You’re in the room. That tiny one with the examination table, the sink, the little chair, and the fluorescent light. Your doctor, running late, finally pops through the door. Quick pleasantries are exchanged, and then it’s down to business.
You explain why you’re there. You go over your symptoms. Already, you feel like you’re off to the races, and you’re probably right. Research says you get only seconds to talk before the doctor jumps in with a word, question, comment, or redirect.
It all seems so scripted. Does the doctor even hear what you’re saying?
Not all visits are like this, of course. But many are. Studies show most complaints about doctors don’t have anything to do with their medical skills. It's mostly about poor communication.
A recent study found that 75% of doctors believed that they communicated satisfactorily with those in their care. Only 21% of the people treated by those doctors said that their talks went well.
Somewhere, there’s a disconnect. That can be devastating.
The more you and your doctor talk with each other -- really, really talk -- the better the chance you’ll feel better.
“I always tell my patients that we’re a team. It’s you and me, working together for the betterment of your health,” says Ada Stewart, a family doctor with the Eau Claire Cooperative Health Centers in Columbia, SC.
“We gotta work this together," Stewart says. "You may not agree with all that I say, and if you don’t, then I need to know ... But I think the biggest thing is to have that trust. To have that patient-physician relationship. That’s really important.”
But what if that bond isn’t there? What if you don’t feel like you’re being heard?
How do you get your doctor to listen? Really, really listen?
What You Can Do
Jot down some notes before you go. Have an idea of how you want your time with the doctor to go. Make sure you talk about what you want to talk about. Ask questions. Listen to the answers. Follow up.
Even more, have your health story ready when you get to the office. And tell it, says Leana Wen, MD, a doctor in Baltimore and the author of When Doctors Don't Listen: How to Avoid Misdiagnoses and Unnecessary Tests.
“Doctors end up asking about symptoms rather than the story. And [people] then get conditioned to talk about their symptoms instead of their stories,” Wen says. “Studies have shown that over 80% of diagnoses can be made just by listening.
"By that, they mean listening to the story, the open-ended story of what happened, rather than asking a list of yes-no questions,” she says.
Don’t go into that little office, Wen suggests, simply saying your chest hurts. Tell the story of it. For example:
- When it started
- If it’s been painful before
- What you were doing when your first felt it
- How it felt
- How often you feel the pain
That can really help clear things up.
“If a [person] were allowed to tell the story, they might also feel more listened to as well,” Wen says.
Leonard Reeves, MD, a family doctor from Rome, GA, says some old-school listening can really help your doctor.
“The old rule when I was in medical school, back in the old days of stone tablets, was that if you listen to the [person] long enough, they’ll tell you what’s wrong with them,” Reeves says.
Be straightforward and open-ended in asking questions, and be honest if you feel you’re not being heard. Some suggestions:
- “I’m worried that we aren’t communicating well. Here's why I feel that way.”
- “I need to talk with you about X. I feel like I can’t. Can we talk about this?”
- “I know you're busy, but I need to talk about X with you. Can we get some time on the calendar?”
- “Can you help me understand X?”
Consider bringing a friend or family member to your appointment. Someone else may catch things you miss, or ask a question you haven’t thought of.
Be honest and accurate. Some people go to the doctor and don’t tell the whole truth.
“Things that they don’t feel comfortable with, mostly," Reeves says. “Whether it’s use of illegal drugs or alcohol use. Maybe it’s sexual in origin. But you need to be able to build up that relationship between your physician and yourself that you feel like you can tell them whatever you need to tell them.
"These things do impact your health.”
Ask about the best way you can contact the doctor with other questions.
Give feedback about the doctor’s care and your office experience.
Robert Arnold, MD, a doctor who heads the University of Pittsburgh’s Institute for Doctor-Patient Communication, says doctors and those in their care should do what nurses often do -- a “teach-back” moment.
“At the end of the visit, [you] say to your doctor, ‘I want to make sure that I have it right. So what you want me to do is this,” Arnold says. “And what the doctor could do is say, at the end of the visit, ‘Just to make sure we’re on the same page, tell me what you’re going to do.’”
The Doctor Perspective
In addition to a lack of time, doctors face other barriers to good communication, including:
- Jargon that is often misunderstood by those in their care
- A general lack of, or perhaps a breakdown of, simple communication skills, including picking up nonverbal cues
- Fear of being sued
- Avoidance of emotional and social issues
- Cultural barriers between doctors and who they’re serving
- Feeling confrontational after resistance or questioning by those in their care
Doctors are trying to do their part to communicate better, following educational models with names like AIDET -- Acknowledge, Introduce, Duration (allowing an adequate amount of time to talk), Explanation, and Thank You -- and RESPECT (Rapport, Empathy, Support, Partnership, Explanations, Cultural Competence, and Trust).
Some experts push the “Four E's” of effective health care communication: Engage (building a rapport), Empathize, Educate, and Enlist (inviting those under their care to actively take part in health care planning).
Like many doctors, Reeves remembers when doctors could take the time to truly listen to people’s problems. With all those barriers to good communication, though, with full waiting rooms and the burden of keeping electronic medical records, it’s getting more difficult every day to make that connection.
“We have gotten away from [good communication] because we’re so pushed to see the next [person],” Reeves says. “If we can ever get it to the point where physicians can actually sit down, listen to the [person] and be involved in their care, rather than feeling like you’re making widgets every day and you got to turn out the next one, then I think we, as a society, are going to be healthier and, to be honest with you, happier.”
The Bottom Line
If there’s a communication problem, though, it’s probably up to you to fix it.
And if you can’t?
“You should always find a doctor that you feel that you can trust and you think is listening to you,” Wen says. “If you don’t think your doctor is listening, how can you trust that he or she is making the correct diagnoses and treatment recommendations for you?
“I would say, though, that it is important to give your doctor another chance, because maybe there’s something that you can do, too," Wen says.
"But if you feel like you’re still not being listened to, maybe it’s time to look for somebody else who you’re more comfortable with.”