Our patient doctor communication habits exposed

We're creatures of habit; habits born of past experiences. Patient doctor communication often suffers as a consequence.

Improving communication is likely to help us get better results.

It cuts both ways, but this site isn't likely to be read by many doctors¹, so I've done it this way.


Is our symptom pain?

The doctor needs to know where it is, how long we've had it and when it strikes (particularly in relation to any activities or bodily functions.)

We are likely to be worried about the possible causes, whether it will get worse, what treatment will cost etc.
Fears can distract us, and we fall back into old habits.


Being a stoic, brushing it off.

Were you brought up to "not complain" and so don't like to make a fuss?

If you're not in pain when you're telling the doctor about it, they won't be able to tell if you're underselling yourself.

Possibly the best way of telling how severe it was, is to describe how it affected your activity. Did you have to pace the floor, stop what you were doing, lay down, double up, vomit?
Did activity actually help to take your mind off the pain?


Catastrophising

The media continually emphasize worst case scenarios. Crashes, fires and floods are all good copy material.

If you find yourself expecting the worst, immediately you realize this, tell yourself that is the least likely outcome. Most illnesses get better. They do!

Calming yourself will help you communicate more clearly.


Wanting to be in control

This is better than always thinking the doctor knows best, but a happy medium is when both are attempting to make it an equal partnership.

You're both working towards the same best outcome.


Feeling the need for sympathy

Debilitating conditions can make us want to curl up and be waited on. Everyone has their limit - how much they can take before battle fatigue comes on.

If you do succeed in getting emotional support however, the doctor will have that much less energy to use in working out what is best for you.


Being distrustful

This is possibly safer than being too gullible, but best to not let it show.

If there is something you need to say but don't want written down, tell your doctor so.
If the doctor has asked permission to voice record the consultation, ask for the recording to be stopped.


Delaying telling the real reason for your visit

It may take time and a bit of talking, to see if you can trust a new doctor. The problem is that by then you may be out of time.

One solution is to make a first appointment just to introduce yourself and deal with something minor.

Before the day, it may help you to write down just for yourself, exactly what you expect of the visit. You can then try to ensure the consultation is steered towards this.


Self diagnosis

I've been upstaged by my patients on numerous occasions over the years. I don't have a problem with this, even if someone is wrong.

Be upfront about your concerns, but tell your actual symptoms first, rather than your interpretation of them. Then ask if it could be...

If you print off something from the web, only take say one page to the doctor. A wad of pages is going to be too much for them to absorb in the time available.


Being like "the boy who cried wolf"

You'll find his story on the web. This can easily happen in medicine too.

If you are fortunate enough to have a doctor you like, and are able to see them readily, it is very easy to fall into a habit of visiting for a chat.

Be upfront about this too, and watchful that it isn't a bother to the doctor.


Avoiding painful news

One has taken the step of attending an appointment with the doctor, but still we don't want pain.
In a recent study² of people who came for a checkup, initially saying nothing was amiss, 59 of 66 did admit to symptoms when questioned.

If you feel more comfortable not voicing something, consider taking a brief written note.


Panic

You're not a block of wood. If the news is bad, panic is natural and expected.
Give yourself time to get over this, before you discuss treatment options. Heart attack, childbirth, strangulated hernia or twisted testicle can't wait, but most things can.
Find your stillness within.



Reality bites

Your doctor is likely to offer you a "counsel of perfection" (excellent but possibly unrealizable advice.)

They may not realize if you have limited funds, and so you may need to ask what proposed investigations and treatments are likely to cost.

Transportation, childcare, or inability to take time off work may be problems you need to mention.

There are likely to be different options worth considering, with all these in mind.



Make sure you got it right - repeat it back

Your doctor hopefully has given you clear advice, but to be sure you have understood what was intended, it's a good idea to repeat it back and ask if you did understand correctly.

This will help to reinforce it in your mind, as well.



Making notes during the consultation.

Remembering stuff can be greatly helped by very brief notes even. Make sure you don't miss things because you were writing or typing, and ensure the doctor is happy for you to be recording points.



References and notes for patient doctor communication page

1. The Austin Hospital in Melbourne, formerly the Austin Hospital for Incurables, had a wonderful physician named Wally Moon. In those days at most hospitals, each specialist would conduct their own ward round at different times. Dr. Moon made sure they all went around together, to ensure the best care for his cancer patients.

His advice to young interns was "backside by the bedside, mind in gear and mouth in neutral."

He commented that a lot of medical treatment involved pushing the person - telling them they had to do this or that. He considered that this was bad for a person with low self esteem and was liable to produce learned helplessness.

He wanted to help his patients to see that they did have choices and were in control of their destiny.

Similar to the modern PCA intravenous opioid infusions, he would instruct the nurses to leave an analgesic dose on the bedside table in addition to the regular doses. The nurses were to record when they were taken and keep them replaced.

From an recent article dealing with communication problems from the doctor's side, "If our baggage remains unpacked and unexplored, we're more likely to get our hot buttons pushed."

2. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3094231/

Also a comment on the above at...http://www.biomedcentral.com/1471-2296/12/22/comments




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