Talking with a white coat

For a lay audience, doctor-patient communication is not some abstract academic concept. It is real life. It is sitting in a stranger's office in a paper gown in an unladylike position and this stranger is using lots of big, unfamiliar words. Even the best-educated, most well-intended among us can get flustered in such a situation.

So for a recent speech at Toastmasters, I offered some tips for how to effectively talk to your doctor. The speech was well-received and I even won best speaker for the evening.

Talking with a white coat

At Toastmasters, we like to think we are all reasonably intelligent and articulate people. But even the most articulate person can be reduced to babbling when confronted with the prospect of talking to a doctor.

Let’s face it: the long wait times and embarrassing questions make many people dread having a one-on-one conversation with a virtual stranger about the most personal of issues: your own health and well-being.

Well no more. Today I will be sharing some strategies for how to successfully and effectively talk to you doctor so you can be an active partner in your care.

We’ll start with some strategies before you even get to the doctor, then some effective ideass for what to do and say once you get to the doctor’s office, and then we will talk about strategies for effective follow-up.

Your preparations for your doctor’s visit begin long before you arrive in the parking lot of your doctor’s office. To begin, make a list of all your questions and concerns. From that list, you are going to prioritize and then create a summary statement. This summary statement is a summary of your main, driving reason for coming the doctor’s office that day. You want to be able to state your primary concern in one or two sentences. Your statement should be specific, be clear, and be brief. For example, “Doctor, I am here today because I have has worsening heartburn over the last two weeks and over-the-counter medications do not seem to be helping.” The reason why it is important to be specific, clear and brief is because communication scholars have found that doctors, on average, usually only wait about 18-23 seconds before interrupting a patient who is talking. So you want to use that time wisely and make sure your primary concern is heard.

If you are going to you doctor to discuss a serious issue, consider bringing a family member or trusted friend with you. The reason for this is cognitive psychologists have found that people who are hearing stressful news may not actually hear everything that is being told to them. That’s why it can be helpful to have someone else also listening to the doctor with you who you can talk to again after the initial shock has worn off. If you do not have someone who can come with you, ask your doctor’s permission to use a personal tape recorder to record the conversation, so you can refer to the tape again later.

And of course, anytime you do to the doctor, you should always bring a list of all your medications and the doses, because if your doctor doesn’t have this information already, he or she is going to want it.

The day of the big doctor’s appointment arrives, and first things first, you need to follow the rules. Arrive on time, if not a little bit early. If you absolutely need to cancel you appointment, give your clinic 24 hours notice, or whatever the policy is for your clinic. The reason this is important is it conveys your respect to the doctor and shows you are serious about playing an active part in your medical care. Also, make sure you have everything you need for your visit, including your list of medications and your insurance cards or any forms you need you doctor to fill out.

Have realistic expectations of your doctor. Your doctor is not a miracle worker, and there is no magic pill to treat every ill. Sometimes it takes time to come to a diagnosis and effective treatment plan. So be patient and be realistic.

Don’t say things that set up barriers to communication, such as: “Doctors never listen” or “All you doctors are pill-pushers,” or “Those HMOs are just out to screw the little guy.” These kind of statements may just make your doctor defensive and will not encourage him or her to be open and honest with you and engage you as an active partner in you health care. He or she will just be in a bigger hurry to get you out of the office.

Be clear about your major concern – what is bringing you in today. Use your summary statement that you prepared ahead of time. Be brief and be clear. Remember the 23 second average; you may not have a lot of time, so you want to use it well.

When you doctor speaks, listen carefully. Taking notes may help. Cognitive psychologists have found that for some people, the act of writing information down can help people process information more than just listening. Plus, you will have a reference for later.

Repeat back key points that your doctor says to make sure you understand. For instance, you may say, “OK doctor, I’m hearing you say this…” If you are correct, the doctor will say so. If you do not repeat it back correctly, the doctor will correct you and perhaps rephrase the information so you can better understand what he or she is saying.

When your doctor asks questions, be honest. Your doctor needs as complete a picture of your health as possible. And to be an active and engaged partner in your health care, you need to be open and honest. While it may be tempting to be idealistic when it comes to questions such as how often you exercise or how many vegetables you eat or how much you drink, it is more important to be honest than idealistic.

Before you leave, make sure you understand what your doctor expects you to do next. If your doctor needs you to get lab tests, make sure you know when and where to get them. If you need a new prescription, make sure you understand the dose and when and how you should be taking it.

If you don’t think you can follow the regimen your doctor has prescribed, speak up before you leave. For example, if you don’t think you will be able to remember to take a medicine three times a day, say so. The doctor may be able to help you come up with another solution. It’s better to let your doctor know that you don’t think you will be able to follow through with a regimen than to just not do it, which can create barriers to the future of your relationship with your doctor.

After you get home from your doctor’s appointment, your work is not quite done yet. Review your notes or tape recording right away. If possible, review your notes with another person. Cognitive psychologists have found that teaching a piece of information to another person can help you retain and understand the information better.

Follow up with your doctor right away if there is something you don’t understand. Sometimes people are embarrassed to call so soon after their appointment. They don’t want to be seen as a nuisance or a bother. But you and your doctor are partners in achieving your best health, and you need to understand the information your doctor has given you if you are going to be an active partner in your care. When you call, often times, there is a nurse or doctor on call who may be able to answer your question over the phone. If not, they will be able to get a hold of your doctor, who can answer your question. So if you find something you do not understand or remember a question you forgot to ask, don’t hesitate to call.

So the next time you get a little reminder postcard in the mail reminding you it’s time to make a doctor’s appointment, or a change in your health you can’t ignore causes you to finally make the call to see your doctor, you don’t need to be intimidated about that conversation with the man or woman in the white coat. With proper preparation, a clear and brief summary of your health concerns, careful listening and immediate follow-up, you can speak effectively and confidently with your doctor, as you work together to achieve what you both want: your good health.