Make the most of doctor visit

Focus on your top concerns, not your latest cold

Medical Matters

September 23, 2005|By Judy Foreman

A visit to the doctor these days is a sprint, not a marathon.

With luck, you'll have about 22 minutes from start to finish, maybe a couple more if your doctor is a woman.

You begin with a disadvantage - you're sitting down, half- naked, sick and scared. The doctor is vertical, dressed, presumably healthy, definitely the top dog. This event is winnable - but winning means finishing together, with a health plan you come up with jointly.

To get the max from a minimal doctor visit, you have to screw up your nerve and ask, front and center, about the two or three things that worry you most, not the 20 other things you're vaguely concerned about. Don't blither on about your latest cold if it's your heart arrhythmia, your depression, your drinking, your spouse's abuse or your sleep troubles that are the real problem.

If you are seeing a new doctor, or even a familiar one whom you haven't seen in a while, take a minute to remind the doctor of important things in your medical history or your life - how long ago you had your heart attack, for instance, or whether you've just been divorced. If your medical history is complicated, bring your medical records with you to save the doctor tracking them down.

"Don't assume that your doctor knows your whole medical history," said Sherrie Kaplan, a social psychologist and associate dean for clinical policy and health services research at the University of California, Irvine, School of Medicine. This is especially true if your medical clinic has a high turnover or you see multiple doctors for different conditions.

To help you and your doctor focus on the important things, write down your questions and take a list of all the medications, prescription, over-the-counter and herbal, that you take, said Dr. Donald Berwick, president and CEO of the Institute for Healthcare Improvement, based in Cambridge, Mass. (You can also put all your medications in a bag and take them with you.)

To be sure, some doctors shudder when a patient walks in with a long list of questions, said Dr. Barbara Korsch, director of patient-doctor communication at Children's Hospital in Los Angeles. But if you're worried about being too pushy, keep the list in your pocket or purse, then check it midway through the visit to be sure you've mentioned everything important.

For their part, doctors should not be afraid to look at their watches and then say something like: "I have about 10 minutes left. How would you like to spend this time?" said Korsch. You can also ask how much time the doctor has for you.

If you're really sick or your disease is hard to understand, take notes and take someone with you to listen and help ask questions, suggested Dr. John Flynn, clinical director of the division of general internal medicine at Johns Hopkins Medicine. "It always helps to have another set of ears," he said.

And another mouth. When husbands and wives go to the doctor together for the husband's checkup, said Kaplan, a common scenario is that the husband will answer, "No," when the doctor asks about chest pain, leaving it to the wife to add something like, "Are you kidding? You sat across from me two days ago, turned gray and started sweating!"

On the other hand, if you're concerned about spousal abuse or your spouse's drinking or other problem, take someone else with you if you can. If your spouse insists on going, try to signal the doctor that you need a private word.

If the doctor's answers to your questions are likely to be complicated, you might consider taking a tape recorder with you - though some doctors may be squeamish about this.

The key to successful patient-doctor communication is what Kaplan of UC/Irvine called "planned patienthood." Kaplan has been analyzing audiotapes of patient-doctor visits for decades to see what works and what doesn't for good communication.

In general, she has found, women are much better than men at asking questions and being assertive with doctors. "Men, on average, ask zero questions. Women, on average, ask six," said Kaplan, who attributed this to the fact that women get more practice dealing with doctors, both from going earlier in life for reproductive issues and from taking kids to pediatricians.

Kaplan has developed a program of "coached care" to help patients get more from doctor visits. While patients are still in the waiting room, her research team goes over their medical records with them and helps them formulate questions for the doctor. The team then audiotapes the doctor visit.

Kaplan, in her study of five chronic diseases, has found that the patients who get coached care actually do better on physiological measures of improvement (such as better control of diabetes) or in daily function (such as being able to move around despite arthritis) than those who don't get help preparing for the visit.

Short of formal "coached care" training, Kaplan said, the best thing for patients to do to get ready for a doctor visit is "rehearsal." This means practicing, out loud if necessary or role playing with a friend or family member, what you want to ask.

Whatever you do, don't wait until the "doorknob" moment - when you're dressed, feeling more adult and heading out the door - to ask the most important question. And before you do head out, make sure you've got a follow-up plan in place.

If you have questions you didn't get to, ask the doctor if he or she will accept a few questions by e-mail or by phone. If you have too many questions for that, ask to schedule a follow-up appointment in a week or two.

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