We have all done it before - after a few days of being sick (and perhaps a bunch of procrastinating), we finally make the call to the doctor, and end up in their waiting room. After what can sometimes seem like an indeterminate wait, we finally make it in to see the physician, and then, the question and the moment that we have all been waiting for - "So, what brings you into the office today?"
While this certainly seems like a fairly simple question, as a matter of fact, it is not at all, and how you answer it can determine to a large degree just how satisfied you are with this visit to the physician, and whether or not you receive the appropriate diagnostic tests and treatments.
One of the most important points to consider in this regard is that most physicians will have a tendency to interrupt you early on into your answer. I'm sure we have all experienced this, and studies have shown that physicians will commonly interject within a matter of seconds. The reason for this is that as physicians we attempt to pick out, what are to us, the really "relevant" parts of your answer (for instance, "when did your chest pain start," and "what makes it better or worse?"), and we often have a very hard time listening to those other parts ("Well, it all started at my cousin Millie's house. She was having a party, and my sisters were there, and it was really raining hard, but the potato salad was delicious..."), that while they might be a part of normal, everyday, social discourse, are not so relevant to what exactly is ailing you.
Part of this is due to some of the modern-day realities of practicing medicine. Physicians commonly only have a very brief amount of time with each patient (sometimes 10-12 minutes), and at the end of what is often a very long day indeed, they still have paperwork to do, and reading to catch up on. In short, they are busy. And if they only have 12 minutes with a patient, they want that 12 minutes used as valuably as possible, discussing relevant symptoms, diagnostics, and treatments (and not cousin Millie's potato salad...).
That being said, another point is that in 12 minutes a physician can realistically only deal with one (or at most, a few) physical complaints or issues, even though a patient may have far more than 1 or 2 complaints (those with chronic health problems can often have far more than this during any one visit). Because of this, physicians will often further redirect or interrupt a patient's answer to the above question, to focus on one major issue (what, in medical terms, is called the "chief complaint", that is, why you really finally mustered up the gusto to make it into the doctor's office), and maybe a second or third if time allows (during a routine "checkup" or "physical" exam, there is often a little more time built into the visit to handle these other issues). So if that chief complaint is chest pain, and you also have a persistent case of toenail fungus or dandruff, your physician is most definitely going to focus on that first, and most concerning, issue. If you mention these other complaints, the doctor will likely interrupt and redirect you again.
Because of these challenges and limitations, many patients end up leaving their doctor's offices unsatisfied. Either they're frustrated because they feel like they didn't get to tell their complete "story" about their illness (which, if doctors listened, often includes valuable information that can be otherwise missed), or they didn't get to have all of their complaints satisfactorily addressed or questions answered.
This does not mean, however, that visits to the doctor have to end this way. In fact, there are a number of steps that anyone can take, that can help to maximize the results of any visit to any physician. If you follow these simple steps that I've outlined below, with a little forethought and preparation, you can avoid much of the dissatisfaction that comes as a result of these limitations.
1) Ask yourself, what is the main reason that I've scheduled this visit? Is it for a sore throat, or shortness of breath, or persistent gas? The answer to this is your chief complaint; write it down.
2) Be aware that your physician is going to want to know a great deal about this chief complaint, in order to evaluate it and to provide you with the appropriate diagnostic procedures and treatment. There are certain questions that are commonly asked about most health problems. You'll do yourself a great favor, if in advance, you ask yourself and answer these questions (and write them down too!), so that when you're in the doctor's office, you can maximize the use of the time that is available. These commonly include:
- What are your symptoms exactly? Describe them in detail.
- When and how did they start? Does anything make them better or worse?
- If it's pain, what is its "character" - is it "sharp", "dull", "stabbing", "aching", etc.?
- Have you ever had anything like this before, and is it getting better or worse?
3) Besides this chief complaint, if time allows, you might be able to discuss additional complaints. These will most often follow a similar sort of analysis, so ask and answer the same questions as listed above of these additional symptoms or health problems. Then, during your doctor's visit, state explicitly that you have multiple complaints, but these other ones are secondary, and you are wondering if time remains to evaluate these as well. Quite often, a physician will be more than happy to take additional time with a patient if they have asked in advance.
4) If this is a visit to a new physician, then have your complete health history at your fingertips. After all, it is within your rights, as a patient, to have access to all of your medical records. This includes a list of your medications (with dosages, and changes over time), allergies, previous medical/health problems and surgeries, smoking/alcohol/drug use history, and family history. It should also include the results to previous diagnostic procedures, like lab results, imaging studies (X-Rays, CT scans, MRIs, etc.), mammograms, colonoscopies, treadmill tests, etc.
Familiarize yourself with this information as much as possible, as well, so when asked about something you will be more than likely to know the answer. This will often speed up a doctor's visit, and help get things done, and in addition, you'll be better able to catch errors that might have been inadvertently made about your health history, medications, etc.
5) Write down any questions that you might have, and inform your physician that you have questions that you would like to have answered. Be direct with those questions, and if you don't understand the answers then tell them! Quite often, physicians will be more than willing to re-explain something, but if time becomes a constraint (which it often does), you might have to leave certain questions until the following visit, or seek out other sources of information.
6) Last, but most certainly not least important, is if something doesn't seem right, or if something just doesn't make sense to you, then never hesitate to inform your provider of your concerns. If a new medication doesn't feel like it's doing the job or if there are side-effects, or if you feel like you're not healing properly after your surgery, etc., then call your physician immediately! When in doubt, make the call, or get to an Emergency Department if necessary.
Following these simple steps can help ensure that you will get the most out of any doctor's visit, that you will use the time that is available most efficiently, and most importantly, that you will be a satisfied (and healthy!) patient.
Jonathan Fay, M.D.
August 4, 2006
References: Beckman, H.B., and Frankel, R.M. "The Effect of Physician Behavior on the Collection of Data." Annals of Internal Medicine. 1984 Nov;101(5):692-6.
Copyright © 2006 Jonathan Fay, M.D.
Dr. Fay is a personal medical consultant, providing answers to patient's questions about their health, diagnosis, and well-being (available on the internet at http://www.doctorfay.com). He has helped thousands to better understand their health, and to be in a far better position to be highly involved in their own healthcare. As such, patients can make better decisions about treatment options, that better fit their own personal preferences (and not those of their physician, another provider, or anyone else).
Dr. Fay is also the author of numerous articles about the state of healthcare today in the United States, new developments in medicine, and articles to help explain medical treatments and diagnoses in terms that patients can easily understand.
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