Posted by Brigham and Women's Hospital April 4, 2013
Today’s post is written by Dr. Leana Wen, an emergency physician at Brigham and Women’s Hospital (BWH) and Massachusetts General Hospital and a clinical fellow at Harvard Medical School. She and Dr. Joshua Kosowsky, Clinical Director of Emergency Medicine at BWH, co-authored the new book, When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests, a guide to help patients communicate with their doctors.
Have you ever gone to the doctor and felt like he wasn’t listening to you? Have you tried to tell your story, only to have her interrupt with a checklist of questions: do you have chest pain, shortness of breath, fevers, cough, and so forth? Have you ever felt ignored, and left thinking that your doctor never understood why you came to him in the first place? If you feel dissatisfied or frustrated by your care, now is the time to figure out how to get better care.
Studies show that 80 percent of diagnoses can be made based on your history alone. Yet, doctors these days spend less and less time listening. “Cookbook medicine” is prevalent, with doctors resorting to checklists of yes/no questions rather than really listening to what’s going on with you. You have to make sure that your concerns are addressed — and even before that, to make sure your story is heard. Here are six tips for getting your doctor to listen to you:
Tip #1: Answer the doctor’s pressing questions first.
Many doctors are so accustomed to relying on a checklist of questions that they have to get these answers before they move on. Help them out and answer these questions. If the doctor wants you to describe the location of your chest pain, describe it. (“It’s in the middle of my chest, right here.”) If she wants to know what you took to make it better, tell them. (“I took an aspirin. It didn’t help.”)
Tip #2: Attach a narrative response at the end of these closed-ended questions.
If your doctor persists on asking closed-ended questions, add a narrative response at the end that may not so easily fit into a yes/no answer. (“It’s in the middle of my chest, right here, and it started after I really pushed myself in swimming tonight.”) Pretend that you are being asked “how” or “why” instead of “yes/no,” and add your own response. Look to make sure your doctor registers this answer — does he ask you more questions to follow up on what you said, for example?
Tip #3: Ask your own questions.
If you don’t understand why a particular question is relevant to your situation, ask about it. You may be surprised to find that the doctor herself isn’t sure and is only asking the question out of habit. On the other hand, you may find out that issues you wouldn’t have thought were related might actually be very important to discuss.
Tip #4: Interrupt when interrupted.
If your doctor cuts you off when you try to explain your full answer, feel free to interrupt. Pretend you’re having a conversation, even when it feels like you’re being interrogated. For example, if you’re asked “When did the headache start?”, rather than responding “10am,” go ahead and tell your story of how the pain started. “I woke up this morning and I was fine, then I started walking to work and the pain came on suddenly like a lightning bolt striking me.” This is not a new tactic; lawyers will often coach clients in advance to answer yes/no questions with a narrative so that answers can’t be taken out of context. Interrupting is a way to ensure that your entire answer is heard, not just the part that the doctor thinks he wants to hear.
Tip #5: Focus on your concerns.
If you get the sense that your concerns are being brushed over, interject, “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?” and so on. You can take charge of the conversation at that point. It’s your body and your duty to advocate for yourself if you don’t feel like your story has been understood and your concerns have been addressed.
Tip #6: Make sure you are courteous and respectful to your doctor.
Your doctor is a professional, and is probably trying her best to help you. Your story has to be heard and your concerns addressed, but make sure you present your points in a respectful manner. This will ensure that a solid doctor-patient relationship is present, and is critical to the partnership you need to establish.
You may be dissatisfied and frustrated by your medical care, but you can take control of your health care and transform your health today. Try these tips on your next doctor’s visit, and build your partnership for better care.
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