Talking about a sore throat or cold may be relatively easy. However, describing abdominal pain, psychological issues, or gynecological symptoms can be more difficult, especially with a stranger. Having your own family doctor – someone who knows you – can reduce anxiety when you must describe sensitive issues. More family doctors are now being trained across Canada. The goal is for everyone to have a family doctor, so people do not have to rely on walk-in clinics or emergency rooms for every medical encounter.
Most people can remember a time when they got off on the wrong foot with someone. When this happens, communication seems forced, key points are missed, and there is little satisfaction in the encounter. It can happen in a doctor’s office too. Approach your medical visit with a few strategies to help ensure that your visit starts well, your concerns are voiced, and your expectations met.
First, consider why you are going to the doctor. Sometimes there is only one reason, such as if you have a sore throat and are wondering if it might be strep. Maybe a few different things are going on – you are running low on your blood pressure medication, and also have questions about your bone health. Make a list to help you to remember the items you would like to address.
Mention all of the issues on your list at the beginning of the appointment. Do not save your biggest concern for the end — mention it first. Most doctors book 10 to 15 minutes for a visit. Each of your concerns might require all of that time to be addressed adequately.
Some offices post signs that remind patients to limit the number of concerns. It is not because the doctor does not want to help you. Most medical issues take 10 to 15 minutes to deal with, so if every person comes in with three or four problems, the office flow will grind to a halt. Some offices are able to book longer appointments for patients with higher needs. If you have more than one major and one minor concern, ask if you can schedule more time when you phone to book your appointment.
If a doctor cannot address non-urgent concerns adequately, you may be asked to book another visit. This can be frustrating, especially if you are disabled, must book time off work, arrange transportation, or hire a babysitter to attend appointments. However, if your doctor tries to deal with too many issues in one visit, your concerns may not be adequately addressed. This reduces your quality of care. Ideally, a doctor should be able to spend as long as it takes to address all concerns. Unfortunately, most must see a certain number of people each day to keep their offices running and to earn a living.
As you prepare for your visit, think about which one item is the most important concern for you that day. When you start the interview, use words like, “I have two concerns today. The most important is this rash that I developed recently. The second is that my sister was recently diagnosed with breast cancer, and I am wondering about my risk.” Stating both concerns at the beginning allows the doctor to understand your expectations, to manage the time, and leads to a more satisfying visit for both of you.
Sometimes people are quite worried about the cause of their symptoms. Very often, wanting reassurance that symptoms are unlikely to be related to a bad diagnosis is the main reason for the visit. For instance, someone with headaches might fear that a brain tumour (cancer) is the cause. Although it can be challenging to admit this deeper concern, your doctor really does want to know these fears. It is okay to say that you are worried about the possibility of brain cancer. Living with the fear of a sinister diagnosis can be as bad or worse than the actual symptoms. The worry may produce new symptoms like poor sleep, irritability, and difficulty concentrating, among others.
One question that can start a helpful discussion is, “What could be causing this?” In fact, your doctor is thinking exactly the same question. This thought process starts even before your doctor enters the room. Usually, the booking staff or the clinic nurse give clues beforehand as to why you have made the appointment. The doctor considers your age, gender, medical history, and the reason for your visit (your presenting complaint) to make a mental list of possible causes. Listening to your story and clarifying by asking questions and doing a physical exam narrows those causes into the shortest possible list. Then, the doctor considers whether further investigations will help to rule in or rule out the items on that list. Doctors always move through this process, but they do not always say it out loud, mostly to save time. When they do think aloud, or are reminded by a question from a patient, the resulting discussion can be very valuable for both patient and doctor.
Most doctors also want to know what you think about your symptoms. Once you have revealed your fear about brain cancer, you could also offer your ideas: “I have noticed these headaches come with certain weather, and I am thinking they might be migraine.”
Another good question to ask is whether there any tests that might help figure it out. If you are curious about the value of a particular test, mention it: “I was wondering if a thyroid test and an iron test might be useful.” When doctors and patients have a mutually respectful two-way discussion, patients tend to feel better about their care. The outcome might also be improved.
Before you meet with the doctor, consider your expectations for the visit. Everyone brings their own ideas and fears to a visit, as well as their own history, culture, experience of illness, and understanding of medical ailments. You may be seeking more information about an already diagnosed condition. You may ask, “Will it get worse? If it does, what treatments are available? Is there anything I can do to improve the situation?” Other times, your visit is to explore new symptoms. You might feel satisfied with a good explanation of your condition, or you may expect more investigations, like x-rays or blood tests. Be sure to state these expectations so the doctor can discuss the pros and cons of various tests.
At the end of your visit, you should know the likely cause of your symptoms. You should also know what happens next, such as when you should return to see the doctor and what to do if the symptoms get worse. If you are not sure, ask. Request written material like handouts and pamphlets. These might also help you to remember your discussion.
In a good encounter with a medical professional, the discussion may flow smoothly. However, some situations are more difficult, even when you know your doctor well. Being proactive and using these tips will help you to navigate any medical situation.