How do I work with Medical Professionals to receive the best possible care?

August 17, 2005 6:57 PM

Medical Professionals and Savvy Patients: what advice can you give for working with Doctors most effectively? If I'm not satisfied, should I look for new doctors, or revise my approach, or both?

I sometimes find myself very frustrated with visits to the doctor's office. I often feel like I'm not being educated about my health, and that a diagnosis given is merely a quick guess, rather than a well-tested hypothesis. I don't see tests run that I'd often think would be of interest, and see tests run that don't make sense to me. I end up with unanswered questions and sometimes feel unsatisfied that a course of treatment is truly addressing the problem.

To illustrate with an example: several years ago when I was suffering terribly from mysterious abdominal pain, I was given a treadmill test to see if it could be cardiovascular related, when at the time I considered myself in good shape from regularly running, hiking, and biking (the treadmill test bore this out). I was given Nexium on the assumption it might be acid reflux (no go). Meanwhile, it took a year to find a doctor who thought that running a battery of tests on stool sample might be an interesting idea, where I thought this would have been obvious thing to do -- the illness *felt* intestinal, and so looking at what intestines produce seemed reasonable (though they found nothing).

I think through these experiences I've become a bit more insistent and pushier,
but it's still a lingering issue. Sometimes when I ask more questions, I've gotten jargon that I feel is designed to test whether or not I'm really ready to talk about physiology/biology on the doctor's level, and discourage further questions. Sometimes when I've tried to guide attention to theories I've been considering, I've found the matter dismissed without much explanation, or glossed over in the hurry that seems to be inherent in a doctor's office.

I understand from my own working experiences in technology that sometimes it's difficult to explain things to clients who don't have the first idea of the field. I'm also empathetic to the demands of time. But it's my health, and I'm gearing up to check out several new and lingering issues, and I want to do better at working with health care professionals to get things right.

Are there practices I can adopt that will help better exchange between my doctors and I? Any kind of self-education that can improve things without making me a hypochondriac? Is this a simple assertiveness issue? Or if I find myself feeling uncomfortable or not listened to, is that a sign I simply need to shop around more to find doctors on my wavelength and care I'm content with?

posted by weston to health (10 comments total)

You have already listed the things that make for a productive doctor-patient relationship-- comfort/trust (this goes both ways), the self-confidence to ask questions, and some level of education (learning to speak the language).

You can judge a doctor's skill, to a certain extent, by the quality and quantity of the questions he/she asks. That it took you a year for a doctor to ask if you were experiencing any other intestinal symptoms (diarrhea, constipation, nausea, blood in stool, etc), is bit disheartening. 2nd question should have been whether it related to any specific activities, foods, etc. If they're not asking these questions, you should definitely find a better doctor.

Once you are headed in the direction of a diagnosis, then you can start with self education-- webmd, google, pubmed, etc, to learn about the physiology of the condition, other related/misdiagnosed illnesses, possible treatment courses, current trends in diagnosis and treatment, etc. There are often "reviews" of current thinking on a disease, etc in medical journals, accessible by pubmed, which, after a little practice, can be read by layfolk.

Being an educated patient (knowing your options, knowing the definitions of terms your doctors use, knowing how to precisely describe your symptoms, diligence in keeping logs/diaries of your symptoms and possibly related activities) while off-putting to some doctors, will ultimately help you get better care.

Don't be afraid to get a second or third opinion, particularly if you aren't getting results.
posted by joshwa at 7:22 PM on August 17, 2005

What's I've learned so far:

1) Write your questions down before you go.

2) Don't let the doc leave the room without answering them.

3) If possible, find a doctor who moves slower than the road-runner.

4) Get second opinions for anything serious.

5) Of course, find the best doctors available.
posted by callmejay at 9:15 PM on August 17, 2005

I think it's most important to ask questions. If you don't get a satisfactory answer, or don't understand the terminology, ask your doc to explain.

If you don't have the type of relationship with your doctor where you feel comfortable asking questions, or he makes you feel uncomfortable asking them, maybe it's time for a new doctor. I found a referral to my last doctor through a cow-orker whose husband is a doc. "Insiders" know who the best doctors are. They also know what their strengths and weaknesses are.

