To ALL patients:

I was just reading a thread by angell titled WORDS with my neurodoc on the MG forum. Interesting matter which has led me to start this thread.

Physicians come in all different "flavors". Each has his/her own personality and approach with patients. Some have fantastic bedside manners and others seem to have the worst dispositions you may ever encounter.

But the flip side is, we as patients, also come in all different flavors with various personalities, conditions, etc.

Part of the problem we encounter is finding the correct "match" between physician and patient, and also the most competent for our health issues.

But that is not the point of this thread. Communication between doctor and patient is vital to successful treatment and that is a BIG failing a lot of times.

I have personally felt a lack of "talking" time with a doc on occasion. We go to the doctor with our "symptoms" (before diagnosis). We get an exam, tests are sometimes ordered, some communication happens but many times we don't get answers at that visit. That is understandable if the doctor needs test results in order to make a diagnosis.

Results come in and we either get them at a follow-up appt. or on the phone. Again, we are somewhat compromised on getting answers to our questions as we are trying to adjust to whatever we were just told. We have not had the time to formulate all of our questions much less have answers we seek. Ever be driving home from an appt. with questions swirling in your head that you wished you had asked if you had thought of it during the appt.?

So many times I wish I could just go back to my doctor a week or so later and just TALK. I don't need another exam. I just want some face to face talk time for asking all of my questions. Discussing all the options. Explanations. More detail. More understanding. Making sure the doctor and I are on the same page. Has he/she understood me? Have I understood them?

I guess they would call that a "consultation" but it has been MY personal experience that we don't get that. The question is WHY NOT? Time constraints are one of the reasons, sometimes self imposed by doctors upon themselves so that they can see a greater quantity of patients and thereby forsaking the desired "quality" time with patients. Cost is another factor. It does not matter if we are self-pay (cash) patients, insured patients, or whatever. The doctor should be paid for the time to sit and consult with us by someone and no one is willing to pay for such a "luxury" as spending enough time with patients to answer all their questions or explain everything they need or should know.

Beyond time and cost limitations, then we have the "personality" of the doctor to contend with and be subjected to as in angell's case. Do we or should we have to "walk on eggs" not to offend the ego of the doc by asking questions or just requesting that they "listen"? If they want respect from us, then it is a two-sided coin and we should also get respect from them.

In younger years and to some extent now, I have held my tongue if for NO other reason than the doc is the guy/gal with MY life and well being in their hands. If you have any sense that you want to stick with a particular doctor for whatever reason, (their skill level, insurance constraints, etc.) you sure do not want to tick them off. We don't want to "rock the boat".

So finally after all my rambling, I am at the point of the thread.

How does one communicate with a doctor?
Do we speak up as angell did?
Do we bit our tongue?
How does one deal with a doctor that has an ego problem?
How do we get answers under time and cost constraints?
How can we avoid the "egg walk"?
Do we need to be well-versed in the art of psychology to be able to stroke their ego while we try to get our needs met?

I am not always very tactful (understatement) so it is difficult when the personalities of doctor and patient do not match up.

Would love to hear various viewpoints from members on the art of talking with your doctor and also on how to get enough time for answers.

The doctor/patient relationship can be a fantastic one or train wreck and all things along the spectrum. How should we as patients deal with it?

Hello Hopeless

Very interesting subject.

I read a paper a month or so ago in our Australian Medical Journal regarding shared decision making.

I'll post the link below and I'm heading out of the house shortly, so will just make it brief for now.

I found it interesting (and sad really) that doctors are needing to use Tools to help them actually learn to participate in shared decision making with their patients.

Shared decision making: what do clinicians need to know and why should they bother?
MJA - Shared Decision Making

Some doctors get it. They treat their patients as they would like to be treated if the shoe is on the other foot.

Many do not.

Many factors may go into the reason they do not always meet our expectations.

My post in NO way is meant to bash doctors in any way, shape, or form. Just trying my best to understand them and get harmonious relationships with them for all patients.

I would really be up a creek without a paddle without them and have been VERY fortunate to have found some really terrific ones. I have also met some real jerks as angell encountered.

