NEED HELP TALKING TO YOUR DOCTOR? Part I

I have been a Board Certified Psychiatrist for 20 years. I’ve spent much of my professional career caring for patients of all ages. Over and over I listen to people tell me they have been frustrated while at their doctor’s office.

The overwhelming reason for patient’s frustration has stemmed from feeling like they were not listened to. This includes by the doctor, the nurse, the receptionist. It could involve sitting for a long time in a crowded waiting room. Of course when someone feels they have not been listened to, they feel like they are not validated and not understood.

I’ve walked both sides of the fence. I’ve been a patient more than once; more commonly I’ve had a waiting room full of people to see- people to care for- people I really needed to listen to.

And with the time constraints of modern practice, imposed by bureaucracy, paperwork, phone calls- routine and emergency, it takes a lot of conscious effort to see that each and every person feels listened to and cared for. And decisions made about patient care directly reflect that act of proactive listening.

I want to help you when you enter your doctor’s office. I want you to get the most out of your doctor visit. I can share with you things that people I’ve cared for have done that have been of great help to me in my efforts to help them.

First, in a followup visit, do your ABSOLUTE best to focus on one major topic. Your followup visit is generally a 5-10 minute visit, but the same principles apply for a 30 or even 60 minunte appointment. I can remember so many time people would tell me very important information in the last few minutes of a 30 minute appointment. And we had already agreed on a course of action before this new important information came up! Had I known this vitally important bit of info, our entire treatment plan would have changed!

But, you may say, I have a complex disorder that involves many different organs- for example, my heart, my lungs etc….need to be discussed today.

No Problem! It is the way we organize and present our thoughts and symptoms that will make all the difference.

It is easy if you know that your symptoms are all related to a condition for which you have been diagnosed:

You may say.. “Doctor, I feel like my fibromyalgia is really acting up.” And in 30-60 seconds, you can list all the symptoms of fibromyalgia that have been bothering you recently.

This will leave the entire visit to talk about solutions and strategies to help you feel better.

More typically, a visit will start out like this:

Hi Doctor, you know my head has really been bothering me; I don’t know when that started….oh yes, I got laid off 2 weeks ago, I haven’t been sleeping lately…I forgot to fill my prescription…Doctor I forgot to have my lab work done…I just don’t feel well, I’m tired all the time…I’m fighting with my husband and my kids more….oh yes, Rebecca was placed in special ed…oh, and my mom said to tell you she needs to come in, her medicine isn’t working well for her, she’s having a lot of stomach pain……and my husband who’s in the waiting room wants to see you for a quick minute- he has a very quick question…(patient’s cell phone rings- it’s a friend)…..oh and doctor, I need these forms filled out to take a few days off from work....and my insurance needs you to call them to get any more visits approved…

In this not uncommon scenario, 10 minutes have elapsed and the patient is just getting warmed up, the doctor is trying to be empathic but doesn’t know where to begin. To do a thorough review of all organ systems with this patient would take over an hour. And the waiting room is full already!

Let’s review the language doctors are trained in:

First, doctors are trained to write down a patient’s CHIEF COMPLAINT: in one sentence, in the patient’s own words:

THIS IS HARD!! But if it’s hard for you, can you imagine how difficult it is for your doctor? As patients, we know our bodies the best. We are with ourselves 24 hours/day, 7 days/week. And you may have spent weeks talking to your friends and family about how you are feeling and what has been bothering you.

And you have minutes to effectively summarize this for your doctor.

In an earlier example, an astute individual knew fibromyalgia was acting up. In a lot of cases, we DO NOT know what our symptoms mean. So what if 4 or 5 things are really bothering us? What is our chief complaint?

In this case, it might be best to start out, “Doctor, a lot of things have been bothering me since I saw you last..”

Your next best step would be to MAKE A LIST of ALL the symptoms that are bothering you, and when these symptoms started.

For example: “A lot of things have been bothering me since I saw you last”…

-my periods have gotten very irregular -I wake up every morning with headaches -I want to eat but have no appetite -I feel a burning in my upper chest -I have leg cramps almost every day

This is a challenging set of symptoms, but by laying it all out in organized fashion, you and your doctor have a much better chance of figuring out what is going on and how to proceed. And you said all these things in the first few minutes of your visit!

Next, it helps to outline how long the symptoms have gone on. If they all happened at the same time, you can state when they all started at the end. If they all happened at different times in the past few months, it would make sense to write everything down and next to each symptom- jot down when each started.

Often there are precipitants or triggers to certain symptoms. For example, “I’ve had out of town relatives in for a month, and it feels like everything has gotten worse since then. We’re having a good time, but we’re running all over town, and my house is a mess, people are everywhere, I’m not eating healthy and not getting enough sleep.”

This is VERY important information!

But perhaps nothing has changed recently. This is also very important information.

Perhaps you started a new vitamin supplement regimen. Perhaps you went on a rapid weight loss diet. Maybe you reengaged in an intensive work out program.

All this is important for your doctor to know.

Recent stresses are important to report. The risk of talking about them is that we tend to get emotionally charged and have a tendency to ramble on about them. It’s best to jot these down too, in a few words:

-working nights for the past month -a lot more overtime -lost 15 lb in past 2 months on diet -haven’t been exercising

As you can see, it will take some thought and preparation to organize your thoughts for your doctor visit. But think of how organized you will be! You will maximize the benefit of your session with this type of planning.

In Part II we will look at more specific ways to organize your current medication regimen as well as talk about natural supplements you may be taking.........

To your good health!

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