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Successful Medical Appointments

David Spero

December 15, 2010

A coaching client named Sally told me, “My medical appointments sometimes seem like wastes of time. [My doctor] doesn’t answer my questions. I always leave there feeling like, what do I do now? I don’t know if he’s even heard me.”

Perhaps you have had similar feelings. Medical visits are often rushed, and if we don’t prepare well and communicate clearly, we may leave frustrated and confused.

Many health-care providers labor under major time pressure. They may have to see three, four, even six patients in an hour. They may come to you still thinking about their last patient, or worrying about the next one or about how much paperwork they have to do or the messages that are coming to them all day long.

Doctors can feel even more rushed when a patient has diabetes. The American Diabetes Association guidelines require regular monitoring of glucose control, blood pressure, cholesterol, kidney function, the condition of the feet, and vision, and that’s if things are going well. Complications demand even more time. And don’t forget flu shots, pneumonia vaccines, mammograms, colonoscopies, and other basic “preventive” treatments almost everyone is supposed to have.

With priorities like those, it is not surprising that doctors may not see patients as people, as much as they see a diagnosis and a bunch of lab values. Your priorities will probably be different; perhaps more personal things like how a medicine is affecting you. Your agenda might be overwhelmed by the doctor’s agenda.

Along with differing priorities, patients and doctors often speak different languages. “He’s always giving me these numbers and scientific names,” Sally said. “I wish he could speak plain English.” So given all these barriers, how can we make medical appointments work for us?

Strategies for Successful Appointments
The Institute for Healthcare Improvement Web site New Health Partnerships advises: “Prepare for [medical appointments] like you would for a job interview or an important business meeting. Know what you want to talk about, write down your top…goals and questions for the visit, and share the list with your care providers.” The provider may not have time to answer all your questions, but he should be able to cover the top two or three and get back to you about the rest.

Don’t wait until the end of the appointment to bring important issues up. “Oh, doctor, one more thing. I almost forgot. I’m having these terrible headaches.” That makes doctors want to scream, because they are already running late. This happens a lot with potentially embarrassing problems, such as sexual difficulties, digestion problems, or family crises. We might be embarrassed, but we need to bring our real problems up early. That’s why having a written list of priorities helps.

It can also help to bring in medicine lists, symptom logs, glucose monitoring records, and records of appointments with other providers.

Active Listening
Just as important as speaking up to doctors is listening effectively. Sally told me that she rarely remembers everything the doctor tells her. “There’s so much information,” she says. “I think I have it down, but by the time I get home, I’m like ‘Was that before meals or after?’”

New Health Partnerships says doctor visits are stressful, so we often need help to remember the details. Among their suggestions:

• Bring a trusted family member or friend with you to listen, ask questions, and remind you of things you wanted to talk about.
• Take notes or ask to record the visit so you can review later.
• Ask for clarification — repeat back what the doctor has told you, and confirm that you have understood it correctly. “So I won’t see the effects of this new medicine for two weeks, and it might make it harder to sleep for the first few days. Is that what you said?”
• If they’re using medical language that you don’t understand, ask, “Could you put that in plain language, please?”

Build a Relationship
Doctors are people, too. If we want them to see us as whole people, we should not look at them as computers with stethoscopes attached. New Health Partnerships advises: “You could ask about family pictures in the office, for example. Don’t forget to thank them for their attention, especially when they have really been there for you.”

Ken Wong, who I interviewed for my book The Art of Getting Well, goes further to connect. “If they have kids, I ask how they’re doing. Perhaps I can relate similarities with my kids, to help him see me as a whole person.”

Ken also tries schedule appointments that will give the provider more time. “I always try to have the first appointment of the day, or if I can’t, the first appointment after lunch. That way, the doctor isn’t backed up and rushed when he sees me.”

I went over these ideas with Sally, and she managed to get her sister-in-law to come to her next appointment with a tape recorder. Sally came away much more relaxed and satisfied. “It felt like the doctor and I understood each other. That’s very reassuring.”

I wrote more about this topic in a blog entry called Mistakes People Make with Doctors.

More about communicating with doctors can be found here. And a four-page handout on collaborating with doctors is here.

If you’re interested in health coaching, click here.

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