On the Same Wavelength With the Doctor

The New York Times - December 25, 2007
Jane E. Brody

From nytimes.com

My friend’s grandmother-in-law, at 94, has refused her son’s pleas to make a routine doctor visit. “‘Why should I go to the doctor?’” my friend recalled her exclaiming. “‘They don’t know anything anymore. You used to go to one doctor and he told you what was wrong and what to do about it. Now all the doctor does is draw vials of blood, order tests, and then tell you to go to another doctor.’”

Dear lady, you are so right. Medicine is not what it used to be. No longer do most people see just one doctor for whatever ails them. And no longer do most doctors have the luxury of spending half an hour or more with each patient, getting to know everything about their lives and families, as well as their bodies and minds. To meet rising costs, doctors are having to cram more and more patients into their already busy and demanding schedules, meaning that appointments are rarely more than 15 minutes apart.

Even those doctors who specialize in family or internal medicine usually limit the time they can spend with each patient. And if symptoms or test results suggest a problem, they must often refer patients to medical specialists and other providers for further diagnostic work and follow-up care.

It is easy to see this as a downside. But considering that Americans today are living longer and healthier than ever, there must be something good about how medicine is practiced today.

No longer can one doctor “know everything” (not that any doctor ever did). Nor do doctors have the training and expertise to perform the myriad tests and procedures that did not even exist half a century ago and that have helped to extend quality years of life for so many.

The doctor-patient relationship has changed, too. Doctors are less likely to be paternalistic and patronizing. Patients are more likely to be knowledgeable about symptoms and ailments, and the two are more likely to be partners in the patient’s care.

Still, insurance problems aside, many people like my friend’s grandmother-in-law are dissatisfied with the tenor of modern medical care. They feel rushed, poorly understood and more like a customer in a supermarket line than a well-cared-for patient.

With just the 7 to 15 minutes that doctors give each patient on most visits, the roots of dissatisfaction are easy to understand. The trick is establishing a good working relationship with a doctor and getting what is needed from these necessarily brief medical encounters.

Dr. Marisa C. Weiss, a breast cancer specialist at Lankenau Hospital in Wynnewood, Pa., who has ample experience as doctor and patient, has written “7 Minutes: How to Get the Most From Your Doctor Visit” (Random House Custom Media, 2007). Some of her advice follows.

Prepare for the Visit

You don’t want to waste doctors’ time on things you could and should have done at home. Arrive with a complete list of all the prescription and over-the-counter medications and supplements you take, including dosages and dosing schedules. Also have the names, mail and e-mail addresses and telephone numbers of the other doctors you see in case your doctor needs to contact them.

Write a list of your symptoms, their nature and frequency, and anything else you may have noticed about them, including what may relieve them.

Make a list of questions and concerns, and put them in order of priority so the most important ones are dealt with. If time is short, ask if you can set up a phone call or e-mail communication for those that remain. Bring paper and pen to write down what the doctor says or ask in advance if you may record the doctor’s comments to be sure you heard them correctly.

When dealing with a complex or serious medical question, take along a trusted relative or friend who can provide a second set of ears and record what the doctor says. That person may also think of other important concerns or questions to ask.

Dr. Weiss suggests that patients set the stage for a congenial visit by greeting the doctor with a smile and handshake (or hug, if appropriate). It’s also good to thank the doctor for seeing you, especially if you required a last-minute appointment.

Dr. Davis Liu, a family physician with the Permanente Medical Group in northern California who has written “Stay Healthy, Live Longer, Spend Wisely: Making Intelligent Choices in America’s Health Care System” (Stetho Publishing, 2008), has devised the acronym DATE to help patients derive the most from a doctor’s visit:

D FOR DIAGNOSIS Write down the medical terms, not lay lingo.

A FOR ADDITIONAL TESTS Does the doctor require or recommend other tests, X-rays or procedures? Tell the doctor you expect to be informed of the results, good or bad.

T FOR TREATMENT PLAN Is a new medication or dosage being prescribed? Is surgery needed, and how urgently? Should you see a physical therapist or change your diet or exercise program?

E FOR FURTHER EXAMINATIONS OR EVALUATIONS When should you return for a follow-up? What are the signs or symptoms to watch for and when should you call the doctor if the condition does or does not change?

Choosing Wisely

Perhaps most critical in gleaning the maximum from a medical visit is to find a doctor with whom you have a rapport. Dr. Weiss suggests that in addition to having good training and experience (at least a few years in the field) and admitting privileges at a good hospital, the doctor you choose should be thorough and supportive, should listen to you, answer your important questions and be open to input from you about your symptoms, treatment and options.

Your doctor should also appreciate that health problems can be confusing and frightening. The doctor should respond to your concerns with patience and kindness, repeating information if needed.

The office should be neat and comfortable, with adequate seating and reasonable waiting times. Still, always arrive prepared with something to occupy the time if the wait should run more than 15 or 20 minutes. Starting an appointment furious about the wait is not conducive to good care.

Most important to me is a doctor who is accessible, by phone or e-mail, and who responds to my concerns in a timely fashion. My family doctor’s answering machine gives his cellphone number for calls that cannot wait until he is in the office and recommends going to an emergency room for urgent or potentially life-threatening problems.