Patients often have trouble talking to their doctors. It can be hard to get the words out when the topic is emotionally charged or one you’d never bring up in polite conversation.
And for various reasons, sometimes including their own embarrassment, doctors may find it hard to bring up certain topics -- and that can compromise the care their patients receive.
“Communication is an inexact science,” says Bob Arnold, MD, professor of medicine at the University of Pittsburgh School of Medicine and director of its Institute for Doctor-Patient Communication. “Communication between doctors and patients is especially hard because the stakes are high and there are strong emotions on both sides.”
Some doctors are better than others at broaching touchy topics. Here are six things some doctors leave unsaid -- and what to do about it.
1. “You need to do something about that.”
Doctors are often reluctant to bring up a topic that might cause offense, even when there are pressing medical reasons to discuss it. A patient’s weight problem is one topic doctors sometimes shy away from. Others include whether the patient is depressed, smokes, abuses drugs or alcohol, has marital or sexual problems, or is experiencing financial hardship.
What to do: If your doctor fails to broach a topic that might be relevant to your health, bring it up yourself.
“Patients often think, ‘I will tell the doctor about this only if he or she asks me,’” says Richard M. Frankel, PhD, professor of medicine at Indiana University School of Medicine in Indianapolis. “They should be thinking, ‘Am I telling the doctor everything that I ought to be telling him or her?”
2. “You don’t need that drug.”
Direct-to-consumer pharmaceutical ads can be pretty effective at convincing patients that they need a particular medication (drugs to treat depression, diabetes, or erectile dysfunction are among the most heavily advertised) -- and even doctors can be swayed by these ads, notes David H. Newman, MD, director of clinical research in the emergency department at Mount Sinai Medical Center in New York and the author of Hippocrates’ Shadow. And when asked for a prescription, some doctors find it hard to say no--even when the patient doesn’t really need that particular drug.
Why is that? Ultimately, medical practices are businesses, and doctors sometimes fear that turning down a request for a drug could leave the “customer” feeling disappointed. “Doctors are terrible at saying ‘no,’” Newman says.
What to do: Newman says there’s nothing wrong with asking the doctor if medication might be helpful. But it’s a mistake to push a doctor to write you a prescription. “It can be dangerous to ask for things,” Newman says.
3. “I don’t know what’s going on.”
For all the advances in medical care, many ailments remain hard to diagnose and treat.
Doctors are sometimes understandably reluctant to admit uncertainty. Some are so fearful of looking ignorant or incompetent that they act as if they know what’s causing a particular symptom even when they don’t. When this happens, they tend to order tests and treatments that are likely to prove needless.
What to do: How do you avoid the rush to possibly inappropriate care? Anytime a doctor suggests a test or treatment, ask questions. What will happen if you don’t get that test or treatment? How much will you benefit if you do? Don’t consent to the intervention until all your questions are answered. “You have to keep probing to know whether what the doctor is recommending is really supported by science,” Newman says.
4. “I’m not sure you got what I said.”
Doctors sometimes worry that what they tell a patient goes in one ear and out the other. Unfortunately, that’s often the case. On average, studies suggest, patients grasp only about half of what doctors tell them.
Yet the fault sometimes lies not with the patient’s inattention, but the doctor’s poor communication skills.
“Physicians tend to deliver information in long, dense mini-lectures,” says Debra Roter, DrPH, professor of health, behavior, and society at Johns Hopkins Bloomberg School of Public Health in Baltimore and the author of Doctors Talking with Patients/Patients Talking with Doctors: Improving Communication in Medical Visits. “They’ll say things like, “Let me explain to you the function of the pancreas” when what the patient wants to know what a diagnosis of diabetes means in practical terms.
To avoid misunderstanding, doctors could initiate a back-and-forth discussion with their patients. But not all do.
“Doctors are not good about assessing the patient’s understanding of our explanations,” says Dean Schillinger, MD, professor of medicine at the University of California at San Francisco. “We’re infamous for saying, ‘Are you clear about what I’ve told you?’ What we should be doing is asking patients to restate what we’ve told them.”
What to do: At the end of your appointment, if your doctor doesn't ask you to recap what they've told you, do so anyway, Schillinger suggests. Simply tell the doctor you want to make sure you understand, and then use your own words to relate what you think you were told.
5. “This is risky.”
Just about every drug and surgical procedure poses risks to the patient. Even something as seemingly benign as a course of antibiotics can cause diarrhea, yeast infections, allergic reactions, and other unpleasant and potentially dangerous side effects.
Yet some doctors understate the risks posed by the treatments they recommend.
Similarly, when doctors order X-rays, cardiac catheterizations, and other diagnostic tests, they sometimes fail to explain the risks. These include the risk of a false-positive (indicating a medical problem that doesn’t exist), which can lead to needless anxiety and to even more tests.
”Doctors are very good at talking about benefits,” says Newman. “They’re not good at talking about risks.”
What to do: Ask the doctor to explain any risks posed by a recommended test or treatment.
6. "I don't have anything to offer you."
Some doctors may paint an overly optimistic picture when talking about life-threatening ailments, Newman says. Some encourage patients to undergo debilitating treatments when these are almost certain to fail. Even when death is imminent, Newman says, many doctors put off talking about it out of a sense of failure.
“Giving bad news makes us feel bad,” says Arnold. “Sometimes we feel inadequate and worry that our patients will blame us.” If you’d like the doctor not to pull punches when talking about your prognosis, say so, says Frankel.
What to do: Newman recommends talking to your doctor about end-of-life care while you’re still healthy. Do you want doctors to do everything possible to save your life, even if there’s little chance of survival? Or would you prefer to forgo treatment likely to keep you on a ventilator and a feeding tube? Either way, let your doctor know.
In addition to talking with your doctor, it’s prudent to draw up an advance directive that allows you to detail your wishes regarding end-of-life care and designate a health-care proxy (someone to direct your care in the event that you are incapacitated). And of course, communicate your wishes to your loved ones.