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 PoppiesInterior with Christmas Tree, and Morning Shadow. All but the second image was sourced from Wikiart.org.

When Your Doctor Gives You the Finger: Why Men Fear “Digital” Medicine

http://upload.wikimedia.org/wikipedia/commons/4/41/Dedoduro.jpg

The current medical rage is the move to electronic medical records (EMR) and the digital practice of medicine. But I’d like to say a few words about some rather different digits. One in particular. Patients may not be afraid of the doctor touching the computer keyboard to bring up their personal information, but many of them certainly are afraid of the docs touching certain personal body parts and telling them that something is wrong. To be specific, men are especially ticklish about another person putting their hands anywhere near their underwear-absent bottom. Computer digits are OK, but human digits to perform the routine prostate exam, aka the single-finger digital rectal exam — no thank you. As Shakespeare would say, “there’s the rub.”

A 2011 Esquire Magazine internet survey sheds some light on this dark place in doctor-land. The survey should not be interpreted as gospel, since it was taken by 519 internet-connected US males, a sampling technique that would tilt the results toward the young and relatively affluent, as well as more educated individuals than might be found in a more representative selection of the male population. That said, it does support the notion that males are touchy about being touched.

When men were asked which medical tests give them the most anxiety, two were tied for the top spot: the digital prostate exam and a colonoscopy, each chosen by 36% of the sample. By comparison, only 23% found a dental checkup to be the most upsetting, and just 5% admitted to being threatened by a hernia exam. Consistent with these results is the fact that only 30% reported having had the rectal (prostate) exam of those men between age 41 and 50 who participated in the research.

What might this suggest about the avoidance of doctors by some males? Conventional wisdom tells medical professionals that stereotypical men identify themselves as “tough” and don’t like appearing vulnerable. They are taught early some version of “the athlete’s creed:” if you are injured don’t complain, rub some dirt on the wound and get back into the game; don’t be a sissy, a wuss, a wimp, a pussy, a weakling, a girly-man or however else being “less than a man” might be characterized. By that standard, going to a doctor when you feel relatively fine is a sign of weakness or fear, a source of shame. And, indeed, there is data to suggest that lots of men do tend to delay seeing physicians even when they are sick; at least until some time passes and the distress can’t be ignored any longer.

The digital advances brought by computer technology (rather than the MD’s advancing digit) hold no such threat. Time will be saved by your doctor having immediate access to your medical history, a record that is not dependent upon your memory and that will be available on the desk top of all your physicians. Drug interactions will be more easily avoided and all the specialists should be able to smoothly coordinate your care as the team that they must be. Computers may even help in suggesting diagnoses that are consistent with your recorded symptom profile. Medical errors will be reduced. All the computerized data will also make medical research easier.

What medical apps won’t be able to do is get you to make an appointment with your doctor if you are afraid of either what he might do to you or what he might say about your condition. Many people would prefer to assume that if they feel good, doctors can be avoided. They like to think that the medical community is too much like any other business and that what passes for evaluation and treatment is just another way to make a buck. Trust is needed if you are going to put yourself in the doctor’s hands. Literally.

But what would make the digital rectal exam (or its even more invasive cousin, the colonoscopy, in which a tube is inserted into the colon through the rectum while you are under sedation) particularly scary? After all, the former takes just a few seconds, the doctor uses a lubricated glove to do it, and it isn’t painful. Well, probably a couple of things. First, men and women generally rate cancer as the disease that they fear the most. Since possible cancer detection is the usual reason for the routine digital rectal exam in men, it could be one of those things that men believe to be better left alone. In other words, don’t look for trouble and “if it ain’t broke, don’t fix it.”

But, there is more. And if you haven’t figured it out yet, it might just be an instinctive fear of assault from the rear. It is probably scary enough for many men to stand with their private parts exposed to another man, but likely even worse to be positioned with your back to him while he enters you. I’m not talking here only about homophobia, but equally about an instinct for self-preservation causing a kind of automatic terror of being injured. “Wild Bill” Hickok, the legendary gunfighter of the Old West, is a possible example of this kind of concern. Hickok is said to have always been careful to sit with his back to the wall. But on August 2, 1876 he joined a saloon card game where the only remaining seat placed his back toward the entrance. Twice he asked others to change seats but no one did. He was shot in the back of the head by a man entering from the door, just as he feared.

Lots of my male patients postponed or avoided the kinds of examinations that I’ve described here, even quite a number who knew very well that it was a good idea to get them. Some were ultimately persuaded by their wives to go to the doctor. Others might have been influenced if one appealed to the desire to be around long enough to care for their family. But, part of the dilemma is that men tend not to talk to potential persuaders about matters as private as this. And, if you don’t have a doctor (45% of the Esquire sample did not) he cannot advise you to do what is needed.

Clearly, early detection of serious medical problems represents a desperately important area for research into how to motivate terrified folks to do what is best for them. As much as we read about the advances expected from digital medicine, it might be useful to hear a bit more about what is being done to reduce the fear of medicine done with digits; a fear that remains in the shadows — an “unmanly” quality in some of the very same men who portray themselves as macho. If, as I’ve suggested, men avoid these tests out of age-old instincts for self-preservation, one can only be struck by the irony that their efforts at such self-defense increase the chance of an early and avoidable death.

As with all such sensitive and very personal areas of life, however, there is always room for a joke. My own physician told me the following:

I had a patient who came in for a routine digital rectal exam as a part of his annual physical. After that portion of the evaluation was completed, he asked me a question: “Doc, how many fingers did you use?” “One,” I answered. “Why didn’t you use two?” “Because the exam is done with just one finger,” I said. “Yeah, I know, but I wanted a second opinion!”

For a very funny, but also serious take on getting a colonoscopy, read Dave Barry’s A Journey Into My Colon — and Yours. The top image is called Index Finger by Cherubino, sourced from Wikimedia Commons.