Doctor, Doctor, allow me to give you the news...

November 6, 2009 10:53 AM

I need help talking to doctors. I never know what to say and don't seem to give the right information. I would like help knowing what kinds of things I should remember to say and how I should say them.

I have, over the course of my life, had many doctors and similar problems always come up.

1) I'll have a visit with a doctor and they'll discover a problem, and ask me how long it's been going on. I'll tell them that it is as long as I've been seeing them. That will of course lead to incredulous looks and questions of why I have "never brought it up before" and I honestly have no idea.

2) I'll get sick and go see the doctor. I'll get a diagnosis and prescription. Then when I don't get better I'll go back to the doctor and often it turns out that something I'll casually mention the second (or fifth) visit will instantly cue the doctor in on what's wrong and bang! problem solved.

The first problem has been helped, but not solved, by making lists of things to ask my doctor about. Otherwise I will automatically say "I'm fine"
The second problem is more of a mystery. Patients: what things do you always tell your doctor about if they come up? Doctors: what sort of things do you wish your patients kept an eye on?

posted by French Fry to health & fitness (10 comments total)

To be honest, sometimes it's up to the doctor to ask about symptoms/previous complaints, etc. For example, when I saw a rheumatologist for the very first time (after waking up one morning with extreme burning joint pain and testing possibly positive for rheumatoid arthritis at an urgent care clinic) he aske me several questions that seemed totally irrelevant and unnecessary to me. For example, he asked me if I'd ever had any problems with my skin. I had to think back about 10 years and almost didn't mention it because it had been so long ago, but I mentioned that I'd seen a dermatologist because I itched a lot but didnt' have a rash. The rheumy perked up and made notes when I told him the dermatologist had remarked "You have very dry skin for a girl your age." Turns out that this was just one other clue that pointed to my ultimate diagnosis of Lupus (and Sjogren's Syndrome).

So, anyway, I'd advise that you keep a written journal of anything that seems unusual health-wise to you. Like I said, I almost didn't mention the skin thing because it seemed inconsequential. If you have, say, a recurring headache jot it down - the date, the time, the duration and describe the pain. Blurry vision? Fever? Extreme fatigue? Brief memory lapse? Anything that is different from the way you normally feel, write it down. My (70-something) Mom started doing this as well for both herself and my Dad a few years ago and now types up the "diary" in a Word document on her computer prior to every doctor's appointment. The doctor appreciates it and gets a clearer overall picture of what's going on.
posted by Oriole Adams at 11:05 AM on November 6

I have no answers but much sympathy.

This is the reason I have often wished I could go to veterinarians.
posted by small_ruminant at 11:44 AM on November 6 [1 favorite]

Bring someone with you to ask questions. No, really. I have a friend who is anxious when he goes to doctors so he brings a friend who listens ad asks what he's to anxious to pay attention to.
posted by Obscure Reference at 12:09 PM on November 6

I always write things down before. It's easier to remember things when you're not on the spot. Try to figure out when your symptoms started by associating them with events ("my head hurt when I saw Harry Potter...let me figure out when I saw that movie...but it wasn't the first time it hurt like that..." etc).

Also write down any medications you're taking and the dosage. Write down your questions ahead of time, and write down doctors' answers and instructions as well.
posted by radioamy at 12:18 PM on November 6

Definitely keep a journal.....any cold, migraines, odd bowel movements, whatever. Hell, sometimes I'll just print it out and hand it to them. I had bizarre vertigo whose origin was traced back to my journal.

And always let them know if you have unexplained weight gain or loss.
posted by texas_blissful at 12:27 PM on November 6

Disclaimer: I am a doctor. I might even be your doctor.

Do bring a list of questions. Make the list legible. Give the list to the doctor at the very beginning of the visit. (Typically, a patient will bring in a list of 6 or 8 questions. I'll ask him to pick 1 or 2 and I'll pick 1 or 2. I don't expect the patient to know which things are trivial and which may indicate a significant problem. And we don't have time for you to tell me 6 or 8 stories.)

The biggest problem in a visit to the doctor is agenda setting. You may have several questions to ask your doctor. Your doctor probably has several items that he would like to address that you are totally unaware of. If he works for a large organization, he'll have a number of things he'll have to record as measures of his job performance. I can fill up a whole appointment without any questions from you.

