Charting Your Course : Seminar III - Getting the Signals Straight : Communication With Health Care Providers

Effective communication with your health care providers helps you understand your disease and treatments, lessening some of the anxiety you may feel.

People often don't understand or remember important parts of conversations with their doctors. These techniques suggested by Lawrence Gelb in "Navigating Managed Care" [ www.carecounsel.com ] may help:

Ask a family member or friend to go with you	Taking along someone with whom you are comfortable can make the visit less stressful and can help you remember what the doctor says. The person who accompanies you should have these qualities: ability to give emotional support capacity to listen and remember accurately skill to think objectively
Take notes during the visit	Take notes carefully so they'll make sense to you when you get home. Ask your doctor to repeat something if you weren't able to get it all down on paper. It might be best if the person who accompanies you takes notes, leaving you free to concentrate on what your doctor says.
Visualize what is being explained to you	Ask your doctor to show you an illustration that will help you understand where your cancer is, how tests will be performed, and how your cancer will be treated. If you can take a copy of the illustration home, it will be easier to explain things to your family.
Ask for explanations in terms that are familiar to you	It's only once you understand what's being said that you'll be an effective partner in your treatment.
Ask how you can learn more	Your doctor can refer you to a pamphlet, book, videotape, or other resource to help you understand the procedure or treatment that is being explained.
Rephrase your question and/or the doctor's answer	If you don't understand the doctor's answer, ask the question in a different way, or ask the doctor to explain the answer in a different way.
Verbalize what you heard	Repeat to the doctor what you thought he or she said. That gives the doctor feedback on what you understand and provides an opportunity to clear up any communication problems.
Take a tape recorder with you	Ask in advance if the doctor would mind your recording the session, explaining that it would help you understand and follow the advice given. It will allow you to be more relaxed during your appointment, since it will free you from note-taking. Nevertheless, give your full attention to the doctor's explanations, asking questions when necessary.
Remember that doctors are human	Doctors see many patients during the course of a week. It can be difficult for them to remember all the details of a specific case if the medical documents are not available. Doctors may not be able answer particular questions because there may not be clear answers.

Making the Most of Your Medical Visit

This is the era of the incredible shrinking office visit. Under managed care, physicians are pressured to see more patients per session, and, as a result, are able to sped less time with each patient. Those minutes are likely to be trimmed not from the physical examination but from the time spent discussing our symptoms and concerns. Thus, not only doctors, but patients as well, are required to be more efficient in using the precious time allotted. No longer do we have the luxury of settling in and having a leisurely chat with our physician; we must approach each visit as we would a business meeting. This doesn't mean that the visit has to be briskly impersonal, but that you make the best use of your time together. The following suggestions may help:

Come prepared - Most health plans required patients to bring an insurance card and/or a co-payment to the visit. If you are seeing a specialist or having a lab test, you may need a referral from your primary care clinician. If your plan allows to schedule a mammogram or other screening test on your own, you may want to do so in advance of your visit, so that you can discuss the results during your appointment. Review your plan's patient information materials for details.

Do some homework - If you are managing a chronic condition, such as diabetes or arthritis, you may have read or heard about new approaches to treatment. If you would like to review your options, bring any information you would like to discuss. Although a newspaper clipping or magazine article may be adequate, tracking down the original source, such as a medical journal article, is even better. If your doctor has the same information you do, the discussion will be more efficient. If you are nearing menopause, the options for symptom relief and risk reduction are so many and varied, it will help for you to read as much as possible about the topic in advance. That way, you can have an informed discussion with your physician rather than requiring him or her to conduct a tutorial.

Make up a list of questions - Of course, it's important to anticipate all the questions that may arise in the course of a physical exam. However, there are likely to be a number of issues you've been meaning to discuss for some time. Write those down, then go over the list and order it from most important to least important. Although it may be natural to "warm up" with small talk, it's important to get your most pressing concerns on the table early, while the doctor has adequate time to discuss them. Pose you most urgent questions first, then go on to as many others as time allows.

Provide your doctor with written information - If you are seeing a doctor for the first time, a written summary of your state of health can not only save time, but may also reveal some areas to explore in greater detail during your interview. You should include your medical records, a family history, an itemization of major illnesses, a list of medications you're taking and those that have provoked allergic reactions, and a diary detailing the timing and severity of any current troublesome symptoms.

Be forthcoming about your concerns - The physical exam isn't a test of your doctor's detective skills. If there are changes that have you concerned, such as a new mole or a thickening in your breast, don't wait for your physician to discover them, bring them to his or her attention. Don't be shy about sharing your fears of illness; your doctor can help put your risk for disease in a realistic perspective.

Share your anxieties with your doctor - In any relationship, honesty is usually the best policy. The doctor/patient relationship is no exception. Let your doctor know if anything about the examination or office visit is uncomfortable or painful, either physically or emotionally. For example, some women who have been physically or sexually abused may find pelvic exams painful or intolerable. The doctor should be able to do an examination that isn't distressful.

Discuss your expectations - If you have a medical condition that required further treatment, you need to tell your doctors what you expect them to do for you. In return, your physicians should let you know the probable course of your disorder, the course of treatment, and when your expectations may either fall short of or may exceed your attainable goals.

Double-check your instructions - Before you leave the office, be sure that you understand follow-up direction-for example, when you should change a dressing, how you should do a recommended exercise, when and for how long you should take medication, and where you should go for further procedures or tests. Even if your doctor has gone on to the next patient while you are getting dressed, go over anything that is unclear with the nurse or other staff.

If you're not satisfied, let the right people know - If you and your doctor agree that there just isn't enough time to cover all your medical issues, let your insurer know. The health-care system is ultimately consumer-driven; only customer revolt will effect changes.

From the Harvard Women's Health Watch, May 1999

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This content is derived from the "Charting Your Course Seminars: A Whole Person Approach To Living With Cancer", provided by Norris Cotton Cancer Center.