June 14, 2013

Are You Communicating with Your Doctor

Is Your Doctor Listening to You?

Establishing a strong doctor-patient relationship often depends more on you, the patient. This is sometimes difficult during the first few times you meet with the doctor. There are several steps you must accomplish to know that you have the right doctor and can establish a good communication between you. This will also determine the extent of your trust and desire to build a relationship with the doctor.

Probably one of the first steps will be in finding out during the first visits if the doctor uses the “cookbook medicine approach” or the “your story first approach.” It is important to know these as this will determine how you prepare for your visit. Both are polar opposites in their approach and you need to determine which is a better fit for you. I know I prefer the second approach, but I do have one doctor that uses the first approach. There are variations on both approaches and this can be a challenge. I know this because another doctor lets you tell your story first and then goes into the cookbook medicine approach and I had better answer his questions with a yes or no. When he has finished, then I can normally fill in the blanks that he has missed. This may or may not start another round of questions.

His method has resulted in my being more specific when I start and leaving the unrelated material for his questions. As we have perfected this over the years, he has modified his questions to allow for some detail and I give it to him as briefly as I can. One day when I was there for a checkup, or semiannual appointment, nothing was bothering me and I said as much. He stopped, looked at me, and casually asked what to do next. I said cover the lab results and we did, in more detail than he has ever done before. When he finished this, he asked if I had any questions. I told him that he had answered the questions I had as he covered the lab results, and I said we were done. He looked like I had just defeated him in an extended tennis match. I told him to take advantage of the extra time for his next patient and he seemed to recover immediately. He thanked me and told me to set up my next appointment in six months, and handed me the lab request sheet for the next appointment to give the person setting up the next appointment. Then he headed for the next exam room.

The next appointment started out the same and this time he handed me my copy of the lab results saying everything was good and did I have any questions. I said no and he handed me the lab request sheet and said to set up the next appointment in a year. He stopped and then said if I did need to see him before then, paused, and decided to walk out with me to the desk for the next appointment and gave her the instructions and told her to note on my record that if I needed to see him before the next appointment – to schedule an appointment. She put her name and extension number on the appointment slip to use if I needed an appointment earlier than scheduled. It is this type of relationship that I have learned to treasure, but it took some time and learning how the doctor functioned.

I have another doctor that is all together different. He enters the exam room and asks me questions related to the reason for my appointment. Once he is sure I am there for the stated problem, it is all business of my explaining what has happened and when. Sometimes, because of the problem, I have had tests done beforehand and at other times after he is sure I need the tests. While he is waiting the test results, he moves onto another patient and then returns with the completed test results. Most of the time he tells me that here is a prescription for 10 days and communicates with me about calling for another appointment if this does not correct the problem. Because this has been a lifetime problem, he knows I know what to do and is very careful about repeated episodes.

The most interesting of my doctors has been the person I see for diabetes. There it is discussion of my A1c and the meter readings. She could spot trouble areas in a glance and knew what to ask. I am very sorry to see her leave the diabetes clinic. Now I will need to see how the next person handles the appointment. I will need to be on my toes to discern how I will be treated.

I am concerned about the new procedures being handed me by several of my doctors and I sense I am being slowly being pushed out of their practices because of Medicare. It may be because of the 2% cut or for other reasons that are being implemented in the affordable care act. Tests are being cut and I am being directed to the VA for more of my care.

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