When you mention a symptom, your doctor will attempt to obtain a history of present illness. Probably the most important of the questions he will ask--in order to make a correct diagnosis--is about duration and timing of symptoms. Be prepared to answer that with something other than "a while". Your doctor does not know what a "while" is. Do listen carefully to the doctor's questions and attempt to answer them.
posted by neuron at 1:49 PM on November 6 [2 favorites]

Medical student here. You sound like a typical patient - most people forget to tell doctors things, even on direct questioning. An example that has happened to me - one patient I asked whether they'd had any operations or hospital stays in the last year, they confidently said 'no'; turned out they'd had a whole limb amputation less than three months previously. So really, not telling your doctor about conditions or symptoms is totally normal.

It is, however, not that helpful.

So, some tips on being a better patient:

- if you think you're going to forget something, write it down and bring it with you. Things you might consider writing down: medications you're on (including over the counter), important questions you want to ask the doctor, if there's a bunch of niggly symptoms and you don't want to forget one.

- as neuron says, listen to what the doctor is asking. They'll often ask very specific questions to rule a diagnosis in or out. If you don't understand the question or you're not sure, ask for clarification.

- as Obscure Reference suggests, bring a friend. They're less involved in your health problem than you, and can provide useful backup - "I'm fine" "You're bloody well not." There's nothing stopping you bringing both a friend and a list.

- there are some things that can come up whatever the consultation is about: your family history of illnesses (serious things, like heart attacks, not whether uncle Dave had a cold last Christmas); your past medical history (so serious illnesses in your past, hospitalisations, long term conditions like asthma); smoking, drinking. It's as well to be able to answer these off pat - if you're in to see lots of different doctors you can give them a typed list to save time.

- also, try and relax. You sound quite worried about this - we may say medical exam, but it's not an exam! You and the doctor are Team Trying To Find Out What Is Wrong - you're both working towards the same goal. Going to the doctor is not generally a happy experience, but if you're extra worried this might be affecting what you remember to say when you're there.

- also also, can we have more patients like you? The fact that you're posting this and want to contribute more to your consultations is excellent from my point of view!
posted by Coobeastie at 2:42 PM on November 6

I've had doctors ask me, "Have you had any other symptoms?" and of course I couldn't think of any until I got home. Now when I hear that, I try to ask something like, "I'm not sure, what kinds of things are you looking for?" Then they can rattle off a list like "headaches, nausea, vomiting, weight loss..." and you can go, "oh yeah, I guess I have been getting more headaches than usual." Not only will this help catch things you forget to mention, but it may also bring up things the doctor is interested in that you would have left out because they seem so insignificant.

Second, when the doctor or nurse asks if you've had any XYZ symptom, feel free to take a second to really think about it. It's easy to feel rushed because appointments these days are so short, but it doesn't help anyone if you give a knee-jerk "no" reaction and forget that you actually had XYZ a month ago.

Third, if you're being seen for a specific problem, definitely ask the doctor what symptoms you should watch out for in the future, and which of them warrant a call or an appointment.

In terms of planning what to report to the doctor, and what you could write down ahead of time... I'm learning to do patient interviews as a student nurse, and we are taught to find out these characteristics of a symptom, as applicable: where in your body you feel it, how it feels/what is different, how bad it is, how long you've had it, whether it comes and goes (and how often) or is constant, when you notice it, things that make it better, things that make it worse, and any other changes you notice that might be associated with the symptom. If you can try to think of all those things (and write them down to help you remember), you will make your provider's job a lot easier.

Hopefully the tips you're getting in this thread will help you guide the conversation, but please don't feel guilty or like you're a bad patient because of these incidents. They reflect more on (a) the rushed appointments we all have to deal with, and/or (b) the [lack of] skill of the person asking you about your symptoms.
posted by vytae at 3:39 PM on November 6

Thanks for the great responses. I don't have much anxiety about going to the doctor, nor am I ill or in poor condition. But my insurance makes normal doctor visits surprisingly expensive so I want to nip this need for repeated visits in the bud. So that I'm not repeatedly shelling out 50 bucks, because I forget that I've been running a fever since 1999 or something.
posted by French Fry at 9:08 AM on November 7

As somebody alluded to above, another difficulty with the medical system as it stands is that doctors don't have time to deal with 15 different issues in one visit, even if you did write them down with all the details. The best they can do is try to handle maybe 2 chief complaints, and hopefully they will collaborate with you to prioritize from your list which ones should be addressed at that visit. A good doctor will then ask you to schedule another visit to discuss your remaining issues, because they really only have 15 minutes to spend with you at a shot. Unfortunately for those of us with high office-visit co-pays, that means we can't cram everything into a single visit.
posted by vytae at 10:28 AM on November 7