Can we talk?
How to communicate with your doctor
Catherine L. Shaner MD FAAP, Fibromyalgia AWARE, Sept-Dec 2002
Small talk, baby talk, girl talk. We fill our lives with conversation. Sometimes, though, we need to go beyond the chatter - we need to communicate. Communication involves the exchange of ideas and requires listening as well as speaking. In healthcare, good communication provides the best outcomes with the least mistakes. As a bonus, it creates happier and less frustrated patients and physicians.
Establishing excellent communication with your doctor is important. Why is it, then, we sometimes leave our doctor's office feeling that a lot was said but nothing was accomplished? Or we feel as if we conversed in two different languages? For example:
Patient-talk: "I fell out, Doc."
Doctor-talk: "You've sustained a syncopal event, Mr. Smith.
They both mean: Mr. Smith fainted.
Were the doctor and patient talking? You bet. Were they communicating? No way! How can you assure smooth communications with your doctor?
Before The Visit
Organize ahead of
Identify goals for
Prioritize your goals, listing your primary reason for this appointment first. How many problems should you talk about at a visit? Two to five, depending on the time allotted and the complexity of the problems.
Other notes to make
Bring your lists! If you forget, ask the receptionist for paper and start writing while you wait. Keep copies of your problems and medication lists in your purse or car in case of emergency and update them regularly.
At The Doctors Office
Speak up: Being part of a team requires trust and clear, open communications. Be frank, even if it's embarrassing. Hand your doctor your lists, so he knows what you want to discuss today. Remember your goals for this visit. Voice your ideas. It is best to ask questions as soon as they arise.
Clarify: Use words such as "exactly" or "specifically". Ask: How will this help me? What will happen if I don't do this? When you say to increase activity, exactly what kind and how often? Does exercise mean weights or walking? What do you mean by "come back if not better"? When and how much better?
Negotiate: Request a cheaper drug or one with fewer side effects and less risk. Ask for an easier regimen or a less painful procedure. If a suggestion is unrealistic for you, say so - don't leave discouraged because you can't do it all. Doctors can simplify or adjust treatments so you can live with the recommendations. And remember: it's okay to think about your decision or change your mind. Never be pressured or scared into an action. Short of a life-threatening emergency, there is always time to think things through.
What can get in the
Poor communication frequently results when we assume too much. Just as "straighten up your room" has both a parent and a teen interpretation, failure to clarify medical directions may result in differing expectations for you and your physician. For example, assuming your test results will be normal unless you are called could be a deadly mistake. Rather than assume, specify. Request a simpler explanation. If you learn best by seeing or reading rather than hearing information, ask your doctor to draw a diagram or give you a brochure. Ask him to slow down or confirm details. Repeat any instructions he gives you and write everything down or tape record it.
If there is not enough time to cover everything, request handouts and brochures that will provide you with information. Then schedule another visit with more time to fully discuss your concerns.
Before you leave
Outside The Office
I forgot to ask
You have the right
to remain silent - but don't!
Pointers For Successful Communications
Pointer 1: Talking
Pointer 2: Talking
Pointer 3: Talking
Pointer 4: Talking
about alternative/complementary therapies (ACTs)
Allentown PA physician Catherine. Shaner not only sees fibromyalgia patients, she is one, herself, and has a daughter who has rheumatoid arthritis and FM. Trained to believe FM isn't a real disease, she now knows how real it is.
Melissa Kaplan adds...
If you regularly carry a date book with you, stick your problems and medications list in there. If you use a PDA, you check into software that will enable you to download your lists from your computer to your PDA and upload your notes back up to the computer.
Bring a printed copy of your problems and questions list so that you can have one and the doctor has one to use during your visit. Some doctors would like this information before your visit so that they can look things up if needed; ask your doctor if he or she would like this type of "preview" and whether they want it on paper (by mail or fax), or by email.
Depending on your level of pain, fatigue and brainfog on any given day, even very simple, explicit instructions can be mind-boggling and impossible to understand. There is a limit to how much time the doctor, nurses or other staff can spend with you go to over and over and over something. If you can't bring someone with you who can be your brain then bring a tape recorder and tape your session with the doctor and anyone else you ask for clarification on the instructions or information you were given.
If you are seeing different doctors, they all need to know about all of the prescription medications the other doctors have prescribed, as well as all of the over-the-counter, vitamins, minerals, herbs, alternative preparations, enzymes, aminos, pre- and probiotics you are taking. Many symptoms that may be ascribed to your illnesses may in fact be adverse interactions between the various drugs, supplements, herbs, etc. that you are ingesting every day.
Make and keep updated a master list of all the medications (prescription and OTC, topical and oral), vitamins, minerals, herbs, herbal teas, and other products you are ingesting. You will want this not only for your records but so that you can easily print it out and take it with you to each new doctor you are seeing. Give updated copies at least once a year to your regular physician, dentist and other healthcare providers.
Keep all your receipts for all of these medications and products, and copies of your notes on their use, especially when you've discussed them with your doctor. The receipts and notes will provide the back up when you claim them as medical deductions on your income tax as well as document the fact that you are "trying" to get better when you are hit with a social security or long-term disability review, an event that may happen once every three years or so until you reach retirement age.
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