1. Identify your AgendaIt is a very straightforward and common sense list. I like her additional bits of advice like "bring all of your medications." Discuss ALL of your meds with your doctor. This includes OTCs and herbal supplements. Just because it is over the counter doesn't mean it is safe for you!
2. Make a List
3. Ask for the Time you Need
4. Be Honest
5. Be Patient
6. Be Nice to the Office Staff
7. Make Sure You Understand: use AskMe3
- 1. What is my main problem?
- 2. What do I need to do?
- 3. Why is it important for me to do this?
8. Tell the Doctor about Barriers
9. Follow Up as Directed
10. Be the Coach
I am surprised that she doesn't mention any of the more controversial issues I've run across like "describe symptoms and presentations, not diagnoses." Some patients have the tendency to say "I have cholecystitis," in an initial interview when they should really say "I have stomach bloating and gas pains about 30 min after eating fatty meals, with loose stools. I saw Dr. X who did an ultrasound that found gallstones." Dr. Engel's book, "The Clinical Approach to the Patient" (out of print,) highlights the importance of this. Reporting patient data is a subjective activity and including tentative diagnoses, even if it is by other physicians, may interrupt the diagnostic process. In the appendix of his book he gives a woman an exhaustive interview that includes everything for a woman who minimizes her symptoms, but in the retelling of her own story from the beginning, she begins to realize how progressive her condition was and how early she began to have symptoms.
"Be the Coach" is not the way I would have phrased #10. "Get in the Game" is what I would have said. The doctor's role is the coach and the patient is the player in the game of healthy living.
Reference:
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The Well blog at the New York Times did a post like this called "Six Ways to Be a Better Patient," and it really hit a nerve with the commenters.
ReplyDelete"Non-compliance? Why don’t you check with the patient and see what they are willing and able to do instead of having unrealistic expectations. Also you asked why patients are not honest with doctors or we don’t describe all of our symptoms. It’s not embarrassment. It’s the self-righteous sneers, eye rolls, and being dismissive that keep patients from being honest."
"When I had a serious health issue and actually saw my doctor, I had many questions about his recommended treatment (I had had experience with this illness before, and knew the side effects of meds he was recommending) he became enraged at my non-compliance and refused to discuss other options (’if you’re not going to do what I tell you I don’t know why you bothered to come in’)."
The sheer number of dissatisfied patients is alarming. And perhaps instructive. In asking our patients to make our lives easier, we should also be better at serving their needs as well.