Also, taking in written notes seems to work well for my wife, so callmejay's technique could work for you.
posted by SteveInMaine at 6:33 AM on August 18, 2005

1. Ask for a copy of your medical records, especially all tests results. Keep these in a folder of your own and provide copies to any doctor you see for additional opinions or treatment. This will let them know what tests were run and what approaches were taken. This will provide lots of useful info to the new doctor so he/she doesn't go down the same path. Do not rely upon your memory for this.

2. As you think of questions between visits, write them down and come prepared to ask the doctor.

3. At the visit, take paper and pen in the room with you so you can take notes on your questions and your doctor's suggestions. Again, don't rely upon your memory for this. I find doctor's respond differently when I'm taking notes and asking my prepared questions.

4. During the visit, offer up more information than what the doctor requests. If it feels like an intestinal issue, talk about why you feel that it's intestinal; what are your stools like, have you noticed discomfort after eating certain foods or doing certain activities, have you been having fevers or night sweats, etc. Sometimes, you'll mention something that you thought was no big deal but turns out to be a major clue to the doc.

5. Don't be afraid to schedule a "consultation" visit in which you talk about your symptoms in light of the test results and what steps should be next.

6. Remember that you have every right to be an informed patient. This may mean in you having to do some research on your own. This may also mean that you ask the doctor to translate an answer rife with medical jargon into layman's terms. Don't get intimidated by the jargon. Ask for spellings and definitions or look the words up later.

7. IMPORTANT - If you are working with more than one doctor, have them communicate with each other. If one orders tests, ensure that copies of those test results are shared with your primary care physician and other specialists who may need to know.

Part of the problem is that doctors don't have the time to really focus on their patients as we expect/want/need them to. For most patients, simply treating the current problem is enough. For those of us with more complex medical situations, we need to be our own advocates with our doctor. They may not always be focused. However, we have only ourselves to worry about. We have the time to help piece things together.

Best of luck!
posted by onhazier at 7:59 AM on August 18, 2005

I think it's worth posting a (slightly) dissenting view. I would firstly agree with preparing questions and writing them down if necessary and finding someone who has a style that suits you. Then stick with them. But consider that sometimes you are drawing adverse conclusions about thought processes of someone who can't be expected to explain every little detail and the reasoning behind all decisions. It's just not possible. That's of course on top of the fact that you have limited knowledge as well.

When we take our cars to mechanics we must have some faith that the tradesman will know what they are doing. It's analogous with the work of Doctors though of course it's accepted that health is of paramount concern. So while asking questions ought to be encouraged and even obtaining a second opinion is indicated if the first visit is of particular concern, it's also beneficial to your mental wellbeing to have some element of faith that the professional you see will be trying to do their best by you. A final point would be that people ought to stick with the one GP where possible. That way, not only is rapport built up, but if referral to other specialists is deemed necessary, then you will be more accepting because it's someone in whom you have trust that has recommended them.
posted by peacay at 8:56 AM on August 18, 2005

The New York Tmes is running a nice series on patient (consumers) relationships with medicine. Of note, the move away from medical paternalism to more automony for patients (Savvy patients). Some patients and physicians have trouble with this move and prefer a more paternalistic relationship or vice-versa.

Your experience with technology may not help understand the patient-physician relationship… but just as most computer malfunctions are software related rather than hardware many patients problems are not serious structural problems and self-correct with time. Because of the high likelyhood the problem is software related, hardware problems are often not suspected til all else fails to work (all software issues are ruled out). The technology jargon term "JOT" (just one of those things) that explains hardware glitches that are sporatic or go away is analogous to some people problems also.

Nonetheless, problems that persist despite "trial and error" approches to solving them are eventially diagnosed. Sticking with one physician who learns that all things tried so far haven't worked but keeps trying is usually (but not always) better that going from physician to physician.

Select a primary physician who has a good speciallity referal network, is not so egotistic as to mind getting second opinions, and listens. Don't be put off if he rejects your self diagnosis as long as he listens and keeps trying to solve the problem his/her way.
posted by jjcurtis at 9:53 AM on August 18, 2005

My fiancee had a great experience at a university healthcare center. It's been her experience that at teaching hospitals / heathcare centers, the Dr.'s are more thorough and take more time to explain things. They also seemed to be the most up-to-date with procedures and medical innovations/research.

