Communicating Effectively with Doctors
Written by: Cherrie
The first time I went to a doctor to talk about my "belly issue" a couple years ago, I was so embarrassed and unprepared that I didn't know what to say, except that it and my daily diarrhea hurt. My doctor tried his best to take the lead in our conversations and fill in the awkward pauses caused by my embarrassment by filling in all the silent moments, but it was more like a question-answer routine in a classroom than a conversation with the doctor. At the end of my first appointment, my doctor said that he was pretty sure it was Irritable Bowel Syndrome (IBS)—but I felt like he was looking only for what he wanted to look for, because I didn't get a chance to tell him the whole story.
In the several appointments that followed, we got to know each other better as doctor and patient. Though I found him knowledgeable, sympathetic, and professional, after every meeting I felt like I didn't get a chance to tell him some of the important things I wanted to say. I’m a pretty fast thinker and talker, but he jumped into the conversation even faster, which made me feel like he was in a big hurry and had no time to listen to me speak. And, at times, it seemed that when I mentioned something I thought was important (e.g., a red flag symptom), I only had a moment to mention it and wasn't given a chance to talk about it; as a result, he wasn't hearing it—or me—and this became a vicious cycle of “who could talk faster.” This affected my confidence in him: If I wasn’t sure he was listening to me, how could I trust that my treatment was in any way personal?
As much as I knew by instinct that he was a good doctor, it was pretty obvious there was a communication breakdown somewhere. But what was it? And how could we communicate better? How could I find a way to communicate better with him?
A good doctor-patient relationship with effective communication is crucial. Luckily, I did, by pure chance, discover how to communicate with the doctor, and others after him. It happened a couple weeks before I had to jump on a plane for a long, international trip. I was anxious and scared and decided that I had to see my doctor and get all my concerns discussed and all my needs heard and met before I could even think of going on that trip. So I grabbed a piece of paper, thought about everything that I wanted to ask him, and made a brief bulleted list. At my appointment I told the doctor I needed to discuss all of the points on my list because this trip was scaring me silly. He actually slowed down and gave me a full thirty-minute session, listened attentively, offered me many coping strategies and reassurance, and prescribed the meds I needed—and a few more, just in case. Apart from feeling understood, reassured, and more confident, this also made me realize that as a patient I could find good strategies to communicate better with doctors.
At first I only planned to write an article on effective communication with doctors for those of us who speak English as a second language. However, in reading through and posting on the forums on a daily basis, I realized that many of the ideas I wanted to write about would benefit everyone. So I expanded and reorganized the content.
Before a Doctor Visit
As funny as this may sound, good communication actually begins before seeing the doctor in person. I felt the way I did after my first appointment because I was embarrassed and didn’t prepare well. Most people don’t realize they are mentally preparing for their visit; however, when seeing a doctor for a new health problem or new symptoms, or when seeing a new doctor, or when being heard by a particular doctor feels difficult, it’s a good idea to prepare as much as possible.
Do a Bit of Research
Do some research, but not too much. A suitable amount of research is helpful, especially for those who do not speak English as a first language and need help with the vocabulary to describe their symptoms and concerns. Doing a little bit of research can prove to be helpful in case the doctor doesn’t think of something you have written down.(Make sure that the information you find is from good, reputable sources such as the Mayo Clinic.) But do not self-diagnose. After all, as my doctor said, "Dr. Google can give you more information in an instant than I can give you in the whole hour or the whole day, but the key thing is how to make sense and organize the information you get and relating the re-organized information to your specific situation. That's where doctors come in and that's where humans are better than machines."
The First Visit: Make a List of Questions for the Doctor
It’s a good idea to compile a list of questions so that you and your doctor have something to discuss at the start. This is also a good idea if you have a short appointment.
You can find some good lists of questions here:
You can also find a patient-generated list of questions on our IBS self-help forums:
However, you are best off using these lists to help you create your own. I will write about this a little more in the section “How to Ask Clear Questions.”
Document Your Symptoms
Document what your symptoms are, if there are changes in your symptoms, what these changes are, what you've taken or tried, what works and what doesn't, and what other factors such as stress can do to your symptoms. List all other health conditions as well as medication you're currently taking or have taken recently. Seeing patterns and anomalies will help you and your doctor find strategies and suitable treatments. I found that when I do a little mental or paper-pencil summary before going to an appointment, I don’t have to rack my brain to try to remember what's been happening with me. A brief, bulleted list that covers the important concerns is the most effective. I feel better about and more in control of what I see from my symptoms and what I'm going to say during the appointment. My doctor also feels better because we actually have a brief but effective list of specific things that we can talk about, rather than talking quickly about nothing and filling in the blanks as we go along.
Highlight What Needs to Be Heard
One simple way to help yourself and your doctor is to highlight your highest-priority concerns so you don’t forget to discuss them during your visit.
