Talking to Your Doctor: A Guide for Patients

Imagine I ask myself the question: which doctor do I see this week?

Witchdoctor or which doctor? Genius, God, or man?

I have no fatal conditions, so don’t worry. But since I’ve known quite a few MDs as a colleague, friend, or patient, here is some advice about how to ready yourself for your next medical visit.

This applies in particular if you will be meeting a specialist. These suggestions are also the product of the numerous comments from my own clients about their experience with the healing arts.

PREPARE: Make a list of your symptoms and medications; consult reputable websites like Mayo Clinic, but do not make yourself crazy with conspiracies or every worst-case possibility. Think about questions you’d like answered.

YOU ARE NOT A HOSTAGE: Don’t be intimidated. God neither wears a white coat nor uses a stethoscope. The MD is a human being. Use your session efficiently, but you are entitled to time. You (or your insurer) will pay for the service.

TAKE NOTES:  Perhaps bring someone along who can verify what you heard, ask questions you don’t think of, and offer his impression of the expert.  

COLLABORATION: Choose a primary care physician (also called an internist) if you are without one. He should come to know you better than a specialist, possess a wide knowledge of the field, and provide insight into advice from fellow MDs. If you see this person yearly, a collaborative relationship should develop.

THE DOCTOR’S STAFF: Take a measure of the people employed by the individual in charge. Their listening skills, competence, thoroughness, and kindness often reflect the qualities of their superior.

TREATMENT CHOICES: At some point in the visit, the doc should indicate what comes next. He might order tests or a consultation with a colleague. Perhaps medication will be prescribed or a procedure involving the examination of an internal organ. Maybe surgery.

If he does not mention alternatives (say, watchful waiting, drugs, or another approach), ask what else might be done. Speak if you wish to hear more about each method. Request printed literature, as well. These days, previously extreme interventions sometimes involve only small incisions, minimal time in a clinical setting, and rapid recovery.

COMMUNICATION ISSUES: If you don’t understand some of the words or names the authority uses, tell him so and ask for language easier for someone not trained in his field. Feel free to slow him down.

The doc might recommend a more than ordinary therapeutic approach. Some will offer possibilities and take a collaborative attitude, wishing not to impose a decision. The following question can be useful: if you were making a recommendation to a loved one, what would you suggest?

Short of an emergency, not everything needs to be determined the same day. Doing your own homework, obtaining a second opinion, and finding time to catch your breath don’t necessitate anyone’s permission.

SURGERY: The expert could say something like, “The two surgeries I perform are X and Y.” Inquire whether there are others and create a conversation about pros and cons.

Seek details. Become informed about potential side effects and their likelihood in percentages, the necessity of hospitalization, and possible rehabilitation afterward (knee replacement often demands this).

Ask how many times the doc has performed the procedure. Consider his age. Not everyone retains undiminished fine motor skills forever. Find out how many such surgeries are done at the hospital where he practices compared to other healthcare centers. The more, the better. Investigate institutional rankings for the particular intervention or treatment you will receive.

If your surgery requires fasting beginning on the evening before, that fact might influence what time you prefer the appointment — probably early if you can get it.

Take a look at any record of legal action claiming malpractice by the MD or the hospital and its employees. Such information should be available on state websites.

PERSONALITIES AND SURGEONS. Doctors need confidence, with surgeons at the top of the list of those needy of the characteristic. You don’t want an uncertain person guiding the manipulation or invasion of your body. Don’t be surprised at the absence of a tender bedside manner.

Why? Even psychotherapists maintain a therapeutic distance from their patients. Surgeons often go further in this direction. They mustn’t feel the full weight or dread of what they are engaged in while in a surgical theater. My encounters with this gifted group have included both the cold and the more approachable variety of humanity.

LEGAL FORMS: Your signature will be desired in many places. The documents detail risks, your rights, who can receive information about your condition, etc.

Medical facilities often employ physicians in training. Ask yourself the degree to which you desire care from these (typically bright and talented) younger people. Doctors must gain this experience to become skilled. For you, however, the question is, do you want the lady or man who performed 2000 procedures or 10?

Make sure the doctor knows what decision you make and your autograph doesn’t contradict your spoken wishes. Don’t assume someone else will tell the doc unless you do.

GUARANTEES: There are none. When asked about surgical side-effects, more than one doc told me, “Well, you could die.” You might have noticed I’m not dead. Ask yourself about your own risk tolerance.

Not everyone reacts to medication in the same way.

Doing nothing can also have physical consequences, as does pretending you are fine despite your physician or relative’s belief you are not.

Too many men avoid doctors in the belief “He cares about my money, nothing else” or “I don’t need an examination.”

Good luck, fellas.

THE HISTORY OF MEDICINE: Because of the lengthy period when the field offered a primitive level of expertise (if any), the discipline’s scientific basis doesn’t have a long past.

Strep throat killed people in the absence of any antibacterial medication. The initial successful use of penicillin in the USA, the first such drug, occurred in 1942.

There was no polio vaccine in the first years of my childhood (the late 1940s and ’50s). During the US Civil War and after, amputations were done with saws.

Years-long gaps exist between fresh knowledge and the point at which the practice of healing changes. The profession requires both learning what is new and unlearning what is no longer considered best and might be harmful in light of recent data.

Remember what I said about the initial employment of penicillin? The first use in the UK was in 1930, 12 years before.

MEDICAL SPECIALIZATION: The dramatic expansion and creation of techniques and other discoveries tax every doctor to keep up. These fine women and men are often lifesavers. They’ve earned our gratitude and more than a decent living.

Understand, however, no one masters every other discipline within the helping professions. Moreover, physicians do not always have easy access to other specialists, nor the infinite time to sit down with them for in-depth discussions.

If you are being treated by multiple professionals, the ability to integrate each of them increases the challenge for them and for you.

When you are consulting more doctors than you can manage, think about going to a place like the Mayo or Cleveland Clinics, where a team approach can be found.

PHYSICIANS WORK MIRACLES: I’ve highlighted some pitfalls because nobody wants to fall into the pit.

Remember this: All doctors are bound by ethical guidance derived from the ancient Hippocratic Oath. They mean you well.

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Another excellent list of Questions to Ask Before Surgery comes from Johns Hopkins Medicine.

Here is the full text of the Hippocratic Oath. It offers the first written ethical guidelines for physicians.

All of the paintings are the work of German Expressionist artist Gabriele Munter. They include Flowers on White (Cyclamen and Hyacinth), Still Life with Poppies, Interior with Christmas Tree, and Morning Shadow. All but the second image was sourced from Wikiart.org.