[Editor's Note: From time to time the narrator of this blog petitions the board of directors of Cheerful Oncologist Productions, Ltd. to reprint certain posts from his old sites that he finds interesting, although where he comes up with this delusion is beyond us. Anyway, in order to humor him and also keep our payroll for security low we are happy to reproduce this amateurish attempt, complete and without any editing, which first appeared on October 6, 2004. [Sit vis vobiscum!]
Have you ever been diagnosed with a serious illness, or known someone facing such a health crisis? Do you recall how anxious you were to get the true facts about the situation? At such a time we all rely on our doctor to communicate clearly the details of the illness and the plan to treat it. Unfortunately, many doctors possess meager skills in counseling; others are talented speakers but poor listeners, and all doctors are rushed for time. This often leads to an unsatisfying visit.
A patient or caregiver always has the right to ask multiple questions about the diagnosis, prognosis and treatment of an illness - I get asked these questions every day, and have learned to answer them as faithfully and completely as possible. Notice I said I have learned - when I started my career I too was a novice at patient counseling. Caring for cancer patients creates expert listeners of most oncologists.
Thus I am amazed when I hear again and again that a doctor "didn't say much" about a patient's recent diagnosis. Is the physician really ignorant or too busy to educate the patient, or is the subject bypassed because he or she has nothing encouraging to say? It is unfortunate that some doctors look at the disease cancer with nothing but hopeless nihilism.
Therefore, as a public service, The Cheerful Oncologist, with only a modicum of sardonic delight, would like to reveal some helpful tips in ensuring that your doctor doesn't race in and out of an office or hospital visit without adequately answering your questions. These little secrets, some practical and some psychological, increase your odds of gaining the answers you need without resorting to exhortation or outright hostility, which tends to freeze the doctor with suspicion and make the tongue spout vague platitudes. No matter how extraordinary these tips seem, take it from one who has had them used on him - they work! I only ask that you apply them judiciously, as overusage can be interpreted as adversarial, and lead to mistrust. Remember, our common goal is to care for the patient with excellence and compassion!
The Practical Tips
1. At the beginning of the visit, tell the doctor you have questions - this warns him or her that counseling will be a part of the visit.
2. Write down your questions, and give a copy to the doctor so you both can go through the list together.
3. Do not be shy about asking the doctor to repeat the answer, or phrase it in more easily understandable language. A good doctor does not assume patients understand esoteric medical terms.
4. Invite the doctor to sit down, which brings all to eye level, and creates a less hurried setting.
The Psychological Tips (which create leverage - use with caution!)
1. Bring lots of family to the visit - the more the merrier. We docs tend to spend less time counseling the solitary patient.
2. Don't hesitate to announce any relatives in the room who are attorneys, whether they litigate or not. Attorneys get the doctor's rapt attention! If you don't have a lawyer in the family, dress all males in suits - looks impressive, if not intimidating.
3. If any family member is a doctor - sibling, offspring, nephew, niece - let it be known at once, whether they are in the room, or live nine states away. Rare it is to find the physician who would disappoint a physician's family member.
4. Produce a tape recorder, and say, "You don't mind if I record this, doctor? My family will want to hear what you have to say." This is the ultimate weapon against the lackadaisical counselor!
Now go, and be an advocate with confidence!
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Cynical tip no 5:
remind the especially hurried physician that if time talking is more than 1/2 of total time -- he can bill based on total time of the visit (99214-25 min total, 99215-40min total).
I recommend reading "Patient From Hell" by Steven Schneider. He recounts his experience of Mantel Cell Lymphoma and his struggle to get top medical attention at Standford University - where he worked.
Loved this essay the first time around nearly two years ago;it remains as pertinent today as it was then.As a nurse I always liked best taking care of patients and families who always asked lots of questions and were truly interested in what was happening to them, why it was happening and what their options for care were.The relationship between healthcare providers and their patients works best if it is truly a partnership and collaberative effort.Hats off to you in your continuing efforts...
Pick up a glass bottle of ether or alcohol, take out a box of matches which you light one by one and start talking about how this is a really nice clinic, reeal nice you know, and it'd be a real shame, see, if anything would happen to happen to it, see. Bonus points for a pinstripe suit and/or a Brooklyn accent.
Pick up a glass bottle of ether or alcohol, take out a box of matches which you light one by one and start talking about how this is a really nice clinic...
Except that might, um, not lead to the, um, particular diagnosis you, um, had in mind....
3. Do not be shy about asking the doctor to repeat the answer, or phrase it in more easily understandable language. A good doctor does not assume patients understand esoteric medical terms.
I don't have trouble stopping my doctors to repeat or rephrase themselves if I don't understand what was just said... I still haven't fine tuned the art of asking them to stop watering down everything. When that happenes I usually drop some obvious hints so it becomes obvious that I'm very informed both personally and professionally but that doesn't always fly.
Item #2 is most important when done with a thorough and thoughtful way, "Write down your questions, and give a copy to the doctor so you both can go through the list together."
Don't forget to bring the entire 15 item list, including "Why am I so TIRED all the time?" and "Why do I keep getting these headaches?" when you only have a 10 minute appointment for a blood pressure check and lab tests. After all, your doctor can do an excellent job with 45 seconds per problem.
"We docs tend to spend less time counseling the solitary patient."
I'm one of those solitary patients due to being divorced, living 3hrs from the nearest relative, having deceased mother, father in nursing home, and friends who work. I'd truly prefer to have another person with me for important office visits, but it's not in the cards. I hope that doctors do understand that a person may come to the office alone, not because no one cares about them, but because no one is readily available. (Besides, even if my mother were alive, she wouldn't be able to handle coming with me to an oncologist's office. She couldn't handle it when I had a root canal.)
Any tips for talking to a surgeon?
An interesting subject - and one very dear to my heart as I had to sit in a doctor's room in 2002 to be told I had cancer of the uterus.
You have prompted me to write a little bit on my thoughts about that day on my blog.
Thanks for the interesting site. Keep up the good work!
It has been my experience that oncologists have a keen distaste for telling their patients their prognosis'. Of all the breast cancer survivors I know only the ones who were diagnosed in stage one have any clue as to what their prognosis is. When asked, my oncologist will skirt the subject.
This is absolutely wonderful advice. I've spent more time in doctors' offices in the past 3.5 years than I care to remember. Even though I've worked in medical research, worked w/doctors, have advanced degrees, as a patient I've felt intimidated about asking questions. It helps to be prepared, to have that written list - a VERY detailed list, as JSW noted. If you have to go alone, take a tape recorder - you absolutely cannot remember everything that was said when you were there, and the tape recorder will make the doc more responsive.
Another tip - if you are seeing a doctor who is a specialist in a fancy center or teaching hospital, if your doctor is a prominent expert in her or his field - you may first have to go through a "screening" interview with a nurse before you go in to see the doctor (as I do with my neurologist). I answer lots of questions, the nurse takes notes - and as far as I can tell, the information disappears into a file and nothing is ever done with it relating to my care. This center is collecting lots of information on lots of patients so as to make statistical observations about what typically happens to patients with various types of migraine under various treatment regimens. Good for them, good down the road for migraine patients who will benefit from this info. What good does it do me now? None. Don't assume that because you gave information to someone first, that you don't need to give that information to your doctor when you are with her or him. Stick to your list, ask your questions, no matter what you have gone over with a nurse before you've seen the doctor.