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Thursday, October 22, 2015

How to Talk Effectively with Your Doctor

You've finally been able to sit down with your healthcare provider to discuss a worrisome health problem. But all too soon it's over, and you realize you didn't quite understand the diagnosis and treatment and you have more questions. Experts offer suggestions for an effective visit with your doctor.

You’ve finally been able to sit down with your healthcare provider at an anxiously awaited appointment to discuss a worrisome health problem. But all too soon it’s over, and you realize you didn’t quite understand the diagnosis and treatment, you have more questions and you feel like you weren’t heard. Perhaps the doctor stared at a computer screen instead of your face.

Clear communication is key when dealing with health problems, and sometimes you, the patient, need to take control. In this day of high-speed Internet, digital medical records and doctors with too many patients and too little time, planning ahead can save your health.

Be Prepared

The first step toward ensuring good doctor-patient communication is preparation. The National Institute on Aging offers the following essential tips for making your medical visit a success:

  • Write down a list of questions and concerns before your exam.
  • Consider bringing a close friend or family member with you.
  • Speak your mind. Tell your healthcare provider how you feel, including things that may seem unimportant or embarrassing (see below).
  • If you don’t understand something, ask questions until you do.
  • Take notes about what the doctor says, or ask a friend or family member to take notes for you.
  • Ask about the best way to contact the doctor (by phone, email or through the staff).
  • Remember that other members of your healthcare team, such as physician’s assistants and pharmacists, can be good sources of information.

Lost in Translation
Health professionals have their own language and concepts that we lay people often don’t understand or interpret the same way. For instance, did you know that to a doctor a “fever” means a temperature above 100.4—not just something above the normal temperature of 98.6? Or, for example, your friend’s heart stopped beating, and he was successfully revived with CPR. You tell the doctor you’re glad your friend survived the heart attack. The doctor says your friend didn’t have a heart attack, he had cardiac arrest, but with no damage to the heart muscle. What does this mean? To better understand medical terminology, an easy-to-follow, free online tutorial from the U.S. National Library of Medicine provides explanations of various medical conditions that cause confusion between doctor and patient.

Speak Up

“There’s no such thing as a dumb question in the doctor’s office,” says Dr. Matthew Memoli, an infectious disease doctor at the National Institutes of Health. “I try very hard to make my patients feel comfortable so that they feel comfortable asking questions, no matter how dumb they think the question is.” Here are some questions to ask (suggested by the Agency for Health Care Research and Quality, a division of the U.S. Department of Health and Human Services):

  • What is my diagnosis?
  • What are my treatment options? What are the benefits of each option? What are the side effects?
  • Will I need a test? What is the test for? What will the results tell me?
  • What will the medicine you are prescribing do? How do I take it? Are there any side effects?
  • Why do I need surgery? Are there other ways to treat my condition? How often do you perform this surgery?
  • Do I need to change my daily routine?
  • What should I do next? Ask for written instructions, brochures, videos or websites that may help you learn more.

Don’t Be Embarrassed

As we age, some health issues seem too uncomfortable to talk about. Bodily functions we took for granted throughout our lives have suddenly changed or become problematic. Sexual issues, incontinence or memory loss can be difficult to discuss. But most doctors are accustomed to talking frankly about such issues. The American Psychological Association offers a series of online brochures on many physical and psychological health issues affecting older adults, which can help you introduce the topic to your healthcare provider. If you have access to a printer, make a copy to take along to your appointment. Being honest about your habits, such as smoking, alcohol use, poor diet and exercise, is best for your own benefit. So, don’t try to please the doctor with the “right answers” if they’re not true. Besides your habits, describe your symptoms clearly and accurately. Before the appointment write them down, including when they occur, for how long, what makes them better or worse and how they affect your daily life. Tell the doctor about any big life changes that affect you emotionally and mentally, such as divorce or death of a loved one. These can manifest physically. For additional advice on discussing various issues, describing symptoms and making the best use of your time with your doctor, read “Talking with your Doctor: A Guide for Older People” from the National Institute on Aging.