I just don't know how to get everything I want and need from them, even the great ones.

The bad ones, well, I leave them in a trail of dust whenever possible. Sometimes we do not have that option. They may be the only game in town so to speak.

I definitely think more patients should speak up when necessary if for no other reason but to inform the doctor just in case he is unaware of his demeanor. My optimistic side thinks maybe it will effect change in them. The pessimist in me thinks they like being the way they are and are not going to change.

I don't think there is a right or wrong response at times. We must do what is best for us.

hello Hopeless.

Yes, this is an interesting and also very important issue to us patients. And, thank you for opening this discussion.

This is how I look at t:

First, we have to choose our doctors. Depending on the unfortunate condition of symptoms, diagnosed or undiagnosed. We usually have a lot of unanswered questions, and sometimes we may feel fearful.

It is important to have a good reliable PCP who get to know us over time. The PCP need to be updated on all our specialist appointments etc. ( for patients who have PPO or similar and do not need PCP referral) The PCP is the one that can be called upon to get a quick Health History.
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It is difficult now a days to choose a specialist in the whatever specialty one might need. This is because each specialty whiten the medical profession now has subspecialties. Example, they might only specialize and treat patient with one particular disease.
And, if you are on your own, how would you know what disease you have (sometimes we might have an idea, and already kind of know) Sometimes this is where the PCP comes in and hopefully guide you to the right kind of specialist.

Enough of choosing doctors, but what I am coming to is:
When you have chosen a doctor to see for what ever reason, it may take you a couple of visits before you really know if this doctor is someone that will be beneficial for your healthcare needs.
To choose a doctor, I think it is important to look at the doctor's history, credentials and expertise. If I feel that this doctor would benefit my healthcare needs, then I learn that doctors style of working and communicating with the patient.
I pay close attention to this, then I try to accommodate him with my own communication so that we have a working relationship. After all, it is my own health and life at stake.

This being said, I will emphasize that it is extremely important that we all as patients try to learn as much as possible about our health conditions or diseases at all time. We must seek information.
And if we find that a particular doctor is not willing to help us as we think he/she should, we must , as you said Hopeless, "leave them behind in the dust"

I have also, as you Hopeless, had a few of "them" useless doctors.
And sometimes it makes me very angry, and it is difficult to just let the whole thing go, and go forward
I have also been lucky and I have some that knows me well, and that works with me and really helps me.
So when we have doctors like that, I think it is helpful to us that we try to "bear with them" in a way, and let them do the work in their style. We do not want to loose a good doctor.
I have 2 doctors that I always say, " saved my life", and to me, "they can do no wrong", sort of say.

Let me tell about the way my doctor/patient working/communication relationship are with these two doctors:
no1 My neurologist. I have come to know him, and he knows me for quite some time. He is very careful and fallow guidelines in his work.
He is a general neurologist as well as a interventional neurologist.
He has sent me to other neurologist in special cases such as neuro of neuropathy who did all my nerve testings, and to MS doctors. So he does all he can, he orders all kinds of diagnostic tests, so he does all he can. So, for tees reasons, I have dicided to stay with him.

This is my patient/doctor working/communication style with this doctor:

It was the doctor who asked me to do it like this, I think it was because he finds that I am a little complicated, and have many different issues and symptoms.
On my computer I have sorted out my medical history like this: I have a revolving list with dates of each doctors visits, all diagnostic tests, lab tests etc. I just simply add the results of diagnostic test shortly. So each time I have a test etc, I just keep adding.
I have a list of problems, issues and symptoms. I date them, and update when needed.
I have copied the lab sheets from this site called :Liza Jane"s chart. Here I try to input all my lab results etc.
The same goes with my medication list. I have a printed updated list every time.
So when I go to the doctor I just print up a copy of all thes updates and hand them to the medical assistant/nurse or whoever is office assisting the doctor.
She gives it to him, he loos over it all, and then he sits and goes over every single issue I have that is active at the time.

