Sometimes doctors call it the "doorknob moment." The physician's hand is reaching for the doorknob to leave the examining room and the patient suddenly gathers the courage to blurt out the real reason for the visit.
"Uh, one more thing. I think I saw some blood in the toilet. Could that be bad?"
Or: "The other night walking the dog, I felt this funny sort of stabbing feeling in my chest, but it went away."
Or: "My head started hurting on the right when my husband kind of pushed me against the wall. Could that have anything to do with it?"
"This definitely happens," James Hubbard, MD, MPH, tells WebMD. Hubbard is editor of Family Doctor: The Magazine That Makes Housecalls and a doctor in private practice for 24 years. "Patients know the doctor is in a hurry and think it's 'now or never.'"
The days of Dr. Welby and the long, personal chat with the doctor are definitely over. A 2001 study done at Rutgers University and published in The New England Journal of Medicine showed that the average visit is 17 minutes, which includes the physical exam.
Another study showed that the doctor may only listen 20 seconds before interrupting you and trying to move your explanation along.
Hubbard feels the patient has as much responsibility as the doctor for organizing the visit and making every minute count. "Asking an important question just as the doctor is leaving usually is not the best time," he says.
"But if you do this," he adds, "you have the right to ask the doctor to come back in and take a minute or two to answer."
Often, this may result in the doctor asking you to make another appointment. If you came for a headache and suddenly say your chest has been hurting, too, this could result in having to start the exam over, Hubbard says. "This will probably mean another appointment and different tests."
Why Doctor-Patient Relationship Can Be Strained
These days doctors and patients often do not have long-standing relationships. The patient may not know the doctor well, or this could be a first visit. "You may not know how the doctor will react," Hubbard says.
And according to a report by the pharmaceutical firm Pfizer, many diseases, conditions, and lifestyles still carry a stigma in our society. Examples would be:
- Mental illness
- Sexually transmitted diseases
- Sexual orientation
- Sexual dysfunction
- Bowel and bladder changes
- Domestic violence
- Memory loss
- Painkiller, recreational drug, or alcohol abuse
Added to this perceived stigma is a prevailing notion that people should be healthy or they are doing something "wrong." To be less than perfect can sometimes trigger discrimination or censure, which Pfizer termed "healthism," putting it on a par with racism or sexism. Some people feel even doctors can have a touch of healthism.
Patients may also be reluctant to talk about private parts, sex, or bodily functions. One patient tells the story of having a paralyzed bowel and telling someone why she was in the hospital. Her sister hissed, "Don't even say intestine!"
"You could be embarrassed," Hubbard says. "But anything you say will not surprise the doctor. It's best to get to the main point right away."
Make the Doctor-Patient Relationship Work for You
Your doctor is not a detective. Even the best diagnostician needs clues. "I have had patients who won't say much and even say, 'That's for you to find out,'" Hubbard says. "You have to be honest with me."
Being honest means:
- Telling about all medications you are taking. One doctor said some patients do not consider birth control pills to be a medication; they are, as are all herbal and vitamin supplements. Be sure to list medications given by other doctors, even if they are painkillers that were prescribed by other physicians. If you must, dump all your pill bottles in a bag and bring it to the doctor's office.
- Answer lifestyle questions honestly. Some doctors ask about sexual orientation; today that can be an issue if you are having unprotected sex (another thing to be honest about). Bill Clark, MD, president of the American Academy on Physician and Patient, tells WebMD he quizzes patients about alcohol use. "I use CAGE," he says. "That is an acronym for: Have you ever felt the need to CUT down? Does your drinking ANNOY others? Have you ever felt GUILTY about drinking? And do you ever need an EYE opener in the morning?"
- Don't conceal symptoms. Some patients are reluctant to report "lost time" that might come from epileptic seizures, because it can mean confiscation of their driver's license. But the doctor needs to know this. Other symptoms that could signal serious diseases -- such as heart disease, diabetes, or mental illness -- are often downplayed.
- Mention your personal situation even if it means taking more time. One of the most stigmatized diagnoses in the minds of patients is mental illness. Treatment is not covered under many health plans and it can prompt discrimination at work or lack of self-esteem. Marla Rowe Gorosh, MD, a family practitioner at Henry Ford Health Systems in Detroit, tells WebMD she had seen a patient 10 times over three years and had treated him for depression, without really knowing the cause. Then the patient finally mentioned some painful personal information about his wife's behavior, and some pieces started falling into place for her. "Sometimes, I realize I have been making incorrect assumptions," Gorosh says. Hubbard agrees. "There are lots of stress-related problems that can influence or cause physical or mental problems," he says.
If the doctor lapses into jargon, ask for an explanation. If he or she wants you to go on a special diet or take a medication, ask for more specifics. "You're paying the doctor for his or her time," Hubbard adds, "make the most of it."
While some doctors issue a sheet on which you can write your concerns, most recommend you limit your discussion to what you think the most important symptoms or problems are. Bring a list of questions if you think you might freeze.
"If there is some question in your mind about whether to bring something up," Hubbard says, "that probably means you should bring it up."
This is one time it is not good to save the best for last.
For more information on questions you can ask, go to www.webmd.com and click on the Newly Diagnosed icon at the top of the page.