May 2, 2013

Is Your Doctor Listening to You – Part 1

Part 1 of 2 Parts

How doctors blog does say a lot about them. Some are very caring and understanding, while others are brisk and matter-of-fact in their approach to patients. This is evident in their writing as well. Communication is the topic of these two blogs and express both of the above approaches.

The first blog is by Dr. Leana Wen and I will take time to list her points and give my thoughts as a patient. I will encourage you to read each doctors blog and then read my response.

Tip #1: Answer the doctor’s pressing questions first. This requires a very concerted effort on your part to be polite. You must restrain yourself when doctors behave this way. This is how many doctors are and they are easily upset when things are not accomplished in their order.

Tip #2: Attach a narrative response at the end of these close-ended questions.
This will often tax your diplomacy, but it can work. If the doctor asks more questions to follow-up, you know that you are getting his/her attention. Don't over dramatize the point as a simple statement of the facts will generally work the best.

Tip #3: Ask your own questions. This can serve you well if properly done. Some doctors are running on autopilot and this can bring them out of it. Be careful if the doctor just repeats the question and then it may be important. Then if you fumble because you don't understand, often then the doctor will know to reword the question. Always respond to the best of your ability.

Tip #4: Interrupt when interrupted. This will work for some doctors, but be polite and use diplomacy. For those doctors that refuse to let you interrupt, follow their lead even though you may be irritated. If this technique works, keep the narrative brief and state the facts.

Tip #5: Focus on your concerns.
Yes, if you feel like the doctor is ignoring your concerns or not listening, use your best diplomacy and politely interrupt. Express your concerns and Dr. Wen's example is appropriate, “Excuse me, doctor, I have tried to answer all your questions, but I am still not certain my concerns have been addressed. Can you please help me understand why it is that I have been feeling fatigued and short of breath for the last two weeks?” (insert your health concerns) or what the problem is. Do not over state the problem, just give the facts as you know them. If this does not bring the doctor into the discussion of your problem, then you may need to consider more drastic action. Depending on the seriousness of the problem or medical issue, ask the doctor if you need to see the emergency department. Don't use this if you really wish to keep your doctor.

Tip #6: Make sure you are courteous and respectful to your doctor.
Yes, your doctor is supposed to be a professional and is probably doing their best to help you, but don't let them bully you into totally doing things their way and ignoring your medical problem. If at all possible use diplomacy and be respectful. This will normally build a solid doctor-patient relationship.

When I was much younger, as a teenager, I was kicked in the groin by a cow and the doctor was very careful and when he was done with his examination, he said that I had a tear in the bladder and this could likely affect me for the rest of my life. After leaving the military, I had a rough time and the doctor I had did many of the same procedures. He said basically the same thing, and gave me a new antibiotic to help with the healing again as it had somehow torn slightly.

After moving to another part of the state, the trouble flared up again, and it was not six months later. I could tell the new doctor had dollar signs in his eyes, as he would not call the previous doctor, so I ended the conversation and appointment and went home. There I called my previous doctor, and he was kind enough to call in a prescription to my pharmacy. In the meantime I had my previous doctor locate another doctor and forward my records to him. He asked me to come in for an appointment and he also gave me a prescription and said if I had more problems to call and he could prescribe the antibiotic again. I went another 28 years before I had any more problems.

The above tips will generally serve you well in most situations. I have had doctors be on autopilot and I have been able politely to bring them back to the present. One doctor had to think a long time about what I had done. At the next appointment, he did apologize and we even discussed how to bring him back to the now. He had asked his nurse if she had seen him go on autopilot and she had to admit this was a problem for him.

Dr. Wen does describe a trend happening because of the pressure more doctors are facing to see more and more patients. She says that today doctors spend less and less time listening. “Cookbook medicine” (I like this term) is prevalent, with doctors resorting to checklists of yes/no questions rather than really listening to what’s going on with the patient.

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