important) and being able to move on to the next of many sick patients waiting to be seen. Definitely a lose-lose situation. However, if you think about what you are going to say before your visit, the visit will run more smoothly and you will be less likely to forget important facts.

When you develop an illness, write down the following and be as specific as possible:
-Onset
-Location
-Radiation
-Association (associated symptoms)
-Relation (relatives or friends with similar problems)
-Characterization
-Precipitation (things that precipitate [bring on] the problem) Also list any relieving factors.
-Severity
-Chronologic sequence
-If you have had this problem before

1. Onset of the problem and what you were doing when you 1st noticed it.
ex: "I first noticed the pain 4 days ago while I was watching television."
2. If your symptom is pain, what is its location?
ex: "The pain is in the upper right part of my abdomen."
3. Does the pain radiate (move anyplace)?
ex: "My abdominal pain is worst in the upper right abdomen, but sometimes it moves to my right shoulder blade."
4. Note any associated symptoms.
ex: "Since the pain started, I have not been very hungry, I threw up my dinner once, and I have been constipated."
5. Note if anyone related to your or around you has had similar symptoms.
ex: "Three of my co-workers have been out sick with the same symptoms I have."
6. Describe the character of any pain.
ex: "It feels like someone is jabbing a needle in my leg."
7. Does anything make your problem better or worse?
ex: " I tried an over-the-counter ibuprofen pill every 12 hours, but it did not help at all. Sleeping in a dark room helps a lot."
8. Describe the severity of the problem and the impact of your illness on your usual activities.
ex: "The pain has been so bad I have not been able to care for my little girl."
9. Describe the chronologic sequence of your problem.
ex: "Last week I had a mild headache that got a little worse each day. Now it is incapacitating."
10. Have you ever had this problem before, and if so, did your doctor do any tests?
ex: "Three years ago I had the same problem and my doctor ordered an chest x-ray, but he did not find anything wrong."