By Paul Haidet
Communication between patients and doctors seems to be a hot topic these days. We regularly read about new initiatives that medical schools are taking to train students to communicate better. While these initiatives are important and much needed, there is another side to the doctor/patient equation that does not get nearly as much attention.
For 30 years, researchers have been studying not only what doctors do and say, but also how patients communicate. The story that emerges from this work is both hopeful and troubling. It turns out that when patients actively speak up — when they ask questions, share concerns, or tell their story — they influence their doctors to communicate in a more caring, “patient-centered” fashion. And when that happens, those active patients receive more information, better care, and have better health outcomes than their less active peers. Unfortunately, most patients are fairly passive, and do not enjoy such communicative or health benefits.
There are a number of reasons for this. The one I most often hear is that “I don’t want to waste the doctor’s time.” The problem is that most doctors will revert to their area of comfort – the technical aspects of medicine – if patients don’t add to the conversation equally important topics, such as what’s concerning them most, what they think is going on, and what they want to know about their illness. There can be no ideal back-and-forth communication between doctors and patients if it all goes in only one direction.
So, what can patients do to be more active participants during medical visits? There are a few simple things everyone can do to be better advocates for their own health:
1. Ask Questions — While this seems so obvious, it is not done that often in practice. The fact remains that those patients who ask questions are the ones who usually get answers.
2. Be Prepared — Come to the doctor’s office with a written list of the most important questions you want to get answered. Be aware that there may only be enough time to get to two or three of the questions, so some may need to wait until the next visit. The written list is critically important, because it is common for people to forget what they wanted to ask in the heat of the moment.
3. Communicate Your Concerns — If some aspect of your health is really bothering you, bring it up first thing when the doctor enters the room, no matter how trivial it may seem. The fact of the matter is that it is not trivial to you, and you want the doctor to have time to give it his or her full attention. A common pattern is for patients to bring up the thing that is really scaring them as the doctor is about to conclude the visit; resist the urge to do this and try to get it out early, because things that come up late in the visit usually don’t get the attention they need.
4. Tell your story — Humans by nature respond and connect with each other through stories, and doctors are no exception. For example, letting your doctor know that you are really scared about a cough because your friend had lung cancer and you are afraid that your cough might be cancer too provides a powerful context that will help the doctor to feel some of the concern that you are feeling. This helps to strengthen the relationship between you and your doctor and can lead to better understanding and caring on the part of your doctor. One word of caution — it is important to be concise and stick only to the most important parts of the story. You should plan to be able to tell the story in less than one or two minutes, and it may be necessary to practice what you want to say before you go to your doctor appointment.
Folks often ask me what my job researching and teaching communication is all about. I often respond with a simple answer: Both doctors and patients could stand to communicate better in today’s world. Doctors need to learn how to listen, and patients need to learn how to give them things to listen to.
Paul Haidet is director of medical education research and a professor of medicine and humanities at Penn State College of Medicine.