What Doctors Say

To help optimize your doctor’s appointment, AARP offers ways–straight from doctors’ mouths–to make the most of your visit:

Hey, look at me. Even though electronic medical records have replaced the handwritten chart, "A doctor who focuses on the screen while talking to a patient is communicating ineffectively," says Dr. Robert Eckel, professor of medicine at the Anschutz Medical Campus of the University of Colorado, Denver. "A doctor should look directly at a patient when he's providing important information about the visit," Eckel adds. If your doctor is not, try saying, "I'd feel more comfortable if you looked at me while we talked."

Show some personal interest. "Doctors are human, and sometimes they need a little attention, too," says Dr. Harlan Krumholz, professor of medicine at the Yale University School of Medicine. "A kind word or showing interest in your doctor can go a long way toward strengthening the personal tie between you."

Be the squeaky wheel. If your doctor is unclear about something you asked or said, or if you don’t understand what the doctor said, don’t let it drop. Ask for a re-explanation or clarification. If it’s something the doctor seems uncertain about, ask about getting a second opinion (see below) and a recommendation for another doctor. Even if this makes you uncomfortable, it’s better than leaving unsatisfied.

Ask about long-term issues. Following a diagnosis, ask for specifics about how long it takes to heal, how long a procedure will take and when you can go back to work or resume normal activities, given your specific situation. If a serious condition or surgery is required, ask if you can continue to live independently or if there are alternatives to the doctor’s recommendations.

Start with your main concern. Discussing your main worry upfront gives you the time to focus on it, says Dr. Lisa Schwartz, professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice. If you haven't covered all your concerns and time is running short, ask your doctor if he'd like to hear the rest now or prefer to follow up by phone or email.

Provide some background. If your medical history is complicated and you have an appointment with a new doctor, bring along a one- or two-page summary of recent tests and treatments so she can get up to speed quickly. Even if your records were transferred to her office before your appointment, she may not have had a chance to read them thoroughly. Providing a short version with only the highlights and test results for the last six months or year will save time and may help you avoid repeat tests and imaging.

When to Get a Second Opinion

Rita Wilson, the wife of actor Tom Hanks, credits getting a second opinion with saving her life. After two breast biopsies that came back normal, Wilson still felt something was wrong. A friend recommended a second opinion, and with it Wilson found out she had a dangerous and stealthy form of cancer often found with another condition she had. She ended up having a double mastectomy and breast reconstruction.

Trisha Torrey, founder of the Alliance of Professional Health Advocates and author of You Bet Your Life!: The 10 Mistakes Every Patient Makes, was diagnosed with lymphoma and told she had three months to live. But this diagnosis didn’t gel with the way Torrey felt. After a second opinion, it turned out her diagnosis was misinterpreted by a zealous medical student, which can sometimes happen at large teaching hospitals. “You have a better understanding of your body than anyone else,” 
Torrey says.

Next Avenue provides some instances when a second opinion may be warranted:

  • If the treatment your doctor recommends or your illness is at all invasive, especially difficult (chemotherapy or radiation) or likely to be chronic
  • If surgery is required
  • If the condition is inherently tricky to diagnose but strongly symptomatic, such as Lyme disease or chronic fatigue syndrome
  • If many treatment options exist for what you have and you want to figure out the best course to follow
  • If a treatment is experimental or you’re considering participating in a medical trial

As a final cautionary note: Don’t assume a second opinion is always right. If you see a second doctor and his opinion is radically different from the first, it may be wise to get a third opinion as a tie-breaker. And sometimes, advises Torrey, it’s best to go back to the first doctor, present what you’ve found and raise questions. Also make sure that the healthcare provider from whom you want a second opinion is part of your insurance provider network. Ask your health insurance’s customer service department for a referral for a second-opinion provider. 

How to Talk Effectively with Your Doctor was recently featured in the October 2015 Senior Spirit newsletter

Blog posting provided by Society of Certified Senior Advisors