 MG Members may obtain passwords with our online registration system |
Communicating with Your Doctor
Linda L. Kusner, B.S.
Henry J. Kaminski, M.D.
Myasthenia Gravis Center of
University Hospitals of Cleveland,
Cleveland Veterans Affairs Medical
Center and Case Western Reserve
University School of Medicine
The Patient
I made the appointment over three weeks ago. Approaching the big day, I thought about what to say. Last week, I forgot to take my medication and wanted to know what to do if it happened again.
Two days ago, I felt dizzy. I filed that question away with a dozen others.
The day of my appointment came, and suddenly I didn't remember anything and couldn't find my insurance card.
I was late, and the registration forms to complete were extensive. I was on edge and wanted to leave quickly. I answered the doctor's questions with little elaboration. By the time the visit was over, I had achieved nothing, none of my questions were answered, my doctor had little additional information, and I felt the same pains.
I had time to think on the way home with traffic stopped because a Volvo had rear ended a Porsche. I probably was a bad patient. I failed to communicate and went away untreated. I appreciated the need for organizing my thoughts before a visit to the doctor. Not only are insurance and pre-certification important, but even more, the doctor needed to know all my problems.
I began a journal of my ailments and questions about my health. I wrote down all my medications and their doses. I reviewed my journal, making notes as to the most important matters. On my next appointment, I was prepared. I arrived on time and had no feelings of being rushed and since their magazine selection was so good, I was enlightened on the proper growing of orchids and several delicious looking dinner recipes. I was at ease and felt comfortable with what I wanted to accomplish.
As I entered the examination room, I began to feel nervous and my mind went blank. I was glad to have my journal. I began to tell my doctor about my weakness and aching joints. Before long, I had described almost all my problems with as much detail as I could.
Even with realizing the importance of communication, I was embarrassed to bring up a rash that I had noticed. My doctor explained to me that I needed to be open with everything no matter how uncomfortable or how insignificant I thought some problems were. If the doctor knew my symptoms, I could receive the proper treatment. I went away from this visit feeling relieved. Not all my problems were solved, but I was on my way to getting better.
The Doctor
It was 4:30, and I was about to see the last patient of the day. I had a full day, and the patient was 30 minutes late. I was annoyed. Usually, I don't schedule new patients last but had made an exception. Further, I had no records from other doctors. Worse, I had a 5:30 meeting with my boss and a MG support group at 7:30.
The patient was nervous and distracted. It was clear from the story that there were significant problems, but it was hard to determine how to put them together. The patient began telling me about aching joints, which made things more complicated and I chose to ignore it.
The patient was also taking a lot of medications but didn't know any of their names. Five minutes in the Physician's Desk Reference, and we had found only half of them. I was feeling rushed and tried to hurry the patient on, which only made things worse.
I knew the patient needed a thorough physical examination, which would take at least 30 minutes. The exam required that I concentrate on some things more than others, but it was difficult to tell from the patient's history what was most important. I called my boss to tell her I would be late. That was too bad because she was leaving for the airport and could not see me for a week.
After 45 minutes we were done. The secretaries were gone, and I didn't know how to schedule any tests or a follow-up appointment. The patient would need to call back tomorrow.
I was mad. I didn't feel the patient was satisfied and I wasn't. As I sat in traffic, I thought about all the complaints.. I began to consider what had gone wrong. First, I should not have seen the patient late in the day. Second, I had been thinking of my own concerns part of the time. Third, I ignored some problems, like the joints. Finally, I got frustrated easily and made the patient upset.
On the next visit I would try to do better. I hit the accelerator, and my Volvo slammed into the back of my boss's Porsche.
A month later, I welcomed my patient back. Now, I had the old doctor's records that I had reviewed before the appointment. Fortunately, I could eliminate some tests since they had been normal previously. I asked my patient to tell me the major concerns-all of them. I heard about the skin problems, the arthritis and the weakness. I examined the rashes, the joints, and repeated the neuralgic exam. Clearly, the patient had MG, but probably another autoimmune disease affecting the skin and joints.
Comment
These accounts are fictional and have been formulated to illustrate patient and physician frustrations with communication. A few guidelines follow which may help your next visit to the doctor be more productive.
1. Be prepared. Know what you want to say and say it. Bring your prescriptions or a medication list. Bring any records or x-rays you have.
2. Be honest. Answer all your doctor's questions the best way you can and say anything that worries you. Rehearse what you want to say.
3. Describe your problems so that your doctor can understand them. Simple statements such as "it hurts," "I feel sick" or "it happens once in a while" do not convey the real
problem. You have to elaborate. Your doctor is relying on you to be aware of symptoms and when they occur.
4. Ask questions. This is a time for you to learn about your health. If you do not understand something, have it explained to your satisfaction. And ask about organizations like the MGF which provide additional information.
5. Realize that you have a limited amount of time. Ask the secretary or doctor how long the visit is and budget your time. Doctors have a schedule to keep. (We realize some doctor visits are limited to 15 minutes or less. This may be wrong in some situations, but the time to fight this is not in the doctor's office, but with letters to the HMO, the doctor, the group practice, or elected officials).
6. Don't be late.
7. Expect to be treated with respect. If you're not, say so.
This article is written for patients, but proper communication cannot occur if the doctor is not listening. A patient and doctor will get to know each other over time, which will allow communication to become easier.
If you don't think a doctor is understanding your concerns, be direct, and inform the doctor of your frustration.
We have tried to provide a few simple guidelines for talking to your doctor. As with any relationship, communication is at its base.
AMPS: Ohio Chapter.