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The simple fact that in over 80 per cent of cases
the diagnosis of the illness can be made purely
on the basis of what the patient tells the doctor
(what is called a medical history) should emphasize
the importance of one's ability to talk intelligently
to one's doctor! While the capability of absorbing
the relevant details of an individual's medical
history is one of the key skills of a competent
physician, being able to provide a lucid history
is a key skill on the part of a good patient.
You need to be able to describe your problem as
accurately as possible. For example, if your problem
is a headache, you should be able to provide all
the details! For instance: Where does it hurt? Has
the pain spread elsewhere ? How severe is the pain?
What does the pain feel like? Is it a sharp, dull,
or throbbing pain? When does it occur? What makes
it better? What makes it worse? Have you noticed
any other symptoms or signs recently, such as fever,
shortness of breath or blood in the urine? When
did the problem start? Has it changed since then?
Have you felt like this before? If so, when? What
made the pain better then? Is it affecting your
daily activities such as sleeping or eating ?
In this context, a useful aide memoir includes the
following details:
- Site: Location (e.g., pain is in the chest
and then spreads to the left arm).
- Quantity: Bringing up a cupful of sputum when
coughing.
- Quality: It feels like an elephant is sitting
on my chest!
- Setting: I usually develop such aches after
fighting with my wife.
- Aggravating factors: Stomachache becomes worse
after eating.
- Alleviating factors: Breathlessness becomes
better after resting.
- Associated Symptoms: Other related complaints.
If you remember to categorize all your problems
systematically, not only can you make better use
of your time with your doctor but you can also help
him arrive at a correct diagnosis more quickly!
You could rehearse the details you are going to
provide to your doctor with a friend or a relative.
You could also summarize them on a single sheet
of paper, just to make sure you don't forget any
vital aspect.
It is a medical truism that if the doctor listens
to the patient intelligently, he will be able to
make the diagnosis correctly. However, just like
learning to take in a good history is a skill the
doctor needs to master, providing an intelligent
history is a skill the patient needs to learn. Patients
are often slipshod while recounting their medical
history so that the doctor needs to methodically
extract the facts from them: and this exercise can
be a painful for both!
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The common gaffes patients make include:
- Getting bogged down in irrelevant details.
- Not providing all the facts.
- Not furnishing the information in a chronological
sequence.
- Jumbling up the details, so that they jump
from one problem to another completely unrelated
one.
Remember to tell your doctor what you think the
reason for your problem is! This 'revelation' can
often provide the doctor with a useful clue. Ultimately,
do not forget that you are the expert on yourself
! You should also be able to provide relevant information
about your health status, both past and present.
The following aspects need to be highlighted:
- Your medical history (including instances
of surgery and hospitalization).
- Your family's medical history.
- Allergies you are prone to.
- Medications you have taken (and are still
taking).
- Your daily routine.
- Your work schedule.
- Pressures you have been subject to (and are
still subject to).
To sum up, the following suggestions will help you
communicate effectively with your doctor:
- Plan well ahead of time what you intend discussing
with your doctor about your problem. Your own
observations about your health problem can prove
invaluable in helping the doctor make an accurate
diagnosis. Carry written lists to make sure
you don't forget any crucial aspects!
- If you are confused by complex medical terms,
ask for simple definitions. There is no need
to be embarrassed; after all, your doctor does
want you to understand what is happening to
you! Remember that your doctor's objectives
and yours are the same to help you to get better
as soon as possible!
- Repeat in your own words what you think the
doctor meant and also ask: 'Is my version correct?'
Such a clarification will ensure that you understand
clearly what the doctor is saying and will also
allow him to present the information to you
again, if required, in a manner which you can
comprehend.
- Share your point of view with your doctor
since he needs to know what's working and what's
not. He or she obviously can't read your mind,
so it is important for you to put across your
thoughts and observations. If you feel rushed,
worried, or uncomfortable, do convey your apprehensions
to the doctor. Try to voice your feelings in
a positive and courteous manner. For example:
"I know you have many patients to see,
but I'm really worried about my condition. I'd
feel much better if we could talk about it a
little more.' If necessary, you can offer to
return for a second visit to discuss your concerns.
