Talking With Your Doctor

Have you ever thought or heard someone else say, “My doctor doesn’t help me” or “Going to the doctor is a waste of time”?

Unfortunately, these feelings are sometimes justified. Not every visit to the doctor is well-spent, and people can leave the doctor’s office feeling discouraged, confused, and disheartened. Why is this so? This article will explore the doctor–patient relationship and seek to understand what can go wrong at a doctor’s visit — and how to make it right. The focus will be on making the most of the important 5, 10, or 15 minutes you have with the physician.

Remember, the goal of a visit to the doctor is to explain what your problem is, come up with a treatment plan that the doctor and you can agree on, check on how well the plan is working, or make changes if the plan isn’t working as expected. For this to happen, you and the doctor must be able to communicate clearly. In seven of the eight “scenarios” that follow, something goes wrong to prevent this. In some cases, the patient is mainly responsible for the problems that arise. In others, the responsibility is primarily the doctor’s. Figure out what went wrong in the scenarios, then use the tips at the end of each one to help you and your doctor avoid similar mistakes and make all your visits the best they can be.

Doctor visit scenario 1

Mr. Social has back problems. He has been complaining to his wife for a number of weeks because they can’t have sex and he can’t sleep, travel, or even help carry in the groceries. Mr. Social has been taking his headache pain medicine to help with his back pain, but Mrs. Social is understandably concerned and has been encouraging her husband to see the doctor. She wants him to explain to the doctor just what is going on and how much the back problem is affecting their lives. On the morning of the appointment, Mrs. Social offers to go with her husband. Mr. Social insists he is going alone. When Mr. Social sees his doctor in the exam room, the conversation goes like this:

Dr. Trying to Help: Hi, Mr. Social. How are you today?

Mr. Social: Hi, Dr. Trying to Help. I’m good, I’m good. And how are you?

Dr. Trying to Help: I’m fine. And what can I help you with today?

Mr. Social: Not much. My wife just wanted me to come in to see you since I haven’t been here for a while. Did you see how great the Eagles played on Sunday? I couldn’t believe the score. They just might make it to the Super Bowl after all. Don’t you think that could happen?

Dr. Trying to Help: Well, maybe. To be honest, I don’t really follow football. So, do you need me to do anything for you? Do you need any prescriptions filled?

Mr. Social: Yeah, I just need my medicine renewed. You know, the painkiller for my headaches — the one I usually get. My headaches have been fine but I still get them and like to have the medicine in case I need it.

Dr. Trying to Help: That’s easy. You’re sure nothing else is wrong?

Mr. Social: No, I’m good. Thanks.

When Mr. Social arrived home, Mrs. Social anxiously asked him how the visit went. Mr. Social said it went fine and that the doctor just told him to use the medicine he takes for his headaches. Mrs. Social resigned herself to additional difficult times related to this health issue.

What happened?

This scenario might sound far-fetched, but it’s actually pretty common. So what happened? Obvious, you say. The patient avoided discussing his health issues and was more interested in socializing. Perhaps he was embarrassed to have a health problem. Perhaps he hoped the health problem would just go away. Whatever the reason for his reticence, Mr. Social not only wasted his own and the doctor’s time, he also wasted money on the visit. More importantly, his failure to address his problem may have let a potentially serious health problem go undiagnosed and untreated. (And remember that early diagnosis and treatment is most often the best.) Perhaps a few simple visits to the physical therapist or a different medicine might have eased his pain and helped his family as well.

Recommendation

Avoid the temptation to socialize. If you have a hard time explaining your health problem to the doctor, either take someone with you who can help tell your story or write down and rehearse what you are going to say beforehand.

Doctor visit scenario 2

Mrs. Worried is concerned because she has a rash on her face. She has also begun to feel tired all the time and has, in the past month, been experiencing joint pain and stiffness in the morning. She had a baby two months ago and thought these symptoms would get better rather than worse. Two weeks ago she went to the doctor. He ordered lots of blood and urine tests and said he might know what the problem was. Mrs. Worried is returning for her next visit. She is upset, but she has confidence that the doctor will explain what is wrong.

Dr. Big Words: Hi, Mrs. Worried. How have you been feeling these past two weeks?

Mrs. Worried: Hi. I’m not feeling very good. I am tired all the time. The baby isn’t sleeping, and I confess I am very concerned. I hope you have some idea of what is wrong.

Dr. Big Words: I am sorry to tell you that I think you have a chronic disease. The blood test indicates that you have systemic lupus erythematosus. It affects many parts of the body, including the nerves, joints, muscles, skin, and kidneys. There’s no cure. To treat it, you will need to take serious drugs, possibly for the rest of your life. I’m going to write you a few prescriptions. You will need to have lots of tests and be on the lookout for side effects. I’ll see you in a month. OK?

