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HEART Insight:
doi: 10.1097/01.HEARTI.0000443045.61553.ef
Features: Ounce of Prevention

You've Got Questions

Stephens, Stephanie

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How to talk to your doctor and get the answers you need

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When Kelly David of Greene, Maine became pregnant with her third child two years ago, she began to develop severe morning sickness and felt dizzy and “swollen” beyond what she thought was normal. Her heart began to flutter, “like a cup filling up and dumping,” she recalls.

This determined mom—who also works in healthcare—prepared a list of pertinent questions for her doctor. Kelly ultimately discussed her symptoms with three healthcare providers, one of whom dismissed her worries as “a normal part of pregnancy.”

“It was nearly impossible to ask a question,” she recalls of that thwarted attempt at meaningful communication with her healthcare providers.

As her heartbeat became increasingly erratic, Kelly sought help with different doctors, refusing to give up. She was finally diagnosed with Wolff-Parkinson-White (WPW) syndrome, a condition caused by an abnormal extra electrical pathway of the heart that can cause rapid and irregular heartbeats.

Kelly experienced an easy delivery and four weeks later underwent a procedure called catheter ablation to fix her heart's erratic rhythm caused by the syndrome. Before her cardiac procedure, the exhausted but still-focused new mother readied another list of queries.

“In addition to the general questions anyone would ask about surgery, I needed to know: How is this procedure going to affect me long term? What are the side effects of my medications for this condition—now and as I age?” Kelly says.

She worried about her newborn, asking, “How will the procedure affect breastfeeding? How will having had a baby recently affect my recovery? How will my surgery affect me since I've just had a baby?”

After the procedure, which went well, Kelly asked her doctor about the long-term effects of WPW. Because she still had occasional flutters, she asked if they would stop and whether they could possibly be caused by something else. Kelly's doctor answered all of her questions and she felt like she had a good handle on her syndrome and how it would affect her life going forward.

Satisfied that she found the answers she needed, Kelly is now an advocate for the proactive patient. “Really talk to your doctor and ask what's important to you because the conversation is ultimately about you and your health,” she says.

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CHOOSE YOUR WORDS

“Patients do not focus upon prettier waiting rooms, better hospital food, smiling office staff or problems with parking,” wrote authors Tom DelBanco, M.D. and Margaret Gerteis, Ph.D. about the doctor-patient relationship on the health information website UpToDate.com. “Rather, they are concerned about issues of clinical significance that have little to do with what we think of as the ‘image’ of the [doctor] or the ‘atmosphere’ of the office or clinic. They want to be able to trust the competence and efficiency of their medical providers. They want to be able to negotiate the healthcare system effectively and to be treated with dignity and respect.”

More than 80 percent of Americans saw a healthcare professional in the past year, and research estimates that patients visited doctors' offices, outpatient clinics and emergency rooms 1.2 billion times. Since the odds are we'll all see a healthcare provider at least a few times in our lives, it makes sense to learn how to do it well, whether talking on the phone, in the doctor's office or in a hospital. Think of it this way: Good communication is good medicine.

It's not unusual to leave your doctor's office feeling dissatisfied and even disoriented, says Zackary D. Berger, M.D., Ph.D., an assistant professor in the Division of General Internal Medicine at the Johns Hopkins School of Medicine in Baltimore, Md. He's also the author of the new book Talking to Your Doctor: A Patient's Guide to Communication in the Exam Room and Beyond (Rowman & Littlefield, 2013).

“It's easy to blame the doctor, but flaws exist in the healthcare system and doctors are shaped by this,” he says. “And although it's easy to just say, ‘Choose another doctor,’ a lot of patients can't. Instead, with forethought and planning, the conversation can emanate from a place of respect and empowerment. Yes, you can train yourself and your doctor.”

In fact, a study in the April 2013 issue of the Annals of Internal Medicine reported that attention to patient needs and circumstances when planning care is associated with improved healthcare outcomes.

Changing behaviors still seems like a tall order, given that the average doctor visit is 15 minutes or less. “The time in the room where the visit takes place—like the interior of a time machine—can expand or contract according to the attention that doctor and patient devote to each other,” says Berger. “It's not about the length of the visit, but the quality. The solution to the problem of communication is to learn the dance that doctor and patient must perform together so communication leads to a healthy conversation.”

And there's no time like the present, with healthcare undergoing major upheaval. “There's even more pressure on patients and physicians to exchange information efficiently now than ever before,” says Peter R. Kowey, M.D., of the Lankenau Heart Group in Wynnewood, Pa.

Trying to see as many patients as possible in one day often cuts a doctor's visit shorter than both the patient and doctor would like, resulting in the dreaded, “Oh, by the way, doctor, I meant to ask…”

“At the end of every visit, I make time to say, ‘What other questions can I answer for you?’” says Kowey. As a result, he says, patients rarely need to call the office later because they didn't understand their diagnosis or treatment.

In his specialty, he says, the reason many patients see him for a second opinion is that they didn't understand the first one. “They're not looking for another answer—they're looking for any answer,” he says. “Incomplete information and unanswered questions may lead to bad consequences. Something that's pretty trivial can really turn into a mountain if not handled correctly at the outset. I've had patients tell me that they didn't have adequate information passed along to them about something serious. It's not an uncommon problem.”

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IF YOU'RE SHY

So you want to go forth and be an empowered patient, but that's easier said than done. Not every patient can just ramp up his or her confidence immediately, Berger says. It's a process.

