Dr. Decipher: Why Won't My Doctor Listen to Me

By Dr. John Janousek, M.D. Monday, July 12, 2010

Patients frequently ask me for a second opinion. They complain that their physician "did not listen" or "did not tell me anything." Why is there a disconnect sometimes between doctor and patient? Is it the patient's fault, the doctor's fault, or a combination?

Health care providers are rushed, as about 3-4 patients per hour are booked plus add ons. Then there is charting time and telephone calls.

Some providers are better than others at multitasking and time management, but the point is as a patient you only have a few minutes for yourself. Here are some tips to maximize your physician visit:

1. Begin with a summary of your problem and what you want to accomplish at the visit. This sets the tone and puts the visit in context for the physician. "I have had pain in my joints for a month, and I was bitten by a tick. I am worried about Lyme disease" is a good example of a way to start, then one can go into specifics such as the description of the tick, any rashes, etc. Most patients do not begin like this; they recite a detailed diary of symptoms which makes me think "Where is this all leading" as I try to fit the symptoms into a category, or organ system of illness.

One middle-aged woman spent the appointment taking about her headache, which was clearly non-serious, and only when I said goodbye did she say, "I only came here because my sister died of a brain tumor and I was worried" - aha! This was the key to the whole visit and I wish I could have addressed this more directly earlier.

2. Write a list ahead of time. It is difficult to remember exactly what you wanted to ask when the pressure is on (the military CRSs). Also write down what the physician tells you, especially names of consulting physicians and plans of action.

Bring a current complete list of medications with you, especially dosages and include herbal supplements, diet pills, and muscle-building pills. Frequently specialists will change or add medications and the primary care physician will not know, and will need to update his records. As an emergency physician I usually only have the information the patient provides me, and it is often very sketchy ("I take a blood pressure pill starting with M").

3. Arrange to bring someone else with you as a witness and additional set of ears. Just like the game when you pass a message down the line, it changes and is subject to interpretation. It helps to get another analysis of the visit and plan of action.

4. Try to work within a time frame context of about 10 minutes. The doctor visit is like a short play. It has a beginning, a middle and a closing, so gear the interaction appropriately. Usually during the closing, the physician will ask if you have any questions. This is the last chance so use this time to close any loose ends. Ask about what the next step will be if the therapy does not work.

5. Realize that medicine is an art and many problems and diseases do not present like the textbook. We are taught to create a "differential diagnosis" list then choose the most likely one. The catch phrase is "when you hear hoof beats, think horses." Occasionally, though it is a zebra.

6. Prescribing narcotic pain medicine is a touchy subject. On one hand there are many patients in chronic severe pain, and on the other prescription drug abuse is a huge problem. These types of prescriptions are best addressed with one's primary care provider or a pain management specialist. Virginia has a new prescription monitoring program, which compiles an on-line database that is immediately accessible by physicians. It lists all controlled drugs obtained by a patient and the provider who prescribed them. I treated a patient who had seven pages of prescriptions in the past year for narcotics from over a dozen providers; this is not good medicine. We as physicians are mandated by JCAHO to treat pain yet can be penalized by the state medical board for unwarranted prescriptions of narcotics.

7. Be friendly yet firm. Many patients these days are hostile as frustrations with health care sometimes spill over. Also, a patient may need to be firm if their expectations are not met, such as specialist referral, or at least obtain an explanation of why the referral is not being done at that time.

An increasing problem is cell phone and texting while I try to speak with a patient.

Humor can be a good tool to establish rapport. Before my colonoscopy I called my physician "Captain Kirk," as he was going where no man had gone before; this broke the ice, he laughed and then proceeded to tell me every colo-rectal joke he could think of during the procedure and explained everything very cordially.

Physicians can also facilitate interactions by shaking hands, sitting down, addressing all persons in the room and asking open-ended questions. I have attended lectures on this subject, as patient satisfaction is very important and every hospital spends a lot of money contracting to companies such as Press Gainey, which survey patients who actually grade physicians. There are even a couple of on-line companies such as Healthgrades where patients enter their comments. If patients do not like their physicians, they are unlikely to follow their instructions.

Finally, if you and your physician cannot seem to connect, you may need to find a new one, but I recommend first trying these steps. It can be difficult to switch because of managed care plans and the shortage of primary care physicians taking new patients, and sometimes relationships take a little work.

Now, make the most of your next doctor visit and please feel free to pass along any tips you have for other patients or for physicians.

You can reach Dr. Janousek by email, doctorj@wydaily.com, or by leaving a message in the comments.