Doctor-Patient Communication

Stephen Barrett, M.D,

Intelligent consumers should locate and use a primary physician (or medical group) who provides care that is scientific, considerate, and compassionate. They should take an active role in dealing with health professionals. They should endeavor to understand the nature of any health problem they experience and the mechanisms and potential hazards of treatment. They should not hesitate to ask questions about fees or request consultations for complicated problems.

Effective Communication

When consulting a doctor, try to present a detailed and well-organized account of present symptoms and relevant past history. Before contacting the doctor, it may help to draw up a list to guide your presentation. If there is more than one problem, start with the most important one. If you have a particular concern, bring it up at the beginning of your visit. If medications are being taken, either write down their names and dosages or bring the original bottles to the appointment. Since patients typically forget much of what they are told in a doctor's office, taking notes or utilizing a tape recorder (with the doctor's permission) might be helpful.

Physicians know much more about medicine than lay people do but are not always good communicators. They may be authoritarian or even patronizing. Patients should not accept this behavior. Consumers have the right to be partners in their care and to receive a clear explanation of the physician's findings and proposed treatment. There is no good reason why a physician cannot provide this. A friendly comment that you want to be able to follow the physician's advice properly usually establishes the desired relationship.

It is important that feelings of fear, embarrassment, or even resentment not be permitted to create a barrier between patient and physician. Put these feelings to good use by sharing them with the physician. Someone who fears an examination or is shy about body parts should say so. Discomfort during an examination is something else the physician wants to know about. If the physician makes a sound or comment that causes concern, ask what it means. Don't let fear or embarrassment stop you from mentioning a symptom or a problem that is bothering you. If you wish to discuss something you do not want to appear in your medical record, ask the doctor not to write it down.

If you have doubts about a diagnosis or treatment plan, voice them. If a particular treatment is objectionable, the physician may be able to suggest an acceptable alternative. If necessary, a consultation with another physician should be requested. Similarly, if the physician suggests consultative action, the patient should appreciate this concern and be receptive to the proposal.

Some consumer advocates recommend questioning doctors closely about the need for diagnostic tests and about alternatives to whatever treatment is proposed. However, challenging everything is likely to antagonize the doctor and could result in dismissal as a patient. The best approach is to select a doctor who makes sensible and cost-effective recommendations without prodding. Questions can then be used to enhance your understanding rather than trying to outthink the doctor.

Be sure to have a clear understanding of fees involved. This matter is usually handled by the receptionist.

Telephone Tips

Proper telephone use can do a great deal to make the physician's life easier while helping the patient to receive better service. Before calling the office, take a moment to organize your thoughts. What is the problem? When did it begin? If there is a pain, does it come and go or is it steady? Does anything bring it on or relieve it? If there is an infection or any other reason to suspect a fever, the temperature should be taken. Try to decide whether the problem is urgent. Before calling, write down a one-sentence description of your problem, your reason for calling, a symptom list, and no more than three questions that you may have.

Most physicians receive many more calls than they could possibly handle alone. So when you call, don't start by asking to speak with the doctor. In a well-run office, the receptionists and nurses are trained to assemble the information needed for a preliminary evaluation of the situation. These people usually know which matters to handle alone and which ones the physician must handle personally. After talking to a receptionist or nurse, if you still believe it is necessary to speak with the physician, that is the time to ask.

When you telephone, have a pad and pencil handy to write down any instructions. Human memory is notoriously faulty. Call early in the workday when the physician's assistants are on duty and hospitals and laboratories are able to give their best services. That way the problem can be handled most efficiently. Emergency calls and cancellations should be made as early in the day as possible. Calls about less urgent matters could be delayed until mid-morning to avoid the period during which the staff is extra-busy preparing for the day's work.

When calling for a prescription refill, know the phone number of the drugstore. The request should be made during the physician's office hours and before you are down to the last pill. That way the physician can review the office record to see whether the medication is still needed, whether the dosage should be changed, and so on. Such a review makes medical care safer. If you telephone outside of office hours, many physicians (especially those covering another's practice) order only enough medication for a few days. That is the safest way in the absence of medical records, but it does increase the cost of medication.

Remember, good medical care should be a partnership between patient and physician.

This page was revised on October 9, 2006.

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