Mrs. Worried: OK, I’ll make an appointment for next month. Thanks. You think I’ll feel better?

Dr. Big Words: Can’t be sure about that. I have to see my next patient. Make your appointment, and my receptionist will give you the prescription.

Mrs. Worried left the doctor’s office and burst into tears.

What happened?

As you can easily see, Dr. Big Words was not very helpful. Using medical terms without explaining what they mean can be very scary for any patient, especially one who is already worried. In this example, Mrs. Worried received a serious diagnosis and clearly needed additional education and support. If Dr. Big Words really wanted to be helpful but did not have the time, he could have asked his staff to help Mrs. Worried by explaining her condition and its treatment, or he could at least have given her some literature to read.

Recommendation

If you have to deal with a Dr. Big Words, remember you have the right to ask for explanations. Request definitions for any unfamiliar terms, and write down important information, such as the names of the conditions, medicines, and test results. If all this information is overwhelming, ask if you can call the doctor later, or request to speak to someone on the doctor’s staff. It also may be helpful to take someone with you to help you sort out all the new information.

Doctor visit scenario 3

Perhaps you believe that it is important to tell the doctor what is going on in your life. The patient in scenario three thinks so, too.

Mrs. Tell All has had a terrible month. She is finally seeing her specialist and has lots to say about why her aches and pains have been far worse that usual.

Dr. Good Listener: Hi, Mrs. Tell All. I haven’t seen you for a while. How are you doing?

Mrs. Tell All: Doctor, it has been a terrible, terrible month. So much has happened to me and my husband and my daughter. First, we had a leak in our roof that the roofer still has not fixed. We’ve been catching the leak with a bucket, and now we are afraid we have mold in the house. Hopefully, the roofer will be out next week. Also, the dog got out last week and got hit by a car. The veterinarian thought he could save him, but we had to put him down. It was so hard. And my daughter’s husband just heard he is being transferred to California. I am so upset and so is she. Now I won’t have a chance to play with my grandchildren. We have been crying all week. Their house needs repainting before they sell it. I don’t know how they will get it all done. And my aches and pains have been horrible! I hope you can help me.

Dr. Good Listener: My, Mrs. Tell All, you have had a few upsetting weeks. I’m not sure I can help you with most of these issues. Unfortunately, we are very busy today. I am going to give you some medicine that I hope will help you, some strong pain medicine and also something to calm you down. I will see you again in a month to see if the medicine is working. I am still concerned about what your diagnosis really is. Please bring me a list of your physical symptoms next time. Here are your prescriptions. See you next month.

What happened?

In this scenario, Mrs. Tell All talked so much about all her family’s issues that the doctor really didn’t have time to help her. By the time she got around to talking about her aches and pains, she had already taken up much of the important appointment time with issues the doctor could do little about.

Recommendation

While it is important to tell the doctor what is happening in your life when it affects you and your condition, you must do it in a concise manner. Remember to focus on those issues you need the doctor’s help with. And remember that many doctor visits are only 5 or 10 minutes long. This includes the time the doctor needs to examine you, explain test results, discuss plans for the future, and prescribe medicines. So if your situation is like Mrs. Tell All’s, simply telling the doctor that you and your family have been under a lot of stress and that your pain seems to be worse as well may be best. Then the doctor can ask whatever questions he or she needs to, treat your condition, and also suggest strategies for dealing with your mental distress. For example, the doctor may recommend that you talk with a social worker, psychologist, or other stress-management professional.

Doctor visit scenario 4

We all know doctors are very busy. We also know that our visits with the doctor can be interrupted by an unexpected issue with a seriously ill patient or by a necessary communication with one of the doctor’s equally busy colleagues. While we want to have the doctor’s undivided attention, we also want to be considerate of our doctor’s other demands. These conflicting desires can present a problem. How would you handle the following situation?

Dr. Very Busy: Good morning, Miss Lots of Issues.

Miss Lots of Issues: Good morning, Dr. Very Busy. I am so glad I am here to see you. I really haven’t been feeling very well and am hop—

Knock on exam room door.

Dr. Very Busy’s receptionist: Dr. Very Busy, Dr. So-and-so is on your private line. He says it is very important.

Dr. Very Busy: Hi, George. Yes, I know we have our golf game this afternoon. 2 PM. I am doing my best to clear my schedule, and I should be able to make it. I’ll plan to meet you at the golf course. See you later. Now, Miss Lots of Issues, what were you saying?

Miss Lots of Issues: Well, Doctor, I am having a new pain radiating down my right leg. It keeps me up at night and there is no one position—

Knock on exam room door.

Dr. Very Busy’s receptionist: Doctor, your wife is on the phone. She says it’s extremely important.

Dr. Very Busy: Hi, Jean. What’s going on? OK, I’ll talk to you about that when I get home tonight. Yes, I’ll remember to pick up the milk. Now, where were we?

