How To Get Your Doctor to Listen

Getting your doctor to listen can help your health.. istockphoto

One of the challenges for anyone dealing with the medical system is in getting doctors to listen. We know that doctors who actually focus on and and take in what their patients are saying tend to make better diagnoses, and their patients experience better outcomes. Interestingly, the Joint Commission, a nonprofit group providing accreditation to health care organizations, reported that failures in communication -- not technical or medical skill problems -- were the root cause of more than 70 percent of serious and adverse health outcomes for patients in hospitals.

At the same time, according to a New York Times report:

  • two-thirds of patients leave the hospital without even knowing their diagnosis
  • More than 60 percent of patients misunderstand directions after a visit to the doctor
  • doctors wait 18 seconds before interrupting patients as they explain their symptoms
The reality is, many doctors simply aren't listening. We can speculate regarding the many reasons: lack of time, poor training in interpersonal skills and communications, professional ego. But whatever the reason, patients have to recognize that this epidemic of poor communications is not likely to subside anytime soon, and in the meantime, pose a challenge in getting properly diagnosed and treated.

As a patient - or as the caregiver or support person for someone with a health challenge -- what can you do? Here are some tips:

1. If you have a choice, recognize quickly when it's time to get a new doctor.

Some of us feel that if we've had a longer-term relationship with a doctor, that leaving that doctor for a new one is somehow a betrayal. Or, we feel that the doctor is an authority figure, and we are intimidated, or don't want to upset the doctor by essentially firing him or her. But let's remember - doctors are service providers, and they work for you.

If they rush you through appointments, don't listen, and aren't helping you get well, you don't owe them any allegiance. If you are in a situation where you have a choice of doctors, make the decision to move on from doctors whose ineffective communication skills are getting in the way of your health.

2. Be prepared and concise.

One of the best ways to get a doctor to listen is to avoid rambling, or lengthy stories about symptoms. Even the best, most empathetic doctors still have time limits. So before you go to see the doctor, know what you want to say, and figure out how to say it quickly and concisely.

You may even want to bring an agenda -- but make it short, with only a few key points. And put your most important issue first! Doctors often report that patients wait until the end of the appointment to bring up the most important concerns.

And don't inundate your doctor with printouts, articles, and paperwork -- earning you the label of "petit papiers" (little papers) person. If you have materials to discuss, send them in advance, with a note regarding which specific issue you'd like to discuss during your appointment.

Or leave the materials for followup later. But if you bring materials, and expect them to be read during your appointment, you will most likely end up with a doctor who is reading, rather than listening.

3. Choose the right practitioner for the challenge.

If you are having an unusual skin condition, you don't go to a dental surgeon and expect diagnosis and treatment. But many patients mistakenly think that their general practitioner or primary care doctor should be an expert in a multitude of complicated health issues. It's important to recognize that GPs and primary care doctors are usually generalists -- and sometimes their role is to triage - to help direct you to the particular practitioner or specialist who can help. Sometimes, however, the GP or primary care doctor has an overinflated opinion of his or her ability to manage more complex situations. In those cases, you may have to push for a referral, or if you can, consult someone else without a referral.

For thyroid patients, there's also an important message here. Endocrinologists are specialists in "thyroid disease," but they are not specialists in autoimmune disease, nor for the most part are they experts in resolving symptoms of hormone imbalance. If you have thyroid cancer, a goiter, or Graves' disease - by all means, see an endocrinologist, who has the technical expertise to manage these situations.And if you need thyroid surgery, see an experienced thyroid surgeon

But if you are hypothyroid, taking levothyroxine, and still don't feel well, or want to explore ways to reduce your thyroid antibodies, this is not something endocrinologists are trained to do. They are focused on using TSH tests to evaluate you, and medications to treat you so they can get you "euthyroid" -- with thyroid levels in the reference range, irrespective of symptoms. What you are looking for is a focus on getting you optimized -- something that tends to be more in the purview of holistic and integrative physicians.

4. Realize that listening does not mean acquiescing.

I have heard from so many patients who have complained about this or that doctor, saying "He just doesn't listen! I told him I had adrenal problems and MUST have hydrocortisone immediately!" or "She refuses to listen. I told her I needed to at least double my T3 meds!" It's true that in some cases, the patient may have a truly valid point, and the doctor is in fact refusing to listen. In that case, see #1! But in some cases, I know for a fact that the patient was complaining because she went in to see a new doctor, demanded the doctor to perform this or that test, or prescribe this or that drug, and when the doctor reasonably and professionally discussed that that this was not a good idea for the patient, or required further discussion, the patient became irate. Doctors are not fast-food outlets or order takers.

You don't get to walk up to the counter, choose from a menu, and "have it your way."

Again, if you have a doctor who doesn't listen, and has no thoughtful reasons for refusing to explore your requests, then it's a bad relationship -- time for a new doctor. But if you have a decent doctor, who is suggesting that what you want may not be the best thing for you -- then it's time for you to do some listening as well.

5. Use less emotional language.

It turns out that when patients go to a doctor and complain in an emotional way about symptoms, doctors are more likely to consider the symptoms to be signs of mental health issues, rather than disease symptoms. So, even though it's difficult, do your best to be specific, more businesslike and less emotional, and quantify symptoms. Better to say "I've gained 5 pounds in a month, eating 1200 calories a day" than "I feel so fat! Ugh!" or "I'm sleeping 8 hours a night, but still can't function," versus, "Oh my gosh, I'm just SO TIRED!"

Doctors are trained to consider numbers and quantification as data and evidence, but your own impressions of symptoms are more in the "emotional complaint" category.


If you have thoughts about getting doctors to listen, or want to share your stories, join for this discussion at Facebook Thyroid Support.


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