This is working out well for me. At the same time, I sort of have a proof of that these issues were discussed, I had them written up and given to doctor.

no2) my ophthalmologist. I will forever be thankful to him when he absolutely insisted that I have an MRI of head/brain back 3 years, and incidental had aneurysm diagnosed. He is extremely particular about all his work. He has a very particular way of conducting the office visit with his patient.
He always is very "matter of fact" and short in his communication, and stay to the important details. First he has his different technicians doing their different tests on me. So when he comes to se me, he sort of really concentrates on the test results, compare to previous, looks at numbers, make calculations etc, before he discuss things. I have learned just to sit still and let him do his things. Then the doctor ask health questions. Then he makes his remarks and disisions, and we discuss. I then have time to ask questions.

So, to say if briefly, I think we come to know the doctors that are good, and we try to hang on to them and find a way of working with them.

This was all my positive issues when it comes to patient/doctor working relationship.
I have plenty of negative too.
I have seen doctors that have lied in their medical notes. I have seen doctors that have totally misdiagnosed me, due to his wish to having me fit in to the criteria for which procedure he wanted to "sell".

I have had doctors put me in danger due to negligence,
And I guess, those are the one that probably should be discussed. Because we need to improve on things.
All this I have sort at first gotten angry for the wasted time and money I spent, then I have disregarded it.
This was just my thoughts.
Stay well.
Thanks for reading

--that talk about communication with doctors, and shared decision making.

I find most of them lacking, however, in that they not only do not tend to take into account the time pressures that doctors are under (though a lot of this, admittedly, we have brought on ourselves with our tolerance of certain types of medical and insurance systems), but also do not take into account the particular ways medical professionals are trained and tend to share and disseminate information amongst themselves and therefore tend to lapse into with patients.

I am not only talking about medical jargon here, though that is part of it, but about the concept of "presentation". Medical students are all taught how to "present" a case other clinicians, and this involves a specific sequence of information delivered in staccato, "just the facts" tone, with emotionality and descriptive color generally stripped from the narrative. Think "BP 150/80, pulse 84 and tachy, cyanotic". This is not only confined to emergency rooms--it's part and parcel of grand rounds and even case conferences.

Most patients, of course, do not "present" in this manner when asked what is wrong with them. Their descriptions tend to be hazy, and from doctors point of view, lacking in precision. It is the rare physician who feels comfortable with interpreting that sort of recitation, who can probe deeper with meaningful questions, without "cutting off" the patient and asking a series of short, sharp questions designed to elicit information in the manner in which physicians, through their training and socialization, have become used to receiving it. And the problems of communication between health professionals and patients begin there, with the clinicians used to getting and giving information in one style and most patients not versed in that style.

While it's nice to get a professional who can gracefully and easily switch from "clinic mode" to a more personal one, one should not count on it. I have found over the years it behooves most of us with chronic problems who will be seeing a lot of doctors often to not only become well versed with the jargon of our conditions, but to learn this "presentation" mode. I realize this is not easy to learn to do, especially if one does not have great facility with medical terms (or with the first language of the physician). But it does help get relevant info out quickly and often has the paradoxical effect of altering the clinician that here is a knowledgeable, savvy patient, which I find often gets one a little more time and empathy.

In other words, if one can make an attempt to speak their language, many will make a bigger attempt to speak yours.

If one can't reach a communication modus vivendi over time, though, the "dump" option is still on the table, though, again, this can be hard to do, especially in non-urban areas where a certain specialist may be the only game in town (another reason, if one is a complex case, I advocate a visit to a major teaching hospital/clinical/research facility, even if travel is involved--the communication skills are not necessarily better at such places, but more minds are at work that might actually be interested in one's case).

Don't have a lot of time this morning, but I will come back to this thread to talk more about "presenting" at some point.

I think that you are probably right, but it doesn't always help, especially when you are presenting with something that does not fit in their "experience" or "training".

I tried explaining from the start that I had Bilateral, monocular, fatigable diplopia. This was simply followed by questions where I had to explain the definition of each term in simple language. Reason being that none of them have come across this combination before.

So if we speak their language, and present with a text book case of disease A or B, then maybe they will listen, somehow I still doubt it.