However, making a list is less useful if you feel your doctor isn’t listening or hasn’t heard what you are trying to say. This is when it might be helpful to highlight what you need your doctor to hear. It is interesting how we learn through different senses—when the sense of hearing fails to recognize the importance of a message, the sense of sight may catch it; reading and then talking about something may reinforce what you learned while reading. I've tried this, too. It doesn't have to be a whole paragraph. It could just be one or a few sentences. For example, "When I have an attack, the pain is excruciating. I'd be shacking in a fetal position and my tears couldn't help but rush out. The meds I've been taking didn't help. I need something new." This could help if you are trying to explain your pain to your doctor, or if you are like me and never seem to appear sick when you are at the doctor’s office.
During Your Visit
Face-to-face communication during a visit is the major, if not only, way that patients can directly describe their health issues, voice their concerns, and discuss or receive treatments (and/or tests) with their doctors. So communication must be effective. Over time I've developed and used a few strategies to make effective use of the appointment time (especially when the appointment is short), to be heard, and to ask questions in a way that I’ll most likely get an answer.
Start by asking your doctor how long your appointment will be. This will give you a rough idea of how much and what to focus on during you appointment. You would probably talk about things very differently if the appointment were only fifteen minutes rather than, say, one hour. You could also ask your doctor if you can make a longer appointment when you do have a lot to talk about.
Although most of your appointments likely will be shorter, while in an hour-long appointment you can cover many issues and take your time. Most of my appointments have been shorter—15–20 minutes. In shorter appointments you will need to focus on the most important or urgent issues. For example, describe symptoms that you're most concerned about and/or new symptoms or symptoms that are red flags according to Rome II/III criteria. If you are planning to do something you typically don't do (e.g., go on vacation at a resort, take long plane trips, or travel internationally), or if your current medication isn’t working well and you need new medication or a dosage change, these are all important issues that you should bring up immediately.
How to Be Heard During the Appointment
This is when keeping a thorough list of questions and concerns really comes in handy. When your doctor sees the highlighted parts of your list or reads your notes, their brain processes the information differently than if they are only told the information. Sound is transient and not durable—sound alone may not have as much an impact as both visual and auditory information. Plus, spoken and written language can be very different—a polite way of speaking face-to-face may soften the seriousness of what you are trying to get the doctor to hear; your tentativeness as part of being a patient may lead you to soften your statements even more; and some written words that can add a lot of emphasis and weight to what you write are seldom used in spoken language. Showing your doctor your notes will likely be helpful. It has been for me.
I don't mean to suggest that using written notes every time is the best way to communicate—if it starts to get routine, what you are trying to convey may sound less important. I recommend that you employ paragraph-long narratives only when your situation is serious and when your doctor has failed to hear you after you've tried at least three times.
How to Ask Clear Questions
There are a lot of questions on our site (http://www.ibsgroup.org/forums/index.php?showtopic=64678
). Make sure to vary the types of questions and ask only those concerning your own symptoms, your medical/family history, and your treatment—theoretical questions about diagnostic criteria and questions about your doctor's qualifications, for example, may not help you communicate effectively; asking these questions may be perceived as being argumentative.
Asking a question in a slightly different way may make your doctor want to answer it instead of ignoring it. For example, "Are there any alternative ways to taking aggressive drugs for me to try first?" is a good question that's likely to be answered, whereas "will you be open to alternative treatments?" may sound too strong, because the latter doesn’t give the doctor a chance to say "no" without sounding closed-minded.
How to Cover All Your Questions
In case you have a long list to discuss but can’t get a long appointment with your doctor, a bulleted and highlighted list will be helpful. Make sure you cover the most important topics first. When I took my list with me to the appointment before my vacation, I actually took out the list and showed it to my doctor. I said in a pleasant way that I really needed to get everything covered because it was going to be my last visit before a long trip, and I wouldn’t be able to talk to him for a long time. Because I was so direct, he knew right off the bat that that the visit would be longer than my usual visits. As I went through the list with him from the most important to the less important, I saw him slow down noticeably, listen attentively, and make sure I said everything I needed to for each point. It was one of the most successful appointments I have had. In retrospect, aside from the list, I also let him know right at the beginning about the importance of covering everything, so he was prepared not to rush.
The End of Your Appointment
I've formed the habit of, at the end of the appointment, asking when my doctor wants to see me again. At the end of your first appointment with a new doctor, make sure to ask how you can reach your doctor (by phone or e-mail) or relevant staff members (pharmacy, nurse). Also ask this when you're ready to start or quit an antidepressant or a drug that poses risk to you. Many doctors will give you contact information when you start new medication that may pose risks, but in case they forget, make sure you ask.
Researching, documenting, organizing, and highlighting will help you communicate with your doctors effectively. Researching, noting down your symptoms, and going over what you would like to say mentally or on paper also may help you organize. You also need to set the structure of the appointment in the beginning by letting your doctor know your major concerns, by showing a list (number) of your questions, and by highlighting what you want them to hear. This will help you and your doctor communicate better and form a long and lasting relationship.