Monday, July 15, 2013

How To Talk So Doctors Will Listen

Portrait of author by @Siredodo

I went to a doctor appointment with a friend this morning and I’m going to write, today, about how to communicate with doctors.  My friend is strong, assertive, and confident but we all need support sometimes.  Right now, my friend is in a cast, in pain, away from her home community, and just spent a hellish week in the hospital.  I was glad I went to this appointment with her. 
This isn’t what I usually blog about but it is something that is vitally important and it’s something I know a heck of a lot about due to my years working in mental health and developmental disabilities where I often attended appointments with clients and acted as a support  and an advocate.  I’ve done this for people both inpatient and outpatient.  I’ve traveled out of state to be with clients during various surgeries.  I’ve gone with people to talk to general practitioners, internists, psychiatrists, emergency room doctors, urologists, cardiologists, orthopedists, oral surgeons and others.  These days, friends and family members often ask me to attend appointments with them.  Let me share with you what I know. 
Doctors are usually under incredible time/billing pressure and are rarely trained to be good listeners.  If you find or have a doctor who listens well, and with empathy, you are very lucky.  Make sure you tell your doctor how much you appreciate this.  Do not be surprised or take it personally if you meet with other doctors who are rushed, pressured, bossy and who interrupt or talk over the top of you.  It should not be this way, but it is this way.  So, until we effect adequate change in the entire system, we must deal with what we have. 
Here is what I want you to know and do:
1-    Unless you have a legal guardian (i.e. under 18 or experience disability that has led to you being provided a court ordered guardian), you are under court-order to follow doctor orders (usually related to probation), or you are in a mental health unit with a court ordered “mandatory medications” order, you have the right to refuse.  You have the right to refuse medications.  You have the right to refuse procedures.  You have the right to refuse services.  If you decide that a course of treatment is not right for you, don’t allow someone to bully you into it.  If they do the procedure against your express wishes and without a court order, please file a grievance. 
2-    You have the right to take along an advocate.  This is a friend, family member or even a professional who can offer you moral support, ask questions you don’t think of, take notes and speak up if they feel you are not being listened to, or treated properly.  Even if your advocate never says or does a thing, having an extra body in the room will improve the chances that you are treated with a bit more respect.  Make sure that you and your advocate agree about what his/her role is and when or if s/he should leave your side.  Make sure you take an advocate who will not be disruptive but actively constructive.  Even if you take an advocate, YOU are the patient.  The doctor should primarily communicate directly with you.
3-    Have a plan before you go to any scheduled doctor appointment.  Know what your top three goals are.  More than three or four objectives and you’re going to lose the doctor along the way.  Leave additional goals for additional appointments.  Rehearse what you want to ask, what you want to say, and answers you want to give to any uncomfortable questions you are expecting.  Write it out.  I ALWAYS take a list to my own medical appointments. 
4-    Try to think and speak in bullet point format.  This isn’t easy and takes practice.  That’s okay.  Practice and you’ll get better.  Unfortunately, few doctors attend well to verbal narrative longer than about a minute or two, so this skill is worth cultivating because it’ll allow you to communicate more in less time.
5-    Speak up.  If you are a soft spoken person, you must practice speaking in a loud (not yelling) voice.  Imagine that you’re in a noisy restaurant and speaking to someone across the table from you.  That’s about the volume I suggest.  If the doctor is speaking much louder or softer than you, it’s okay to adjust your volume to match.
6-    Speak in a firm, or even stern tone of voice.  You’re not trying to make friends here, you’re trying to get your needs met and be treated with respect.
7-    To the best of your physical ability to do so (I understand pain & various ailments can interfere with this, as well as being on your back in a bed) use assertive body language.  Face the doctor head on.  Make eye contact.  Don’t smile or grin when you’re talking about what is most important to you.  Keep your shoulders back and your head up.
8-    At the end of your appointment, verbally summarize the plan of action while talking to the doctor.  Example, “So, you’re going to call that prescription in to my pharmacy and send a referral to the hospital for an MRI.  I’m going to go to my other doctor and sign a release of information so they can send you records, and I’m going to schedule the MRI and a follow up appointment with you for about three days after the MRI.  Is that right?”
9-    If you don’t know what you want, or if you are emotionally overwhelmed, ask for a time out.  Most doctors will be happy to go work on another task (or take a bathroom break) for 3-5 minutes while you compose yourself and/or make a decision. 

I hope you find this helpful.  I may well have forgotten or overlooked important things, so please feel free to leave comments and add to what I’ve written.