Communicating With Your Doctor

by Betty Soldz

When we were growing up we had a "family doctor."  There was a sense of  trust that he would take care of us and at that time, it generally was a 'he' rather than a 'she' who carried that title of doctor.  He always seemed to have time to talk with us about our health and, even, our lives. Times change and, with it, situations in our lives do also.  Our health care system has changed dramatically in the last few years and Managed Care has become the norm for many. 
    How well you and your doctor communicate with each other is one of the most important parts of receiving good health care under today's medical system..  It is not always easy.  It takes both time and effort. A good patient-doctor relationship is a partnership, with both of you working together to maintain your health.  The doctor should allow you an active role in deciding when to seek medical attention, whether to accept her/his advice, and when to seek a second opinion from another doctor. You, the patient, owe your physician cooperation and honesty.
    Pathways for good communication mean that you ask questions of your doctor until you clearly understand his/her explanations and instructions.  It also means bringing up health problems, even if your physician doesn't ask, and also sharing your concerns even if they are sensitive or embarrassing. Good communication is the responsibility of both partners.  If you are not at ease with your doctor, or you think your doctor attributes your problems to "aging", or he/she automatically prescribes drugs rather than dealing with the underlying cause of your medical problem, it  may be time to find a new physician. 
    This is a system that is not only impersonal but one where doctors have limited time to spend with patients. Planning ahead for your medical visit will facilitate good communication between you and your doctor.  The following tips will help with your planning. 

• Be prepared - Make a list of what you want to discuss - what your concerns are about your health; about your medications.   Prioritize your questions and share your concerns with your doctor.  Be sure to say what is really going on with you. Let the doctor know about any major changes or stresses in your life.  Stick to the point because under today's medical system each patient is given a limited amount of time.  If you are describing your symptoms, describe when the symptom started, how often it happens, and if it is getting worse  Also, what seems to work well for you and what doesn't.
• Ask questions - Asking questions is the key to a successful visit.  The doctor will address your questions but, if you don't ask them,  he/she may assume that you understand everything you are being told.  Be sure to ask for more information when you don't know the meaning of a word or what a medical test or treatment entails.  It may help to repeat back to the doctor what you think he means in your own words and then say something such as, "Is that what you mean?" If you are still not comfortable,  ask the doctor to explain further and request written information.  Don't hesitate to ask if there are any alternative treatments. Remember, there are no dumb questions when it is your own health.   When a doctor gives you a diagnosis you are uncomfortable with or unsure about, you might want to consider seeking a second opinion from a specialist.  Getting a second opinion is a common medical practice that doctors should encourage.
• Disclose your needs - If you have a hard time seeing or hearing, for example, it helps the communication process if you say,  "My hearing makes it hard to understand everything you're saying.  Would you please speak slower."
• Take notes -  If you can't write while the doctor is talking, or you would like to be sure you correctly heard what was said, bring a relative or friend with you.  If  this is not possible, make notes as soon as you leave the examining room.  When possible, have the doctor provide written advice and instructions. A couple of good questions to ask after being informed of your diagnosis are: "What will the course of treatment be?" and "How long will it be before I can expect to see some improvement?"  Tell your doctor that you may have more questions later, and ask how long he/she takes to return telephone calls. Ask if you can fax your question to the office. 
• Check other sources of information - To increase your knowledge of your condition as well as the medication or treatment prescribed, there are other sources of information from such places as nonprofit organizations, i.e. Heart Association,  your library, or the Internet . (Caution is advised when using the Internet for medical information.  A lot of the material is anecdotal, opinion, untested or just plain wrong.)  The U.S. Department of Health and Human Services has a good medical site  (www.healthfinder.com) The more information you have, the better you will be able to discuss your health with your physician..
• Make a list of all prescription and over the counter drugs you use - Your list should include the name of the doctor who prescribed the medication, the condition it was prescribed for and the dosage.   If you don't have this in writing, take all of your medicines with you. Do not forget over-the-counter drugs. Also include a list of your vitamins and herbs that you may be taking.  Many drugs can interact in negative ways, so it is very important that your physician be aware of all of your medications.  If  your doctor gives you a new prescription, make sure you  understand what it is for and how it might react with the drugs you are already taking.   Some of the questions you might ask when given a new prescription are:  "What are the risks, side affects and benefits of this medicine?"  and "How long will I have to take it?"
•  Know how your health insurance coverage works and how you get a referral -  If you belong to a Health Maintenance Organization (HMO) your primary doctor is probably your 'gate-keeper'. A primary care physician is responsible for coordinating your healthcare and must get authorization for you to see a specialist.  Your doctor should be your advocate but you also have to be prepared to advocate for yourself.   Demand to know all the alternatives for treating your condition not just the ones approved by your health plan.  If you think that you need to see a specialist, ask your doctor to request an authorization from your insurer.  If the request is denied make an appeal to your health plan. (A large number of appeals are won by the patient.)  Speak clearly but forcefully when asking for a referral.  If you have private insurance you should be able to make your own referral.  Since many specialists, however, will not accept you without a referral from your primary doctor, it is important to get authorization.   Upon receiving your referral, follow the communication guidelines above and be prepared with the same information you shared with your primary physician.  In this way, you can make the best use of your specialist's time.

    Contemporary American healthcare is a difficult and controversial matter. The more you prepare yourself to communicate well, the more likely you are to receive competent care and to be able to stay in control of your own health.