Seniority: The doctor's new partner

The doctor's new partner

Experts say that physicians need to learn better communication skills, and there are ways you can help them.

By RANDOLPH FILLMORE

"Doc, it hurts when I do this" and "Take two aspirin and call me in the morning" were pretty simple messages in the Marcus Welby era.

But these days, doctors are more in a hurry than ever.

Health maintenance organizations want doctors to see as many patients as possible in a short period to make health care more cost-effective. Shorter times make it tougher for doctors and patients to communicate effectively. Adding to the headache is that medicine is more complicated, patients may feel intimidated and doctors may find lay explanations difficult.

Francisco Fernandez, chairman of the Department of Psychiatry and Behavioral Medicine at the University of South Florida, says that patients often complain that their doctors don't hear them.

"If you don't feel you are being heard, don't be afraid to interrupt," Fernandez says. "Tell the doctor that you are frustrated and don't feel you're being listened to."

'Communication partner'

Experts in medicine and communication recommend being a "communication partner" with your doctor for your health care. But such a partnership takes extra effort on both sides of the stethoscope.

"As health care practice becomes increasingly dependent on technology, it becomes more alien to patients," says Marsha Vanderford, formerly a communications professor at the University of South Florida and now the deputy director of the office of communication for the Centers for Disease Control and Prevention's National Center for Environmental Health.

In her recent study on physician communication skills, Vanderford found that health-care providers needed to be interpreters for and allies of patients. This means that doctors need to be better-trained as communicators.

"Most medical schools have incorporated communication training into their curriculum," Vanderford says.

Robert J. Campbell, assistant professor of family medicine at USF, teaches first-year medical students that good communication comes from a partnership between doctors and patients. He says that patients can help communication.

"Bring a list of your problems or questions to your appointment," Campbell says. "Put the most important questions at the top. You may have eight or nine questions, but your doctor may have time to address only two or three. But be prepared for the doctor to spend time discussing some altogether different health issue."

Campbell also recommends taking a list of all your medications with you.

Retired nurse Mickey Lentz agrees with Campbell. Patients need to take charge when it comes to keeping their medications listed accurately in the doctor's office records, she says.

"It so important to keep a list of all your current medications with you at all times," she says. "I keep a list of my medications and a list of my husband's medications in my purse. He keeps his list in his wallet. Your doctor should review your medications at each visit, and you need to make sure your chart is up to date. This is even more important if you need to go to the hospital."

Lentz also recommends making sure that all your doctors know what each other is prescribing. If you suspect that your doctors and specialists don't communicate with each other, make sure they do.

Take notes -- or a friend

It's important to remember what your doctor tells you during an office visit, Campbell says.

A study in the Jan. 13 Archives of Internal Medicine found that patients recall or comprehend as little as half of what physicians tell them during a visit.

To keep this from happening, take another set of eyes and ears to your appointments. Or tape record your talk with the doctor.

"If you have a hearing or vision problem, let your doctor know so he or she will speak more slowly," Campbell says.

"Take notes on what the doctor says, or take along a friend or relative to help you get the information right. If the doctor has recommendations, get them in writing."

Good communication requires that patients be honest when talking about their problems. According to the National Institute on Aging, patients are often reluctant to talk to their doctors about intimate issues, such as sexual problems, depression after the death of someone close, incontinence and memory problems.

Don't withhold information in order to get a good report from the doctor, Fernandez says.

"Doctors and patients should discuss intimate issues," he says. "Sometimes a patient feels anxiety and pulls away from discussing difficult issues. A good doctor can sense this. Patients need to find a doctor who is an ally."

Being comfortable with your doctor is key to understanding your health, and yes, some doctors are better at communicating than others.

A 2002 Northeastern University study concluded that patients spoke up more to their female physicians and were more likely to share information about their health. Patients were also more assertive with female doctors, the study showed.

Fernandez says that physicians practicing in academic settings are often better communicators than those practicing in corporate settings. "The teaching experience seeks to create a physician who is an empathetic listener,' he says.

Finally, good communication with the doctor's staff and the other health-care professionals in the office is as important as your communication with the doctor, Campbell says.

"Learn about the office and its procedures," he says. "Get brochures, find out about the doctor's refill policies, and get after-hours phone numbers."

-- Randolph Fillmore is a freelancer who lives in Tampa.

Ten rules for good communication with your doctor:

1. Choose a doctor you feel you can talk to.

2. Be prepared for your visit: know your medical history, write down questions, write down answers. Know your allergies, make sure the doctor knows them.

3. Bring a relative or friend with you, if necessary.

4. Be honest and forthcoming about your concerns.

5. Get clear directions for medications, exercises, tests, etc. Get things in writing.

6. Take a list of your current medications; better yet, take the bottles.

7. Interrupt if you don't feel you are being heard.

8. Ask for clarification if you don't understand something.

9. Fully understand the side effects of medications.

10. Learn about the doctor's office procedures.

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