Q&A with Dr. Barbara Pierce, MD, of the College Station Family Medicine Center
Q: Why is it important to have clear communication of your health (or concerns) with your doctor?
A: A person must work to develop a good line of communication with their physician, in order to get the most accurate and helpful information regarding their health. It is estimated that about 5% of medical office visits result in a wrong diagnosis. One of the factors we know that contributes to this is lack of complete information from the patient. It is important for patients to be their own best advocate for their health, providing all the information that they can and questioning anything that is not clear or does not sound right to them. In an ideal medical encounter, patients and the physician work together to come up with a correct diagnosis and plan of action for their health issues. The most effective way for this to happen, is to have a good working relationship with your physician so that you feel comfortable talking to them about anything and questioning them if needed.
Q: What are some ways that a patient can improve their communication with their doctor?
A: One of the best ways to improve the effectiveness of an office visit is to write down a list of concerns and questions. It is important to prioritize them though, because unfortunately in today’s medical system an office visit lasts between 10 and 15 minutes most of the time, and therefore we can’t always address 8-10 concerns or questions. Sometimes it is best to go for the top two or three, and make a return visit for other issues. Sometimes after a visit for a sinus infection or something similar – where the entire time has been spent on diagnosis and treatment of that issue – that when it’s time to go, patients then ask, “What about my weight?” That is the best way to get the answer, “diet and exercise”. Because there was no time to discuss eating habits, exercise habits, and motivations for weight loss and develop a plan. The patient is then unhappy with that office visit because they didn’t get that question answered well, but they did not communicate that that was something they wanted to talk about in advance.
It’s important to talk to family members about their medical conditions to know if there is anything you’re more likely to have. Example, diabetes does run in families, but things like depression are important to know about since being raised by a depressed parent may affect their child even into adulthood.
Doctors are not perfect, and we have agendas as well as patients. It is important if you do not understand what or why a treatment is recommended, that you ask questions about it, make sure it is the best thing for you at your time and situation.
For example, I recently had a patient ask me about a change in her medication; she wanted to go from a patch delivery system to a pill. We discussed why the patch form of the medication was better for her and she was comfortable with continuing her medication as it was originally prescribed.
If you do not know how long you’re supposed to be on a treatment plan, or you do not know what the next step is if the treatment plan you have agreed on doesn’t work, ask questions. It is important to have a clear idea what is wrong, what to do about it, and if that doesn’t work, what you are going to do next. This helps you feel more comfortable and confident in your healthcare. Ask about medicines, side-effects, and allergies. While discussing medication, you might recall having taken something similar before and although you don’t have an allergy, you had a reaction, and knowing that in a discussion can help prevent problems with taking the medicine or having you not even fill your prescription because you aren’t comfortable with taking it in the first place.
And a warning; question why you need a product if a doctor or healthcare provider recommends you purchase their supplement in their office. It is important to feel like you are getting the best care for you, not a vitamin or health supplement that a healthcare provider is peddling. The exceptions to this are dermatologists with specialized skin treatments, and weight loss providers who are providing meal replacement shakes.
It’s okay to write things down, even record things. If needed bring somebody else with you to help remember things that you might forget to write down, or ask further questions. Sometimes in the stress of talking to somebody about your health you forget small details that might be important, so having an extra brain and set of ears that you trust can be very helpful.
It’s important to be honest with your physician. Bring a list of all the medications and all the supplements you take, and be specific. Having “Prostate Formula” on a medicine list is not as helpful as having the brand-name such as “Nature Valley Men’s Prostate Health”, where we can look up the ingredients. It’s also helpful to bring in your medication and supplement bottles.
Let your doctor know about things in your past, even if you find this embarrassing today. Whether that is previous drug use, previous sexually transmitted diseases, or even previous mental health issues. All of these things help us understand you better and commit to the best diagnosis and care plan for you.
Q: What are some problems you have encountered with ineffective (and inconsistent) communication by a patient? What were the ramifications?
A: Sometimes if the patient does not make a list, they will call the next day and say, “I have a rash that we did not talk about, what can we do about it?” And at that point there is really nothing I can do without seeing it, so they have to come back in. Sometimes the patient will come in and say they are tired, and not reveal some major stressful event in their life that can be contributing, because they were embarrassed by it or upset by it and do not want to talk about it.
Q: What are reasons patients may not be forthcoming or thorough in their communication?
A: Sometimes the patient is embarrassed about their past, sometimes a person is too depressed to provide all the information we need, and sometimes people do not realize that even the smallest things can be important in their situation.
Q: How can you try to open the lines of communication with a patient?
A: One of the biggest problems today with communication is the electronic health record, where often times the doctor is typing at the same time they’re talking to and listening to their patient. If your doctor never looks up at you, they may not actually be listening to you. Eye contact and physical touch is important.
If I don’t feel I am getting through to the patient, I’ll try to talk to family members or refer elsewhere to see if we can get the “big picture”. Sometimes people just don’t click with each other. But if you do not feel you are getting all your questions answered as best as your doctor can, it may be time to change.