- Take notes on what the doctor's analysis of
your problem is and what you need to do to rectify
the situation.
- Discuss frankly with your doctor if any part
of the visit has been annoying or dissatisfactory,
such as a lengthy waiting time or discourteous
staff. Your approach ought to be tactful, but
honest.
- Don't hesitate to voice your apprehensions
about what you may have heard from well-meaning
but ill-informed friends or relatives regarding
your condition. The doctor may be able to dispel
any misconceptions.
- Discuss any self-medication practices you've
used which have relieved symptoms.
- Don't waste your doctor's time by asking irrelevant
questions (for example, about your brother-in-law's
medical problem ). Such a digression is likely
to upset the doctor! Also, try to do as much
homework as possible, so that you can ask your
doctor questions specific to your particular
problem. After all, if you can find the answers
to your questions from another source, say,
a book or by asking the nurse or receptionist,
you can save your doctor's precious time, something
which he will deeply appreciate. You can, nevertheless,
ask your doctor to confirm that the knowledge
you have acquired is accurate!
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Even though most patients realize the need to ask
their doctor certain important questions, many of
them get tongue-tied when they actually come face
to face with their doctor. Not only can they not
think straight, but they also often forget what
questions to ask! But remember that you will only
get answers if you ask the right questions! Rudyard
Kipling's five best friends - What? When? Why? Where?
How? - should help guide you as to what to ask!
A simple example would be asking: 'What is wrong
with me? When did the disorder originate? Why? What
can you do about it?'
A clear understanding of what precisely your doctor
has told you is crucial if you're going to work
together as a team.
At the end of your visit,
you should be able to:
- Describe your condition fairly accurately.
- Know what additional tests are needed and
why.
- Explain your treatment, including the use
of medications.
- State if and when you need to return.
If you can't fulfil the preceding objectives, you're
not communicating properly with your doctor! Remember
that communication between a doctor and a patient
is a two-way process. Both the doctor and the patient
must work together on activities such as listening
as well as speaking to one another. Honesty and
openness with each other are also important factors.
The more honest you are, the better your doctor
can help you. Much of the communication between
the doctor and the patient is personal, as well
as confidential. In order to obtain optimum results,
you may need to be open about sensitive subjects
such as sex, sexually transmitted diseases and death
even if you feel embarrassed or uncomfortable. Doctors
are accustomed to talking about personal matters
and will try to ease your discomfort to the maximum
extent possible.
It would definitely be advantageous to take a family
member or a friend with you while visiting the doctor's
clinic. You will feel more confident if someone
accompanies you. Also, a friend or relative can
help you remember what you planned to tell or ask
the doctor. He or she can also help you remember
the doctor's advice. But don't let your companion
play too prominent a role; after all, the communication
is between you and your doctor. Also, you may want
to spend some time alone with the doctor to discuss
personal matters. Therefore, let your companion
know in advance the extent to which he or she can
be helpful.
If a relative or a friend has been taking care of
you at home, taking that person along when you visit
the doctor could prove beneficial. In addition to
the questions you have in mind, your caregiver may
have certain concerns he or she could like to discuss
with the doctor.
Even if a family member or a friend can't accompany
you to the clinic, he or she can still help. For
example, such a person can serve as your sounding
board, helping you to practice what you want to
say to the doctor before the visit. And, after the
visit, talking with that person about what the doctor
said can remind you about certain important points
and help you come up with fresh questions to ask
the next time.
Most capable doctors will agree that they learn
from their patients all the time, just as a good
teacher learns from his students ! A skillful doctor
treats the patient as the captain of the ship and
himself as the navigator, and a balance of respect
between the doctor and the patient can foster a
partnership in which both learn all the time! However,
remember that playing an active role in your own
health care places the responsibility for reliable
communication with your doctor squarely on you!
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