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PrintGetting the Most out of Your Doctor
What to Ask and What Not to Ask
“Listen to your patients!” This is the first lesson I teach my medical students.
Sounds easy, doesn’t it? The art of listening comes naturally to some, but for many, it has to be learned. We can all do better at it. Listening, caring and respecting patients surpasses any prestigious medical degree or super subspecialty.
So many times, I’ve heard from my patients, “I don’t care what school he graduated from, or how specialized he is; he didn’t listen to a word I said, so he’s an idiot. And I’m not going back there!”
Fair enough. Within our health care reform debate, we need to understand that physicians are reimbursed much more for doing procedures rather than listening, diagnosing and giving advice. The income gap has become so significant that good primary care doctors are getting pretty rare these days. Last year, only 2% of all medical students went into Internal Medicine primary care. Our time really is the most valuable thing to a patient.
There are a few things that patients can keep in mind to make the best use of this time when they visit:
A few things NOT to say to your doctor, or at least think hard about it first:
“I have ______( fill in blank with disease the patient thinks he or she has).”
Ok, so you’ve been watching House on TV, and you think that the rash and chest pain you have is some rare syndrome. Little do you know that it only exists in pygmies located in New Guinea. So, I spend my limited office visit time explaining to you why you probably don’t have it—starting with the fact that you’re not a pygmie.
My point? Stick to the symptoms. Explain when you started feeling sick, what it feels like, what makes it worse or better. Be as descriptive as possible to provide your doctor a picture of how you’ve been feeling, rather than what you think you have.
“I need you to order this test _____”
So, what’s the problem with asking this of your doctor?
Keep in mind that the approach to ordering tests we teach our medical students is the following:
What are the diagnoses that can cause the patient’s symptoms?
Do the symptoms provide solid clinical suspicions for any of those diseases?
If so, can we confirm or rule out any on our list, and do we need to test to do that?
Finally, even if we do a test, tell me how that will change how you’ll manage the patient.”
This ranges from legitimate concerns related to family history to something the patient is just worried about. I’ve been asked by chain-smoking, obese Type-A patients, who have no symptoms at all, to get a total body CT scan. What’s the point? (Besides the fact that these CTs have a ton of radiation, haven’t been found to really help and have a high rate of false positives causing even more testing). Instead, we should be getting the cholesterol checked, enrolling in a smoking cessation course and seeing a dietician—money and time much better spent in the long run.
“I read on the Internet_____”
Probably the greatest waste of valuable time with your doctor is asking him or her to steer you through the scattered information you derived from Googling. You can waste a lot of time asking doctors how they can be so sure that you don’t have that rare syndrome because you read somewhere on the internet that occasionally non-pygmies get it. This is time that your doctor should be thinking about you, not internet pathology. Perhaps once you’ve achieved an unbiased evaluation you can bring up what you’ve researched on the internet, so your doctor doesn’t overlook your concerns.
“I saw an ad for______”
Ahh, the power of marketing and advertising!
It works. Problem is, we usually don’t choose a treatment until after we’ve made the diagnosis. And then we choose based on what’s best clinically for the patient, not on what the best ads are. At least it brings the patients in—we’ve diagnosed diabetes in men who came in for Flomax thinking it was their prostate causing frequent urination, and heart disease in some who came in for Nexium thinking it was heartburn. Last year, we had a whole lot if people coming in thinking they were bipolar because of the TV ads. Unfortunately, they did have medical problems but we spent a lot of valuable time trying to convince them they weren’t bipolar.
“I want to be referred to this specialist for_______”
“Doctor, this patient wants you to recommend an orthopedic spine surgeon for his back pain.”
“Has he had an evaluation. I should see him first.”
“No one has seen him for this, but he says he knows it’s his back and doesn’t understand the reason why he has to see you, so he’s going anyway.”
Ahem. Well, there are probably four billion reasons why ($4B/yr in health costs for back pain). But worse, he’d already self-diagnosed his problem as his back. Several CT scans, epidural shots, physical therapy, chiropractor and MRIs later, he finally came in, where we diagnosed him with prostate cancer. Asking for a specialty referral before any other evaluation narrows your care almost into a tunnel-vision.
We are a health care system in crisis due to costs. There are not enough primary care physicians to adequately serve everyone, mainly because it’s a tough job and much more poorly reimbursed than procedural specialties. Health care can be so complicated these days, but it doesn’t have to be. Explain your symptoms in detail first and then, and only after that, explain what diseases you’re worried about. We as doctors in turn need to care enough to listen closely to what you have to say. Together, we can make sure that your medical needs are well taken care of.
