Do you ever feel like your physician is speaking another language? It may not sound quite like a foreign language. You can clearly hear English words here and there but overall you have no idea what they mean.
Communication between health care providers and patients is crucial to obtaining the best health outcomes; however, it remains among the most challenging tasks for both patients and providers. There are many factors that affect the ability to communicate effectively with physicians including limited time, complex medical language, social differences, differing agendas (for patients and providers), and unspoken expectations.
Here is an example of a patient visit with a physician in which the patient feels as if the appointment went terribly wrong and the physician is very happy with the visit.
-Hello, Mrs. B. I’m Dr. Dean. It’s nice to meet you. I see that you are 56 years old and you are taking no medications. It looks like you saw my colleague Dr. Barnes about 3 years ago for a sinus infection but you’ve had no other appointments.
So, how are you doing?
Fine.
It looks like your blood pressure is high today. It was high when you were here 3 years ago as well. Let me examine you. (Doctor performs physical exam.) Your heart exam indicates that you have probably had high blood pressure for some time. I am going to order some blood tests, urine tests, and schedule you for an echocardiogram, which is an ultrasound of your heart. In the meantime, you need to have your blood check 3 times on 3 different occasions so have the nurse schedule these for you. If your blood pressure continues to be elevated you will need to go on a special diet and exercise plan and you many need to take medications to control your blood pressure. You also need to get a colonoscopy and a mammogram scheduled since you are over 50 and haven’t had these previously.
Do you have any questions about this?
I don’t think so.
Great. It was nice to meet you.-
So what just happened? From the doctor’s view, she just diagnosed a middle-aged woman with long-standing untreated hypertension and she proposed a management plan that will likely prevent her from having a heart attack or stroke and will get her on track with screening for breast and colorectal cancer. The doctor is patting herself on the back.
The patient on the other had is very unhappy. She came to see this doctor for the headaches she has been having more often in the last 4 months. Not only did the doctor not talk to her about her headaches, but she has to do a lot of medical tests and she has half a dozen different appointments scheduled. None of which will give her an answer to her headache problem. As she is driving back to work, the patient is wondering why she ever went to the doctor and how she will get time off from her job for all these appointments.
How could two people have such differing perceptions of what occurred? First, when the doctor asked ‘How are you doing?’ and the patient responded ‘Fine’, the doctor assumed that the patient was there for a routine visit and had no concerns. The patient on the other hand had completed 6 pages of questions before seeing the doctor and stated clearly on the questionnaire that she had headaches for four months.
Why didn’t the doctor ask about the headaches? She probably assumed the headaches where due to the patient’s elevated blood pressure. Why didn’t the patient bring up the headaches later in the appointment? She was probably in shock thinking about all of the tests and what could be wrong.
Unfortunately, this time of ineffective communication occurs often in healthcare settings. So here are some tips to help you get the most of your visit with your health provider:
– Be prepared for your visit. Write down your questions and concerns and mention them early (before your doctor starts with his/her agenda).
– Bring a list of all your medications (including over-the-counter) and if possible, give a copy of the list to the doctor so he/she doesn’t spend time writing them down.
– Be honest. Don’t be embarrassed about any symptoms you experience or questions you have. Your goal is to be healthy, not to get the approval of your doctor.
– Before you leave, ask the doctor to review the plan. Be sure you know how long you will be taking any new medicines and what the purpose of any tests or medicines.
– Finally, if the doctor seems too hurried to answer all your questions, ask if you can schedule another visit to discuss all your concerns.
Of course, physicians and other health care providers can definitely work on being more effective communicators as well. This task is much easier said than done.
