9 mistakes we make when talking to doctors – and how to do it better
Do you ever get flustered, panicked or angry at a medical appointment? You’re not alone. Here’s how to get the most out of your time – and talk so your doctor will listen.
Do you ever get flustered, panicked or angry at a medical appointment? You’re not alone. Here’s how to get the most out of your time – and talk so your doctor will listen.
If you’ve ever come away from a GP or consultant appointment feeling frustrated that they haven’t really listened, have fobbed you off or even refused to order the tests you wanted, then the problem might not be just theirs. It may partly be due to how you’re presenting yourself.
Sometimes we can be too passive, sometimes too aggressive – and sometimes simply not accurate enough when describing our symptoms in such a tight timescale, explains Penny Parkes author of How to talk so your doctor will listen: Helping your doctor to help you.
“It is entirely understandable to find the current healthcare system challenging to navigate – the evolution of the NHS over the last 30 years means that being a passive participant in our own healthcare is simply no longer an option,” Parkes says.
With decades of experience of navigating the NHS for her chronic autoimmune conditions, Parkes stresses that the vast majority of doctors really do want to do their best for you, but these days they are under tremendous time pressures.
Not only that but the rules they operate under often change, and patients aren’t always aware of this.
“For instance, under the new GP contract, GPs can’t refer you to a consultant (for planned care) without first consulting them for advice,” she says.
“It’s no longer automatic that you’ll get a referral and government guidelines say one in four cases will be bounced back. That’s not your doctor’s fault, that’s the system.
“The secret of getting the most out of your appointment is preparing for it, using the right words and working with your doctor in partnership.”
“Research shows that you’ve got 23 seconds before your health professional will probably interrupt you,” says Parkes.
“It’s not a lot of time but if you are giving them valuable, credible, actionable information, you’re much less likely to be interrupted. I advise patients to prepare what I call your ‘personal health headlines’ beforehand. Think of it as your ‘elevator pitch’ – your chance to get an idea across to someone in a tiny amount of time.”
She says doctors are trained to expect us to mention our main symptoms first, but many of us will preamble with a story about the twinge that started last Tuesday and waste time getting to the point.
‘In a time sensitive environment, it’s all too easy to become flustered or to go off on a tangent. We have all done that from time to time – blurting out some crucial symptom halfway through the conversation and forcing the GP to re-evaluate everything. Or, potentially worse, focusing on the less crucial issues first, in the interest of a timeline narrative, and running out of actual time (or your doctor’s attention).”
Parkes recommends the 4 Cs – speaking clearly, concisely, coherently and in context.
“You need to give a really clear concise summary and put it into context and spell out how it’s affecting your daily life – tell them if it means you can’t drive, walk up the stairs, or have sex for instance,” says Parkes.
“Say what steps you’ve already taken to resolve the problem – such as discussing your medication with a pharmacist or joint pain with a physio. If you have an asthma or allergy action plan, say you’ve tried all the recommendations, and you need medical help. You could do this prep at home with a pen and paper in five minutes.”
“Remember doctors are scientists, and they want data,” says Parkes. “If they ask you how many times you are getting up at night to go to the loo, or how many hours sleep you are getting, it doesn’t help them much if you say you don’t know.
“Track your symptoms and keep a record, take photographs or some blood pressure readings – it all helps your doctor build up a pattern of your symptoms and how they might be affecting you.”
When it comes to chronic pain symptoms, Parkes recommends comparing the pain to something familiar and tangible rather than using a score out of 10.
“It’s easier to convey how much pain you’re in by saying something like ‘It was painful as stepping on a Lego brick,’ or ‘When I dislocated my shoulder I couldn’t sleep, lie down or walk for x days,’ than saying it’s a 6 or a 7 on the pain scale.
“Think about the location of your pain, whether it comes and goes or is there all the time and how it feels. For example, is it a dull ache or a burning pain, are you experiencing spasms or pins and needles, throbbing or tingling? The more specific you can be, the greater the chance your doctor will have of making an accurate diagnosis.”
