Chapter 15: How to Talk Intelligently to Your Doctor

A doctor who cannot take a good history and a patient who cannot give one are in danger of giving and receiving bad treatment... - Paul Dudley White

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 ones ability to talk intelligently to ones doctor! While the capability of absorbing the relevant details of an individuals 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 dont 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!

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 familys 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:

1. 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 dont forget any crucial aspects!
2. 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 doctors objectives and yours are the same to help you to get better as soon as possible!
3. 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.
4. Share your point of view with your doctor since he needs to know whats working and whats not. He or she obviously cant 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 Im really worried about my condition. Id 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.
5. Take notes on what the doctors analysis of your problem is and what you need to do to rectify the situation.
6. 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.
7. Dont 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.
8. Discuss any self-medication practices youve used which have relieved symptoms.
9. Dont waste your doctors time by asking irrelevant questions (for example, about your brother-in-laws 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 doctors precious time, something which he will deeply appreciate. You can, nevertheless, ask your doctor to confirm that the knowledge you have acquired is accurate!

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 Kiplings 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 youre going to work together as a team.

At the end of your visit, you should be able to:

1. Describe your condition fairly accurately.
2. Know what additional tests are needed and why.
3. Explain your treatment, including the use of medications.
4. State if and when you need to return.

If you cant fulfil the preceding objectives, youre 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 doctors 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 doctors advice. But dont 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 cant 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!