Thursday 13: Communication strategies for dealing with doctors

Ha! Photo Credit.
For a healthy person, I've seen a lot of doctors in my day. I've visited specialists in oncology, neurology, cardiology, ophthalmology, and orthopedics to name but a few. I've met excellent physicians and characters I wouldn't let wash my car, let alone treat my family. I've survived MRIs, CTs, x-rays, bone scans, biopsies and surgery. I also worked in health care for six years, but the majority of my expertise in dealing with doctors comes from my experience on the ground, in and out of offices. And so, for this Thursday 13, I bring you some insight on communicating with doctors. (Note: These tips are focused on outpatient medicine and mostly on self-care versus caring for loved ones who are in the hospital.)

1. Expect delays, bring a book. Duh, I know. But I have to say it. I'm still waiting to meet a doctor who runs on time and so I always, always, always bring reading material or something to do in the lobby. What kills me is that they plan on YOU being late. Typically, the scheduler will add 15 minutes to the appointment time for paperwork. If you have a 1 p.m. appointment, there's usually a 15 minute buffer to 1:15.

2. For heaven's sake, be nice. To the front desk staff I mean. These folks deal with people--and sick ones, too--all day long. If you think it's hard to get an appointment, imagine what it's like to schedule them for hundreds of other people. Plus, in my experience, a little nice goes a long way. If you develop a rapport with your doctor's staff, they can often help grease the wheels on future appointments, find out test result information for you, message your doctor, etc.

3. Know thyself. Every doctor I see asks me to fill out some sort of medical history sheet. Guess what? These are important. Recalling accurately family history and personal medical experiences makes my doctor's job easier in knowing what to recommend for a particular problem. This is especially important for prescriptions and over-the-counter medications. Write down what you're taking so that your doctor won't prescribe something that may conflict or cause adverse reactions.

5. Don't lie. The doctor's office is not the place to fib about lifestyle. Although it may seem harmless to lie about how much exercise you get, how many vegetables you dutifully consume and how much you don't smoke, hiding information from your doctor makes it that much more difficult to get good treatment. And, I think it's like lying to the dentist about flossing everyday--they can tell.

6. Ask questions. It's okay to ask questions, to seek definitions of terms, to try to understand the medical jargon, and to get the information repeated. I remember seeing a cardiologist who explained my issues in one long run-on sentence of medical terms I couldn't pronounce, let alone understand. After he finished I asked: "So what does that mean exactly?" He drew me a picture and used plain language. Miraculous. I find asking simple questions like "Why?" "Could you explain that part, please?" and "How is that important?" (in addition to definitions, of course) is really helpful.

7. Question authority. A second type of inquiry is a little more challenging because it involves questioning The Doctor. If you've heard of the Milgram Experiment, you know that lab coats and authority DO count for something and we are more likely to go along with what the "expert" tells us, than what we know is right. (Or even actors dressed up as experts! Scary, but true.) In the doctor's office, I think this means we should make a concerted effort to respectfully stick up for ourselves, question treatment, and engage in dialogue with our doctors instead of just accepting all prescriptions/diagnoses. For instance, when I was having anxiety attacks pre-thesis, my doctor immediately wrote me a script for Xanax. In general, I am incredibly concerned about docs that try to fix everything with pills, so I asked about alternative measures, the motivation for that particular course of treatment, etc. By asking questions, seeking a rationale and engaging in dialogue with my physician, I understood her motivation. In the end, I used homeopathic methods to control my anxiety, but by understanding her motives for prescribing the pills--that having them on hand in case I had a serious attack would be helpful--I felt more confident in my physician.

8. Bring pre-written questions. As you're preparing to see a physician, write down questions ahead of time so that they don't escape you in the office. This may be very helpful when processing a new treatment or diagnosis, or allaying the fears of family members. After dealing with chronic hip pain in high school and seeing way too many doctor types, I ended up with a recommendation for hip surgery. Believe me, my mom had LOTS of questions. Writing them all down helped us when talking with the doctor at our next visit.

9. Take notes. It's difficult to remember details. In fact, research suggests we forget upwards of a third of what we hear almost immediately after we hear it. Ever meet someone and then promptly forget their name? Think of that same principle at the doctor's office where your memory is the difference between taking your medications correctly or not. I like to bring a small notebook with me to write down advice/recommendations, my blood pressure/heart rate, and any to-dos. Having notes is helpful when I need to relate the pertinent info back to Mr. T, too.
How cool is this thing? I found it here.
10. Bring a friend. Speaking of significant others, for complex appointments consider bringing an advocate or friend. T has accompanied me on a doctor's visit or two, and it really improved the type and quantity of questions I asked the doctor, and the resulting discussion.

11. Do what you're told. Guess what? Medications will only help if you take them and advice not followed is useless. (I just erased a rant about people not doing what they're told, but then I realized I was bitching about students past. I figure less is more, yes?)

12. Be self-efficacious. Ah, a nice $10 word. Related to number 11, developing self-efficacy--loosely, the belief that we are capable of accomplishing a particular task--is vital to following directions, especially the behavioral types. In fall of 2008, a "doctor" at a work wellness screening told me I was obese. Incensed (and weighing only 7-10 pounds more than I do right now by the way), I dragged myself to the doctor who then laughed at my "diagnosis." (I may or may not have freaked the hell out at work and complained to HR and then the president of the company who teased me mercilessly.) Despite my not being obese, I did have high cholesterol. What the what? High cholesterol at 26??? Yup. Although a normal weight and having high "good" cholesterol, I had a couple concerning risk factors like genetics and uber-high stress. I talked with my doctor about what I could do to solve my cholesterol problem. She gave me reading material (that I actually read) and told me about fish oil, oatmeal, garlic pills, EXERCISE, etc. The point is, after talking with her, reading the materials and learning about my options, I felt more confident in my abilities to combat the problem. 

13. Realize they call it 'practice' for a reason. I know this may come as a surprise, but doctors aren't magic. Sometimes they may not know what is wrong, or if they do, they may not be able to fix it. I think my favorite medical dramas like "Grey's Anatomy" and "House" generate unrealistic expectations about miracle cures and fast fixes. Sometimes the answer is "I don't know." For example, early in 2008, I maintained a headache for six weeks straight. Initially I thought it was a vestige of a sinus infection gone mad, but post-antibiotics, I still suffered. Advil didn't work. Increasing or decreasing caffeine didn't work. When my eyesight went slightly blurry I wondered, "What if I have a brain tumor?" (I know, I know.) My fears were not assuaged when my doctor admitted she had no idea what was up and sent me for blood work, a CT (BRAIN and sinus) and to the ophthalmologist. After the CT came back normal and the eye doc said my 20-20 was fine despite the blurriness, I waited on the blood work. Weeks and weeks of testing/guessing showed that yours truly was/is anemic. If a normal score is 50, I was a 7. Luckily I found a "cure" in the form of oatmeal, iron pills* and dark leafy greens (I refuse to eat kidneys or liver), but it wasn't without cost both in dollars and time. While I really appreciate my doctor taking me seriously, it was a frustrating indirect process, even with excellent health insurance. However, it helped to keep in mind that she was trying her best and in the absence of answers, she would direct me to other experts who could possibly help. The long and short, reigning in expectations and remembering that doctors are human is really helpful.

As I write, I realize that this list could be a mile long. Anything you would add?


* For some like me, the anemia problem has more to do with absorption of iron than with low numbers in particular. When taking iron pills, try them with orange or citrus juice to aid absorption.

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