When I was in elementary school, we had Show & Tell Days. Betsy (future veterinarian) showed us her hamster and told us what he liked to eat. Joey (future geologist) showed us a lunk of quartz he'd found and explained how it was formed. Jeannie (aspiring art teacher, future author) showed a potholder she'd made and gave a fascinating and heartfelt lecture on how to weave a potholder. Paul (aspiring magician, future attorney) showed us a card trick he'd learned.
As grownups, when we go to the doctor “presenting” (as the docs would say) with a symptom, we play an adult version of Show & Tell. If we have a rash or a bruise, we can easily show the doctor what’s wrong. But often the problem is invisible, even to x-rays and blood tests, and sometimes a rash is just the tip of the medical iceberg. In that case, the Tell part of our presentation is extremely important. Our doctors are not mind-readers, each patient is unique, and graduating from medical school doesn’t automatically make a person perfect. As far as I know, there are no sensitivity training courses or even bedside manner courses in medical school. So we patients are trying to connect and communicate with a scientist, not a clairvoyant.
Communicating with doctors is a special interest of mine because of the extremely frustrating experiences I had while seeking a diagnosis and treatment for my chronic pain. It seemed to me then that my vaunted communication skills were completely ineffective when I was standing or sitting before a scientist in a white coat. I was told that my pain was all in my head; that my pain was typical of middle-aged women with emotional problems; one guy even said, “What do you expect at your age?” and “I can’t spend any more time with you now; I have sick people to take care of.”
I eventually realized that many of these docs saw me as someone seeking pain killers and/or disability income, not a diagnosis and cure. They distrusted me because I had “inappropriate” knowledge: how to pronounce medical terms, the correct names for various parts of my body; and the names of medications commonly used to treat symptoms like mine. I tried different approaches, different communication styles, as I went from one doctor to the next (which is called “doctor shopping”), but the results were always the same. I had no diagnosis, no cure, and no treatment after 6 months of consultations and tests.
Close to the point of giving up entirely and sinking further into despair, I made two more appointment: one with my counselor, the other with an internist who’d been recommended by a local nurse. My counselor assured me the pain was not all in my head (some maybe, but not all). The internist turned out to be a treasure, willing to listen to my whole sad story, asking me questions, and somehow able to believe my tale of woe. If Dr. H. held any opinions about my sanity, he kept them to himself. He diagnosed fibromyalgia and myofascial pain syndrome, contradicted other doctors who’d told me I exercise too much, and prescribed medications to help me sleep and to manage the pain. He didn’t cure me, but he offered a treatment plan that worked well enough to improve my daily functioning and give me hope for the future. And hope is a very powerful medicine.
During that long medical ordeal, I learned a few things about successful communication with a doctor. Solely for sake of simplicity, I will refer to the doctor as “he” (and at any rate, I think I may be the only feminist in the state of Tennessee).
1. Tell him why you’re there, as simply as possible and without extraneous information that may be important to you but probably has no value to the doc. “After lunch at Wendy’s the other day, when I was driving down Main Street on my way to pick up a ceiling fan at Lowe’s, I had to turn onto First Avenue and stop the car because I felt like I was going to vomit…” would be better said as, “On Tuesday afternoon, I regurgitated some chili about 30 minutes after eating it, and since then I haven’t been able to keep any food down.” When I met Dr. H., I wanted to tell him about every little physical and emotional hurt I’d experienced for the past 6 months, including derisive commentary on the medical professionals I’d dealt with. That approach probably would have set me up for another “neurotic middle aged woman” label. So I kept it short and pithy.
2. Avoid self-diagnosis. If your research has led you to what seems like a clear diagnosis and you start out by saying, “I have a band erosion,” (something even the doctor can’t definitively diagnose without doing an upper endoscopy), you will erode your credibility as well as your band. Frame it this way instead: “For the past week, I’ve been having these symptoms [list them] that make me worry that I have a band erosion.”
3. One thing at a time. When you make an appointment when your list of concerns has more than 3 items on it, tell the scheduler that you might need extra time with the doc because you have a lot of concerns to address. Repeat this at the start of your conversation with the doc. Then do your best to present each concern as a stand-alone issue, starting with the one that bothers or worries you the most. It’s up to the doc, not you, to make connections between your different symptoms. If you absolutely must point out a connection that’s obvious to you, frame it this way, “I’m wondering if the pain at my port site could be related to my difficulty swallowing.”
4. Show & tell, using clear, descriptive language. “My stomach hurts” is not clear enough. Pointing at your port site (which is on your abdomen, not your stomach) and saying, “It feels like someone is pressing a hot poker into my right side,” is better. Be sure to tell the doc how long you’ve had the symptom, if they’re constant or intermittent, if anything (time of day, body position, medication, etc.) makes them better or worse, and if you can reproduce the symptom. For example, can you trigger the abdominal pain by bending at forward at the waist, or is does it occur at random?
5. Just the facts, ma’am. Keep it drama-free, don’t exaggerate, don’t embellish. I have a habit of hyperbolic (wildly exaggerated) expressions. It entertains me, sometimes it entertains others, it’s my personal style, but it’s wasted on a scientist who yearns for precision. So I have to rein myself in, at least at the start of a relationship with a doctor, and say, “Since I’ve been taking this medicine, my mouth is always dry,” instead of saying, “My mouth feels like the 101st field artillery just marched through it.” When a symptom is worrying you, it’s tempting to verbally paint it in vivid colors, but if you use that same extreme style for everything that happens to you, you may end up as the little boy who cried wolf so much, no one paid any attention when the wolf finally ate him.
6. Ask for feedback. If your doc’s response to your show and tell is unsatisfactory because it seems that he’s not taking you seriously enough, or he’s misunderstanding you, or he’s in too much of a hurry to give you the attention you need, don’t sulk in silence. Speak up now. Remember, your doc is not perfect, he’s probably very busy, and he may be distracted by the fight he had with his teenaged son, or his worry about a patient he just admitted to the hospital. Bring his attention back to you by saying, “Have I described everything clearly enough?” or “I feel like I haven’t explained this very well,” or “What are your thoughts about this?” or “What is the next step in taking care of this problem?” or even, “You seem in a hurry today. Would it be possible for me to come back tomorrow (or whenever) to discuss my problem(s) in more depth?”
7. Establish a timetable. If the doc doesn’t say, “I want to see you again in a week (or whenever),” or “We’ll get you in for an upper GI study this week,” or “Call me if you’re not feeling better by Wednesday (or whenever),” ask the doc to establish a timetable, keeping in mind that he’s probably not the one who manages his appointment calendar or schedules medical tests.