We probably all start out intending to be calm and respectful but things don’t always go to plan.
“Frightened, unwell patients often forget that there is a human being on the other side of that stethoscope – someone who has a personal life, a family, and may not have had a drink, any food or even a wee for the last six hours,” says Parkes.
However, this doesn’t mean you have to be a doormat, she stresses. If you feel yourself getting flustered, it’s worth stopping and going back to your notes. Sometimes doctors don’t like patients handing them a pre-prepared list of symptoms (apparently, they are medical Marmite!).
In which case she advises saying something like: “I really hope you don’t mind, doctor, but I wanted to make sure I remembered the crucial information to tell you, and I’m finding the pain/insomnia/nausea so distracting, I thought it better to write things down rather than waste your time by coming back again.”
In these days when you rarely see the same hospital doctor twice, and GP practices have a seemingly endless rotation of locums, it can really pay to have a “cheat sheet”.
“It should list all your medical conditions and the drugs you are being prescribed, plus your personal details such as name, age, address and next of kin and GP contact,” says Parkes.
“Make sure your partner, or a younger relative, has a copy too so they can explain and advocate for you if you’re not able to.
“If you have specific allergies, diagnoses and needs, wear a medical alert bracelet. They cost very little and could honestly save your life one day. Paramedics do look for them. If you have a constantly evolving medical situation, you can either have a bracelet linked to a service that allows you to update your information, or you can buy cheaper silicone bracelets that are easily replaced as your situation evolves.”
“It’s understandable to be frustrated sometimes if you think you’re not getting through to your doctor but avoid setting up a ‘them and us’ situation,” says Parkes.
“The moment you lose your cool, you lose the high ground and any hope of getting your appointment back on track. This is not the time to exaggerate your symptoms to try to get help, because your greatest asset is your authenticity at this point. Try instead to ask for appropriate next steps.”
Instead of asking “What are you going to do next?”, Parkes suggests that you rephrase it as “What are WE going to do next?”, or ask what they would do if they had a relative in your situation.
“You want to be working in partnership with your doctor. It also shows that you’re proactive and want to be involved in your own healthcare.
“Say for example ‘I appreciate that you would like me to supplement my B12 with tablets, but as you can see in my notes, I’ve already been taking B12 tablets for six months – and this latest blood test has just shown it’s still very low. I’m utterly exhausted and I can’t manage my usual activities/work. I would really like to explore next steps. Can we discuss why I don’t seem to be absorbing the tablets?’”.
“Although your family history might be noted on your records somewhere, it’s always worth reminding your doctor as they may have forgotten or not had time to read your notes,” advises Parkes. “Mention your relative having bowel cancer if you have symptoms such as tummy pain and explain that’s why you are worried.
“Similarly, if you have witnessed a parent in the early stages of dementia and you are getting the feeling that history is repeating itself, mention this.”
We all get worried about what the doctor will say if we mention we’ve googled our symptoms, but if you feel the consultation isn’t addressing what you really fear, it is worth speaking up.
“Sometimes it’s just worth asking direct questions such as ‘Could this be sepsis?’ or ‘Could this be cancer?’, particularly if your doctor is looking a bit stressed and distracted” says Parkes. “It forces them to address it directly.”
“Once you’ve been diagnosed with one medical condition, it’s common for any new symptoms to be attributed to that – this is called diagnostic overshadowing,” says Parkes. “You may have a diagnosis of fibromyalgia for instance and then any new pain symptoms are put under this umbrella, but it could be due to another condition that has been missed.
“In these cases, it might be worth saying: ‘I’d really like us not to fall into diagnostic overshadowing. Yes, I do have arthritis or IBS, but these symptoms are new to me, severe and sudden.’ These are red flags which should make your doctor take more notice.”
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