How to talk so your doctor will listen

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How to talk so your doctor will listen

Doctors Aren’t Listening

A classic study in the Annals of Internal Medicine found that patients were allowed to finish their “opening statement of concerns” in only 23 percent of doctors’ visits. A more recent analysis found patients speak for an average of only 12 seconds before being interrupted by resident physicians.

Surely, doctors aren’t all cold-hearted and inattentive to patients’ health concerns. So, what’s to blame?

“Over the last five to seven years, physicians have been placed in a position where they have numerous conflicting task priorities when they go in to see patients,” explains Nirmal Joshi, chief medical officer of PinnacleHealth in Harrisburg, Pennsylvania.

No longer does your doctor walk in with a chart and a pen. Now, she must account for every statement, question and answer in your electronic health records, and check boxes for what Joshi says are more than 100 measures, patterns and health outcomes being tracked by national organizations.

“Physicians are learning to manage their time with a very limited amount of resources, and it’s a struggle,” he says. “So face-to-face time with patients, where they have undivided doctor attention, has dropped.”

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Lessons in Listening

Joshi and his colleagues have created a program in Harrisburg that’s sort of a communication boot camp for doctors, involving mock patient interviews with direct patient feedback. During their analysis, they found doctors introduced themselves upon entering the exam room only about one-fourth of the time.

The program is unique; perhaps the first of its kind. But Joshi says they recognize communication is the foundation for positive health outcomes, and the research agrees.

An analysis from The Joint Commission, a nonprofit that accredits U.S. health care organizations, faulted “inadequate communication” – both between physicians, and between patients and their doctors – in more than 70 percent of sentinel events, or adverse health outcomes not related to the natural course of a patient’s illness.

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What You Can Do

As a patient, you are not powerless when it comes to effective communication in the exam room and after you leave. There are things you can (and should) do to ensure your voice is heard and concerns addressed.

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1. Come prepared.

Know what you intend to talk about before you arrive for your appointment. Write down your concerns and questions, and make them specific. The more pointed your questions are, the more direct answers you’ll get.

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2. Prioritize your concerns.

Know that your doctor may not have time to answer all 50 of your questions, so ask them in order of importance.

“When a patient prioritizes their concerns it tells me they have very specific health interests, and they understand we’re both working with limited resources,” Joshi says. “It also tells me you respect my time and allows us to focus on what concerns you most about your medical situation.”

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3. Don’t be afraid to ask for another appointment.

Ultimately, you want all of your concerns addressed with ample time and attention. So rather than trying to rush through your list of questions, if you don’t finish, ask for a follow-up appointment.

Joshi says it’s not uncommon for patients to remember something they wanted to talk about as the doctor is getting ready to leave the room. In that situation, the doctor has a choice – address the concern quickly, possibly sacrificing good clinical care, or setting up another opportunity to discuss the issue. As a patient, you can take the reins by requesting a follow-up.

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4. Be willing to communicate outside the exam room.

“Never underestimate the power of communication that’s not necessarily face-to-face,” says Joshi, who recommends patients ask their doctors whether they are willing to email. “Many physicians love that. I personally love that. That freedom allows me to instantaneously communicate with patients when I have the time for them.”

Email or communication through a patient portal is particularly useful when a face-to-face appointment has already occurred and you have questions about what was discussed, or your treatment instructions.

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5. Bring someone with you.

“If the person getting care happens to be elderly or is otherwise incapable of asking questions in an assertive way, I strongly advise them bringing someone along,” Joshi says.

When a caring son or daughter is present, for instance, Joshi says the expectations are very high, and he is most likely to respond in kind. In other words, the added person can serve as a medical advocate for the patient who may otherwise just accept that “doctor knows best.”

Your time with your doctor is limited, so making every moment count is crucial. Though it may seem like 15 minutes can’t possibly be enough, learning to use these precious moments wisely will help you get the most out of each appointment.

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When you go to the doctor are you prepared to give a complete update of your health, even if some of your concerns seem embarrassing to discuss? Dr. Brent Ridge explains how to prepare for a checkup and how to talk to your doctor.
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You show up five minutes early for your doctor's appointment and wind up waiting 20 in the lobby and another 10 in the exam room. As you hear your doctor approach, talking in the hallway, you ready yourself. If you're lucky, you have the next 15 minutes to voice your concerns, be examined, receive treatment recommendations and ask any questions.

It's little wonder patients don't feel listened to when they are at the doctor; they're hardly given enough time. When you consider you'll spend only a small portion of that 15 minutes talking, you better have your well-rehearsed speech ready and anticipate your doctor's questions in advance.

Check out the slideshow above to learn how to talk so your doctor will listen.

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