We Asked a Doctor How to Talk So That They'll Listen
Photo: Stuart Fisher
But too often, doctors take a more hurried approach in the name of efficiency: Ofri cites a study that found that doctors typically interrupted their patients 12 seconds after they started talking. Yet according to other research, the average person takes a mere 92 seconds to sum up why they're in the office. "Doctors need to stop talking, turn away from the computer, and give patients one to two minutes of full-frontal listening," Ofri says. "If yours isn't doing that, don't be afraid to speak up." How to assert yourself when you're sitting on a table in a paper gown? We asked Ofri, who's also an attending physician at Bellevue Hospital in New York City, for her best Rx.
O: What's the most tactful way to let my doctor know I still had more to say when he interrupted me?
Danielle Ofri: A gentle reminder can actually be very helpful for us. If a patient says, "Do you mind if I just finish what I was saying?" I usually respond with something like, "Sure. Oh, wow, I shouldn't have cut you off."
O: How much information should I give the doctor?
DO: Before your visit, choose two or three concerns you want to discuss. If you have more, write them all down and show them to your doctor at the beginning of the appointment so you can decide together what's most important to discuss today and what may need to wait until next time. Try to cover the bases without getting bogged down in unnecessary details, which can waste time.
Photo: Stuart Fisher
DO: It's effective to say, "I just want to reiterate my top three things: X, Y, and Z. Is there any other information that would be helpful for you?" At the end of the appointment, say, "Okay, let me make sure I've got all of this right." Then repeat back the doctor's advice or treatment plan. This not only ensures accuracy, but also helps jog your memory—and your doctor's—about points you or he forgot to mention. For example, it may prompt him to tell you about a potential side effect of the medication he's prescribed.
O: How do I make extra sure I don't miss anything?
DO: Always have a pen and paper. You can also consider bringing a family member or a friend to your appointment to help fill in the gaps. I recently saw an older patient who'd just been diagnosed with breast cancer, and she was having trouble keeping things straight. On the next visit, she brought her adult daughter with her. We all talked together, and the daughter took notes.
O: Should I ask what my doctor would do if he were in my shoes?
DO: This question comes up a lot. I try to help patients work through their own values using the medical facts I can offer. I once had a patient whose cardiologist had recommended an implantable defibrillator. The patient's general philosophy was to leave everything to God. So when he asked me, "What would you do?" I thought about his past decisions: He was taking blood pressure pills and had done a cardiac catheterization—clearly in this case he seemed okay altering the course set out by God. He also had a lot to live for, including a wife, children, and grandchildren. We discussed the medical evidence and his religious beliefs, and ultimately I recommended that he get the defibrillator. It's so important that your doctor take your values, not his, into consideration, along with the risks and benefits of treatment. So a better way to phrase this might be, "Given my situation, what do you think I should do?"
The Patient says... "I have the worst stomach pain, the worst dizziness, the worst headache—24/7."
The Doctor hears... "I'm under a lot of stress."
The Doctor thinks... "When a patient tells us that every symptom is the most horrible ever—and the physical exam and labs are normal—we often suspect something psychological is going on. The symptoms aren't fake. They're physical manifestations of anxiety, depression, and stress. So while I'm always on the lookout for a serious underlying disease, I'm also thinking, Can I get her to see a therapist or enroll in a yoga class or eat a healthier diet and get better sleep?"
The Patient says... "Everything's fine."
The Doctor hears..."There may be something I'm not telling you."
The Doctor thinks... "I worry that the patient may be uncomfortable about sharing something. It could be sexual dysfunction, an eating disorder, depression, domestic violence—these are serious topics many people don't want to talk about. I'll try to follow up with questions like: How are things at home? How's work? But we don't always have time to probe. Don't be afraid to bring up the important things going on in your life, even if they don't feel 'medical.' Your doctor would rather know than not know."
The Patient says... "Oh, just one drink per night."
The Doctor hears... "At least two drinks per night."
The Doctor thinks... "We're taught in medical school that people ususally underreport their alcohol and drug use, so we genreal double the amount we're told. Don't be insulted if your doctor asks follow-up questions about yout drinking. We're trying to be diligent so we don't miss an alcohol or drug disorfer that could be amenable to treatment."
The Patient says... "Here are my records from my previous doctor."
The Doctor hears..."I'm about to dump a pile of info on you."
The Doctor thinks... "Patients sometimes bring in years' worth of medical records, and reviewing them would take valuable time from the visit. It's best to prioritize what you want the doctor to see (like a recent heart test from a cardiologist) and put those documents on top."
Missed connections In a survey of nearly 240 hospitalized patients, only 32 percent could name even one of their treating doctors. —From What Patients Say, What Doctors Hear