It’s less common today but people used to think empowered patients were anti-doctor. One part of our response on this blog was to point out the many clinicians who are e-patients themselves, as in Let’s hear it for the d-patient e-patients (with dozens of comments).
This guest post by SPM member Leana Wen, MD (Twitter: @DrLeanaWen) is another, about her book released this week, When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests. Her words illustrate that participatory medicine is about patients playing an active role, in partnership with their clinicians – including when the patient is a clinician. She’s turned her family experience and clinical experience into a list of six tips. (Check out the advice to interrupt!) (But also to be respectful.)
Have you ever gone to the doctor and felt like she wasn’t listening to you? Have you tried to tell your story, only to have him interrupt with a checklist of questions: do you have chest pain, shortness of breath, fevers, cough, and so forth? Have you ever felt ignored, and left thinking that your doctor never understood why came to him in the first place?
As an emergency physician, I have seen patients who are increasingly frustrated at their lack of control over their healthcare. As a caregiver, I have experienced the consequences of this firsthand.
My mother, Sandy, was a school psychologist in Los Angeles. When I was in my second year of medical school, she began complaining of a cough and feeling run down. Her doctors reassured her for six months that she had a virus. They blamed it on her being around kids all the time—but she’d never been sick like this before. And she was getting pains throughout her body—she knew it wasn’t right. It wasn’t until nearly a year later that she was found to have breast cancer that was widely metastatic. She was 48.
All along, she knew something was wrong. She just didn’t know how to get her doctors to listen to her concerns. And even though she was a highly educated person, and I was a medical student and knew something about healthcare, I felt powerless to help her, powerless against her doctors who just didn’t seem to listen, and powerless against this vast medical system.
Everyone talks about “patient empowerment”—and that’s very important, but we didn’t have the tools to empower ourselves to get the care that she needed. As I discovered throughout this process, it’s not about looking up information about the Internet about treatment, or asking lots of questions—it goes through something a lot more fundamental. You have to take control of your healthcare by making sure your doctor listens to you. I wrote this book to really empower patients to help their doctors help them.
Isn’t this backwards, you might ask. Shouldn’t doctors be the ones to take the lead to help patients? Absolutely. Almost without exception, the doctors I know are very well-meaning. Unfortunately, they are under a lot of pressure from the healthcare system, and end up resorting to “cookbook medicine” with checklists of yes/no questions rather than listening to patients. This has consequences: as I noted on Huffington Post, 80% of diagnoses can be made based on history alone, and not listening can lead to misdiagnosis and fatal consequences. That’s why it’s so critical to make sure your concerns are addressed—and even before that, to make sure your story is heard.
Here are 6 tips for getting your doctor to listen to you:
Tip #1: Answer the doctor’s pressing questions first. Many doctors are so accustomed to relying on a checklist of questions that they have to get these answers before they move on. Help them out and answer these questions. If the doctor want you to describe the location of your chest pain, describe it (“it’s in the middle of my chest, right here”). If she want to know what you took to make it better, tell them (“I took an aspirin. It didn’t help”).
Tip #2: Add a narrative response at the end of close-ended questions. If your doctor persists in asking close-ended questions, add a narrative response at the end that may not so easily fit into a yes/no answer: “it’s in the middle of my chest, right here, and it started after I really pushed myself in swimming tonight”.
Pretend that you are being asked “how” or “why” instead of “yes/no”, and add your own response. Look to make sure your doctor registers this answer—does he ask you more questions to follow-up on what you said, for example?
Tip #3: Ask your own questions. If you don’t understand why a particular question is relevant to your situation, ask about it. You may be surprised to find that the doctor herself isn’t sure and is only asking the question out of habit. On the other hand, you may find out that issues you wouldn’t have thought were related might actually be very important to discuss.
Tip #4: Interrupt when interrupted. If your doctor cuts you off when you try to explain your full answer, free to interrupt. Pretend you’re having a conversation, even when it feels like you’re being interrogated.
For example, if you’re asked “when did headache start,” rather than responding “10am,” go ahead and tell your story of how the pain started: “I woke up this morning and I was fine, then I started walking to work and the pain came on suddenly like a lightening bolt striking me.”
This is not a new tactic; lawyers will often coach clients in advance to answer yes/no questions with a narrative so that answers can’t be taken out of context. Interrupting is a way to ensure that your entire answer is heard, not just the part that the doctor thinks he wants to hear.
Tip #5: Focus on your concerns. If you get the sense that your concerns are being brushed over, interject, “Excuse me, doctor, I have tried to answer all your questions, but I am still not certain my concerns have been addressed. Can you please help me understand why it is that I have been feeling fatigued and short of breath for the last two weeks?” and so on. You can take charge of the conversation at that point. It’s your body and your duty to advocate for yourself if you don’t feel like your story has been understood and your concerns have been addressed.
Tip #6: Make sure you are courteous and respectful to your doctor. Your doctor is a professional, and is probably trying her best to help you. Your story has to be heard and your concerns addressed, but make sure you present your points in a respectful manner. This will ensure that a solid doctor-patient relationship is present, and is critical to the partnership you need to establish.
You may be dissatisfied and frustrated by your medical care, but you can take control of your health care today. Try these tips on your next doctor’s visit, and empower yourself to get the healthcare that you deserve.
Dr. Leana S. Wen, M.D., is an emergency physician at Brigham & Women’s Hospital and Massachusetts General Hospital and a clinical fellow at Harvard Medical School.