Miss Lots of Issues: Well, I was telling you about my pain. What would you like to know?

Dr. Very Busy: I’m thinking I may need to see you again in a few weeks. We’ll see if you are feeling better. Please make an appointment with my recep­tionist.

What happened?

This appointment was a nightmare for Miss Lots of Issues. The doctor’s mind was clearly elsewhere, and she couldn’t get a word in edgewise. While few doctors would be this inconsiderate, similar situations do arise. What can you do?

Recommendation

If there are too many interruptions during your visit, make sure you speak up and ask that the doctor spend time with you. You deserve your doctor’s undivided attention, allowing for those occasional times when a needy fellow patient may require the doctor’s help. You and your doctor need to see yourself as a team. If the behavior should continue, it may be time to look into finding another doctor.

Doctor visit scenario 5

With our busy lives, fitting in visits to the doctor can be hard. It is especially stressful for patients, as well as for family and friends who may come along for the visits, if the doctor constantly runs late. Patients often find it difficult to complain because they need help and do not want to upset the doctor by criticizing his or her staff. You can make the situation better, however, by having a simple conversation with the doctor during the visit. It is important to think through and practice what you would like to say. The following is an example.

Dr. Always Late: Hi, Mrs. On Time. How are you today?

Mrs. On Time: I’m good, Dr. Always Late. I have been taking my medicine regularly and am hoping the blood test I just had will show that my health is improving.

Dr. Always Late: Actually, your blood tests are excellent. Much better than at your last visit. It looks like the medicine you are taking is working. We will stick with the medicine and stay with the same dose.

Mrs. On Time: That’s great, Doctor. I will keep taking my medicine regularly. There is something else I want to mention. I’m hoping you can help me with this. As you know I work about 15 minutes from here. I have to miss my lunch and get special permission from my boss to come to these appointments. When I arrive, I usually have to wait at least an hour, sometimes more. I really want to come to see you. You have helped me so much. I was wondering if there was a way for our visits to be on time?

Dr. Always Late: I know I run late. I am so sorry. I will try to do better. I’ve been planning to talk to my staff and see if there is a way we can cut back on delays. All of my patients are important, and I want them to get the attention they need. Sometimes I get called to the hospital unexpectedly, but still an hour or more is a long wait. For now, why don’t you call my office before you leave your office and see what time the receptionist thinks we will be able to see you? Or maybe you could try to schedule an early-morning appointment. That way, you won’t have to sit here waiting. In the meantime, I’ll see what I can do to fix the problem. Thank you for bringing this up in such a nice way.

What happened?

When discussing this issue with the doctor, Mrs. On Time did not accuse the doctor but was very polite and even gave the doctor a compliment. She used an “I” statement (“When I arrive, I usually have to wait at least an hour”) rather than making the doctor feel angry or defensive by using a “you” statement (for example, “You are always running late”). She took the time to explain her dilemma, and in return the doctor offered a few suggestions to help her with the problem.

Recommendation

Take the time to discuss problems with the doctor in a nonthreatening manner.

Doctor visit scenario 6

Mrs. Didn’t Try has recently been diagnosed with rheumatoid arthritis. She has been told by her doctor that she must take her antirheumatic drug regularly. She has also been prescribed the corticosteroid prednisone, which the doctor hopes will bring her inflammation under control more quickly. If this plan does not work, the doctor will decide at the next visit on a new course of treatment.

While this patient wants to do the right thing, she has decided not to tell the doctor that she has not been taking the recommended prednisone. Mrs. Didn’t Try heard that prednisone can make a person gain weight and has told her husband that she will not take the prednisone “no matter what.”

Dr. Doing Right: Good afternoon, Mrs. Didn’t Try.

Mrs. Didn’t Try: Oh, Doctor, I’m so glad to see you. I’ve been taking my medicine, and it really doesn’t seem to be helping. I am so upset.

Dr. Doing Right: Yes, I can see your finger joints are really swollen. Are you still stiff in the morning?

Mrs. Didn’t Try: Oh, I am so stiff. I can hardly get out of bed. My hands are so painful, my feet hurt, my knees are swollen. I feel horrible.

Dr. Doing Right: You said you are taking all of your medicine. I am concerned that what we have you on now is not working. We need to better control your inflammation. I think I will keep you on the medicine you are already taking while also starting you on some stronger medicine. I had hoped the first medicines would help, and I confess I am a little worried.

What happened?

For one reason or another, Mrs. Didn’t Try didn’t want her doctor to know that she hadn’t been taking her medicine. When Dr. Doing Right prescribed a stronger medicine, she therefore did so on incomplete information. This is a dangerous situation and can lead to a wrong diagnosis or an unnecessary drug prescription.

