May 15, 2000 -- As a nurse practitioner, there's nothing I appreciate more than the patient who reminds me when I'm not doing my basic job -- listening to her. The other day, a patient said to me, "You're really busy today," and I knew that was code for "You're not making eye contact, you're not asking questions, you're treating me not as a person, but as a product on a conveyer belt."
Here are some situations that might lead you to suspect your doctor is not listening -- and how to find out if you're correct.
- Recently I was a patient at the office of a dentist who seemed totally distracted. In between the first shot of novocaine (which wore off by the time he got back to me) and the second, I heard him ordering furniture, taking calls, and giving orders to his staff. When he finally got back to me, I said, "You seem distracted today." He said, "No, I'm not."
Wrong answer. He should have said, "I'm sorry you feel that way," or given some other explanation for his behavior. After he finished working on my teeth that day, I never went back. Perhaps I should have also, as a courtesy, sent him a letter explaining why.
- Your doctor enters the exam room, sits down, and immediately puts her pen to the prescription pad as if she's in a contest to see how fast she can get you out. You barely mutter "big globs of green sputum" and she's handing you the prescription and telling you not to call her in the morning. Her rushing leaves you feeling neglected. How can you get the healing you came for?
Jerome Groopman, MD, author of Second Opinions: Stories of Intuition and Choice in the Changing World of Medicine, says, "You should simply say, 'I feel a need to talk about this with you and I want your attention.' You can say it in a nice, yet clear way. If you feel you're not getting the time or the attention you need, then you have to ask for it or find another provider." If the doctor says she's too busy today, ask if you can make a follow-up appointment to address additional questions.
- Your doctor has spent time explaining your treatment plan, but you still don't get it or aren't ready to accept it. You fear that asking for more information is being a little too demanding. What is appropriate?
"It's not really a question of demanding," says Groopman. "It's a question of seeking clarity and seeking a connection to make sure that what you've articulated has been listened to carefully. Careful listening is the beginning of careful thinking. Even if the answer isn't in sync with your own perceptions, it should make sense to you. "
You can also
- Ask your doctor if he has any printed material on the subject so you can mull it over.
- Offer to send a self-addressed envelope so he can search for literature later.
- Say that you will do your own research on the Internet later and ask your doctor if you can phone, e-mail, or return with any follow-up questions.
- You suspect that your doctor isn't listening but you don't want to be rude by saying anything.
You can always apply the Groopman test to determine if the doctor is listening. (See Speaking to Your Doctor) "If the doctor is distracted and you start to hear questions addressing the material that you've just covered, that is the key that she's not listening."
- You've told your doctor what you are willing to do and what you won't do but he doesn't seem to hear you. He's ready to go ahead with the surgery that you're not sure you need.
Tell him you want to get a second opinion. As Groopman says in his book, "Asking for a second opinion can be a sign of a communications problem. ... It may be [the patient's] way of saying that I [the doctor] need to reopen our dialogue, to listen again, more carefully, to his words."
Alice Kahn, RN, NP, spent eight years as a reporter and columnist for The San Francisco Chronicle. She currently works as a clinician in the Chemical Dependency Recovery Program and as a research nurse-practitioner in the Women's Health Initiative Hormone Study at Kaiser Permanente in Oakland. She is the author of five books, including Your Joke Is in the E-mail.