I second the idea of finding a Dr. that you feel comfortable w/. Your relationship with you Dr. seems to be key in communication.
posted by itchi23 at 10:23 AM on August 18, 2005

Trust and rapport go a long way. I have a smart doctor who isn't afraid to say "I don't know exactly what it is; let's assume one of the obvious candidates and see how we do." I liked a dermatologist who told me that treating my dry but pimply skin would require a good deal of trial and error; others had just assumed or pretended they knew what would work right off the bat. It's the attitude that turns me off more than the fallibility.
posted by wryly at 10:37 AM on August 18, 2005

This is an interesting thread. I agree that it is important for the patient to trust and work with the doctor to some extent, even without full understanding. I will spend an hour or more, if necessary, explaining things to my patients; but when they expect me to put them through medical school and a neurology residency during their clinic visit, and equip them with the judgment they need to corroborate my conclusions independently, I cannot accomodate them.

If it's not working, though, don't be afraid to find another doc. I've had my patients correctly diagnosed by other doctors, with and without referrals, and it's always delightful when that happens. No living doctor can master the entirety even of his own specialty these days, much less the entirety of medicine, so when you have a diagnostic problem, more opinions can be helpful.
posted by ikkyu2 at 11:55 PM on August 18, 2005

Whenever I need to choose a new doctor (if I move), I call up first and ask three questions, in order :

1- How long in advance do they recommend I call in order to get an appointment?

2- If a patient has questions, does the doc mind taking the time to answer them?

3- If a member of my family has an illness or injury, will the doctor generally find a slot to fit us in on the same day?

answers:
1- they all say as early as possible, of course, but I listen to the tone so I can compare when I spring question 3 on them.

2- again, listen to the tone. They will try to say yes, but the ones I want have receptionists with neither hesitation nor suspicion at this question.

3- spring the question, even though you've already asked question 1. ANY hesitation here and I'm off to phone the next on the list.

You can say what you want about the best doctors being booked up for months, but I don't care. The best doctors for me are the one's who put their patients first no matter what.

And in 30 years of picking doctors for myself and family members (yeah, I started young, just cause my mom seemed to often choose intimidating gestapo docs) this has never once failed me. Every doctor I've picked with this formula has treated me and my family like equals, with respect and care and approachibility and gone above and beyond what was expected. Doesn't matter what type of insurance plan I've been on, from welfare to I-can-afford-the-best, from hmo to ppo, from general doc to high specialist, it has worked every time except once -- and that was after a specialist had grown into a conglomerate and was, in contrast to the wonderful doc he'd been 24 years earlier, a total ass now that he was head of a vast empire.

So I took my medical records from his office -- getting them without paying a cent of the 'you're kidding' fee that his office first asked of me, and found someone else.

Please also note that this was the only instance in which I ever needed to assert myself with a doctor.

Although I've always asked if I could be a pest (with questions, same day appointments, etc.), I woud never think of being a pest. I just wanted to know the extent of my family's value to them, and I've found that they were indeed there for us when we needed, just as they'd answered.

Anyway, to sum up this unintentionally long post (I do hope you'll forgive me, too tired to pare it down now), I have had none of the horror stories I often hear from others regarding their doctors. My husband, who won't give up the doctor he had when we met, baffles me by waiting weeks for appointments and enduring unreturned phone calls, crappy referrals and substandard care, IMO.

In contrast, my doctors have (remember when I said beyond expected?) been directly responsible for the suspension of an emergency room doc when they discovered she'd prescribed a dangerous and unnecessary drug for my 8-week-old, literally saved my life by remaining by my side when I had a previously unknown allergic reaction during a routine test before surgery, sped the healing of a family member by accepting my suggestion (and phone call) regarding a medication prescribed, and more.

Finally, I've found a very low turnover and high satisfaction factor in the staff of the doctors I've chosen, and I find that very telling. So in conclusion, I think my 3-question method just reveals the more human docs.

Good question. Good luck.
posted by thewhynotgirl at 2:18 PM on August 23, 2005 [1 favorite]