Recommendation

Tell the doctor the truth. If for any reason you are not taking a prescribed medicine, the doctor needs to know about it. And if your doctor prescribes a medicine you know you are not going to take, do not leave the office without letting him or her know. If you let the doctor know your concerns, perhaps he or she can help assuage your fear about the medicine or recommend another treatment that is just as effective. Above all, it is important that you be comfortable with your own treatment.

Doctor visit scenario 7

We all have a vision of what we would like to happen at a doctor’s visit. When that doesn’t happen, it can be very upsetting.

Mrs. Needs Help has been diagnosed with rheumatoid arthritis. She has two small children ages one and three. Her relatives, while concerned, live five hours away and have been dealing with their own health problems. Mrs. Needs Help has a husband who does not help, calling her lazy and telling her to get a job. The medicine the doctor has put her on is very costly, and the family’s insurance plan has no drug coverage. Mrs. Needs Help has been very depressed, crying all the time, and is worried that she will get worse and not be able to take care of her small children, much less return to work. Dr. Not Helpful is her doctor.

Mrs. Needs Help: Hi, Dr. Not Helpful. I am not doing well. I have been taking my medicine, and it really doesn’t seem to be making a difference. I think I will have to stop it.

Dr. Not Helpful: That’s ridiculous! The medicine will begin to help you soon. Why in the world would you stop taking it? Have you been getting the rest I suggested at our last visit? Just stay on it like I told you last time.

Mrs. Needs Help: Well, I will try, but the medicine is so expensive. My husband is worried we will not be able to keep buying it. He wants me to go to work. But I don’t think I can work. I feel so stiff. The kids are little and need so much help, and I’m not getting much rest. I’m tired all the time. I cry and cry.

Dr. Not Helpful: I’m not sure what more I can do for you. I wanted you to get plenty of rest, and you’re not following my suggestion. Just take the medicine and I’ll see you in a month.

What happened?

Obviously, this was not the doctor visit that Mrs. Needs Help needed. Dr. Not Helpful was so focused on the treatment he prescribed that he was completely deaf to Mrs. Needs Help’s legitimate concerns.

Recommendation

If you are ever faced with a doctor like Dr. Not Helpful, you should try to assert your needs so that they are heard and properly addressed. If that doesn’t work, there may be no option but to consider changing doctors.

Doctor visit scenario 8

Now let’s see what happens when Mrs. Needs Help has an appointment with a doctor who is a little more supportive.

Mrs. Needs Help: Hi, Dr. Wonderful. I am so glad to see you. Things have not been going well.

Dr. Wonderful: I’m sorry to hear that. Tell me more about what is happening.

Mrs. Needs Help: Well, I have been taking my medicine regularly, and it really doesn’t seem to be making a difference. I think I will have to stop it because I don’t have insurance, and my husband says we can’t afford it. We can barely afford these appointments. He wants me to go to work and says I am just lazy. But I feel so stiff, and I don’t think I can work. I’m tired all the time. I don’t seem to be able to get the rest you told me to get. The kids are so little and need so much help. And this past month all I do is cry.

Dr. Wonderful: I’m very sorry to hear all that. But I’m glad you’re able to explain so well how you’re doing. I think your medicine is important, and I want you to stay on it. I will give you some samples and give your name to the drug company who makes the medicine to see if we can get some help from them so you can continue to take it. Getting rest at this time is very important. Do you have any relatives or neighborhood babysitters who could watch the kids in the afternoon for an hour while you get some rest? As for your crying and depression, I am going to prescribe an antidepressant medicine. If you are not feeling better by next month’s visit, I will send you to a psychologist who works with some of my patients and really understands chronic illness issues.

Getting used to having a painful chronic condition such as rheumatoid arthritis takes time, but we’ll get through this together. Tell your husband if he wants to talk to me, I’d be glad to answer any questions he might have. I do not recommend that you return to work at this time.

Also, I’m going to send you to see my office manager. We will make sure you are on a reduced payment schedule that you can afford. I do not want you to be without care. See you next month.

What happened?

Dr. Wonderful could not make all Mrs. Needs Help’s issues go away, but she was able to do a world of good by listening, offering emotional support, and proposing concrete ways to address her patient’s concerns. Mrs. Needs Help left the appointment feeling hopeful about her ability to control her arthritis.

Recommendation

Make sure you thank your doctor for the sincere and important help that he or she has offered. Let the doctor know how some of the suggestions worked for you. Positive feedback will help the doctor know what a big help he or she has been.

Want to learn more about having a successful doctor visit? Read “Your First Appointment With a New Doctor” and “Six Helpful Questions to Ask Your Doctor.”

Wendy McBrair spent 30 years as a health-care professional in the fields of rheumatology and orthopedics, where she specialized in patient and community service, patient education, and advocacy.

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