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Dr. Kowey's tips on how to get the most out of your doctor's visit
  • Pick your doctor carefully: Rely on people you trust for help.
  • Read up on your condition to get background information, then ask your doctor for clarification if you don't understand something.
  • Bring written questions and write down your doctor's answers. Relying on memory will be problematic.
  • If you don't understand something, keep asking questions. Don't accept medical jargon you don't understand.
  • Ask for specific numbers or percentages: How many times I have to take this medicine and how much do I take?
  • There are always options: Ask your doctor to tell you what they are.
  • Consider getting a second opinion, which is important for new or very risky procedures.
  • Don't be bashful: No topic is taboo.
  • Don't lie or exaggerate: You'll never get what you need if your doctor is in the dark.

“Start with being sensitive about how you communicate and be mindful during your visit—be in the moment,” he says. “In this and any relationship you want to listen and be listened to, and to share in every decision.”

Not every patient is comfortable participating in the technical aspects of a healthcare decision, he says, but you can open up about what's bothering you and your preferences for healthcare so your doctor can make those decisions based upon his or her knowledge.

“Try to frame [your] symptoms as a story or narrative as you share your experiences,” suggests Berger. Stories help the provider understand the patient's experiences.

In the process, sometimes you have to talk about what makes you nervous, embarrassed or just plain grossed out. “Using professional and specific language can make a difference in how others perceive your problems,” he says. You don't have to spout like a medical encyclopedia, but beating around the bush about what's “down there” slows things down and makes the doctor guess when you discuss bodily functions or sex. “This is the chance to get answers and to remember that you're not the first human being to have these questions,” Berger says.

By the end of the visit, there should be a plan made between you and your doctor regarding the communication you should have during the course of the year, Berger says, proposing these questions, if applicable, to your doctor for follow-up:

  • Can I communicate with you by e-mail, Skype or social media?
  • If you prefer I communicate by phone, whom should I expect to speak to when I call the office?
  • How soon should I expect a return call?
  • What are the situations when I should reasonably expect to speak directly to you?
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TOOLS YOU CAN USE

Maybe you have a daily “to-do” list in your life, and making a similar checklist before you see your doctor can help keep your conversation and ultimately your health on track. You may also need to step out of your comfort zone and be persistent—no, you're not “bothering” the doctor. He or she is there to help. Speaking up is the most important thing you can do when visiting your doctor (see How to speak up, at right).

You can improve your communication skills with the PACE Guide sheet created by Donald J. Cegala, Ph.D., Professor of Communication and Family Medicine at Ohio State University. You can download the document at www.heart.org/visits and use it to write down your feelings, questions and concerns before your doctor visit.

PACE stands for:

P = Provide information about how you feel.

A = Ask questions if you don't have enough information.

C = Clarify what you hear.

E = Express any concerns about your treatments.

A day or two before your visit, review the PACE sheet and fill in the answers. Know the reason for your appointment and be ready to describe symptoms and concerns and ask questions about your condition, tests, procedures and medicines, as well as what you hope can be done to treat you. Solidify your hopes and expectations for your visit. Take the PACE sheet with you to show your doctor. Bring paper and a pen so you and your doctor can write down the answers to your questions, or bring a tape recorder and ask your doctor if it's okay to tape your visit. Don't be afraid to write things down or ask your doctor to spell medical words or draw pictures for you.

During the visit, once your doctor has answered any questions you have, clarify what you hear:

  • If you don't understand something, ask the doctor to explain.
  • Repeat the doctor's instructions using your own words.
  • At the end of the visit, review what you and the doctor agreed upon.

Be yourself, but be comfortable, relaxed, honest, inquisitive and straightforward. Still feeling timid about the whole thing? Bring a friend or relative to help ask questions for you and even write down the answers—then you can focus intently on what your doctor is saying. Don't forget to bring a list of your medications and supplements—since both can interact with each other—and double-check supplement dosages.

If you see a doctor who's a reasonably good communicator, he or she will innately anticipate many questions, Kowey says. He personally likes to sit down, indicating that he's not rushing to the next appointment. Then he starts with some banter and non-medical questions. Follow-up visits evolve and mature in context, as does the doctor-patient relationship. Remember that your visit isn't a one-time event, but a prelude to achieving long-term health goals.

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How to speak up

Whether you're at your doctor's office, in the hospital or on the phone, it's important to speak up and say what's on your mind. Talking openly about your concerns will help ease your fears and help your doctor understand you better.

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Ask questions

You probably have a lot of questions about your health—symptoms, tests, procedures, medicines and treatments. So you have to ask! Remember that when it comes to your health, there are no dumb questions. All of them are important.

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Give information

Doctors may know a lot about medicine, but they can't know a lot about you unless you tell them. You need to tell your doctor the symptoms or problems you are having, how medicines are affecting you or if you're taking your medicines as prescribed. Don't be embarrassed—be honest. Without this information, your doctor may be unable to provide you with the best care or treatment.

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Come back to your concerns

If you don't think your doctor has given you the answer you're looking for, speak up! Sometimes asking questions can lead to a different topic—if this happens, bring the conversation back to what's bothering you. Don't be afraid to repeat questions if you're not getting the answers you need.

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Tell your doctor about your beliefs

Everyone has different beliefs about their health, which can come from religion, family, culture or even what we see and hear on TV, radio and the Internet. These beliefs affect your health habits, so your doctors need to know what you believe. This will help them understand you better and provide you with correct information.

“It's essential to pick someone you like and stick with [him or her], and try to stay within one healthcare system to coordinate care,” Kowey says. “That helps tremendously to keep things from falling through the cracks.”

Communicating effectively with your doctor may be hard at first, but once you get used to it you may be surprised at how much information you can get from your doctor's visit. “You just have to trust yourself,” says Kelly. “Be your own advocate. Ask those tough questions even if it's hard for you.”

© 2014 by the American Heart Association

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