Talking to the Doctor

Definition
Purpose
Description
Preparation
Results

Definition

Talking to the doctor is a fundamental requirement for an accurate exchange of information between patient and healthcare provider. It includes communiating private or potentially sensitive information, and requires a climate of trust. Without trust and accurate information, treatment and healing are difficult at best and impossible at worst.

Purpose

The purpose of talking to a doctor is to exchange information and obtain a cure or relief from pain and suffering. This outcome can only occur in an atmosphere of openness and mutual confidence.

Description

Talking is a basic human mode of communication. Talking to a doctor should be easy, but for many people, this is not the case. Barriers to straightforward communication include inhibition (shyness), fear, and guilt. These barriers may be present whether the patient is an adult who can speak for him- or herself or a child or elderly person whose history and symptoms must be described by another family member.

Inhibition

People often hold physicians in high regard. The stated reason for this feeling is a difference in educational level. Doctors have more educational credentials than most people in the general population. This differential tends to make patients self-conscious and hesitant to offer information.

Inhibition is further fueled by the sense of hurry and urgency that many health professionals project. Patients feel uncomfortable when they sense that they are being rushed by their doctor. As a result, they are reluctant to speak freely.

Fear

Apart from vaccinations or routine physical checkups, people in the United States do not ordinaly visit a doctor when they are well. The norm is to make an appointment when something hurts or does not function or feel right. It is natural for people to feel anxious in these circumstances—they are afraid of receiving bad news.

Guilt

Many patients’ health complaints are often the direct consequences of their own behavior. Obesity often results from a combination of overeating and inadequate exercise. The leading cause of lung cancer is smoking tobacco. Casual sex can lead to unwanted pregnancies and sexually transmitted diseases. Having to accept responsibility for choices that lead to undesirable consequences is painful. Having to tell a person who is an authority figure as well as a trusted confidant often arouses guilt feelings.

Establishing trust

Trust requires time to develop, but it is also a two-way interaction. People seeking the advice of a doctor may reveal only a portion of their symptoms at first. While it is the doctor’s task to elicit relevant information, the patient who is answering the questions must be open.

Doctors often assume that patients do not give completely honest answers. Women typically understate their body weight, while men overstate their strength. Smokers rarely admit to the true number of cigarettes that they smoke per day. Drinkers underestimate the amount of alcohol that they consume.

Preparation

Important elements of any doctor-patient conversation are honesty and openness. Some people may have to make a conscious decision to be open with their doctors. To avoid wasting time and feeling pressured, people should decide to be completely frank before they enter a doctor’s office. In addition, inaccurate or incomplete information may lead the doctor to make an incorrect diagnosis or treatment decision.

Bringing records from visits to other healthcare providers is very useful to a doctor. People who have known their doctors for long periods of time are a steadily shrinking minority. Providing a new doctor with copies of one’s medical history saves time and usually improves diagnostic accuracy. For example, old photographs are especially invaluable when evaluating skin problems.

Results

The passage of time, repeated positive interactions, and good outcomes from the information provided by the patient help to establish mutual trust. Trust then enhances the therapeutic interaction. The result may well be better health for the patient.

Preventive care should be part of the interaction between doctor and patient. A frank exchange of information is one form of prevention. If a conversation with one’s doctor accomplishes nothing else, it will reduce inhibition, fear and guilt.

Resources

BOOKS

Bickley, L. S., and P. G. Szilagyi. Bates’ Guide to Physical Examination and History Taking, 9th ed. Philadelphia: Lippincott Williams and Wilkins, 2007.

Jarvis, C. Physical Examination and Health Assessment, 5th ed. Philadelphia: Saunders, 2007.

Seidel, H. M., J. Ball, J. Dains, and W. Bennedict. Mosby’s Physical Examination Handbook, 6th ed. St. Louis: Mosby, 2006.

Swartz, M. H. Textbook of Physical Diagnosis: History and Examination, 5th ed. Philadelphia: Saunders, 2005.

PERIODICALS

Arar, N. H., C. P. Wang, and J. A. Pugh. “Self-Care Communication during Medical Encounters: Implications for Future Electronic Medical Records.” Perspectives in Health Information Management 24, no. 3 (2006): 3–12.

Buzaglo, J. S., J. L. Millard, C. G. Ridgeway, E. A. Ross, S. P. Antaramian, S. M. Miller, and N. J. Meropol. “An internet method to assess cancer patient information needs and enhance doctor-patient communication: a pilot study.” Journal of Cancer Education 22, no. 4 (2007): 233–240.

Hassan, I., R. McCabe, and S. Priebe. “Professional-patient communication in the treatment of mental illness: a review.” Communication and Medicine 4, no. 2 (2007): 141–152.

Mills, P., J. Neily, and E. Dunn. “Teamwork and Communication in Surgical Teams: Implications for Patient Safety.” Journal of the American College of Surgery 206, no. 1(2008): 107–112.

ORGANIZATIONS

American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (913) 906-6000. E-mail: [email protected]. http://www.aafp.org (accessed April 8, 2008).

American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007-1098. (847) 434-4000. Fax: (847) 434-8000. E-mail: [email protected]. http://www.aap.org (accessed April 8, 2008).

American College of Physicians. 190 N. Independence Mall West, Philadelphia, PA 19106-1572. (800) 523-1546, x2600 or (215) 351-2600. http://www.acponline.org (accessed April 8, 2008).

American College of Surgeons. 633 North St. Clair Street, Chicago, IL 60611-3231. (312) 202-5000. Fax: (312) 202-5001. E-mail: [email protected]. http://www.facs.org (accessed April 8, 2008).

American Hospital Association. One North Franklin, Chicago, IL 60606-3421. (312) 422-3000. http://www.aha.org/ (accessed April 8, 2008).

American Medical Association. 515 N. State Street, Chicago, IL 60610. (312) 464-5000. http://www.ama-assn.org (accessed April 8, 2008).

OTHER

Agency for Healthcare Research and Quality. Information about Talking to the Doctor. 2008 [cited January 3, 2008]. http://www.ahrq.gov/CONSUMER/quicktips/doctalk.htm (accessed April 8, 2008).

Cable News Network (CNN). Is Technology Changing the Doctor/Patient Relationship? 2008 [cited January 3,2008]. http://www.cnn.com/HEALTH/9906/30/internet.house.calls/ (accessed April 8, 2008).

National Library of Medicine. Talking with Your Doctor 2008 [cited January 3, 2008]. http://www.nlm.nih.gov/medlineplus/talkingwithyourdoctor.html (accessed April 8, 2008).

L. Fleming Fallon, Jr., MD, DrPH