This guest post was written by Vicki Whiting, Ph.D., MBA is a Professor of Management at Westminster College, and an Award-Winning Author of the health care advocacy book, “In Pain We Trust.”
Doctors interrupt patients 18 seconds into an office visit, on average. Given this fact, patients who seek to maximize their healthcare must learn how to speak so that doctors will listen. There are three communication skills that, when applied to a doctor’s visit, can increase odds that your physician will hear, and help solve the problem.
1st – Prepare what you will say.
2nd – Know what you would like to achieve.
3rd – Formulate collaborative questions.
1) Prepare:The first step in effective communication is to prepare your message. Successful preparation for a doctor visit requires identification your primary health concern, symptoms relevant to this concern, and the length / frequency / intensity of each symptom. Stick to the facts, keep focused on what you believe to be relevant data, and keep your explanation short.
A friend called this morning. Her daughter has suffered from abdominal pain for four months and has begun to vomit after each meal. As my friend prepared for an appointment with a new specialist, she called to ask my advice.I got an earful of physical details, ailments, concerns about her daughter’s future, and conjectures about an injury five months ago that might be related to her daughter’s problems.
After two minutes I stopped my friend. I reminded her that her doctor would likely stop listening after 18 seconds. What did she want her doctor to know that could be heard in 18 seconds? After a bit of coaching she focused on the increase in her daughter’s focal pain, the fact that a diagnosis of SMA (Superior Mesenteric Artery Syndrome) was made, but was not being treated, and that her daughter has thrown up after each meal since a feeding tube was removed after a recent hospital stay.
Once the Mom’s message was stripped of dramatic details, non-related facts, and instead focused on relevant, actual elements of her daughter’s symptoms and medical history, chances that the doctor would listen to issues key to her daughter’s health greatly increased.
2) Communicate with purpose: Complex health concerns are solved in increments. If you have an earache, diagnosis and treatment is straightforward. However,appointments related to complex and chronic health issuesmake the desired outcome ambiguous for both the patient and the physician. If you don’t know what you want to achieve from the doctor visit, it’s unlikely that you will be content with outcome of the visit.
Since SMA is not cured in one doctor visit, my friend needed to think about a realistic outcome for the doctor’s appointment. “I want to understand the standard protocol for fixing SMA, and what plan the doctor recommends to fix my daughter’s SMA.” With this focus, my friend can leverage the doctor’s expertise, and start down a path of wellness for her daughter.
3) Prepare questions. To maximize the 14 – 16 minutes a primary doctor spends during an appointment (less for specialists) prepare questions you would like to have answered. If questions occur to you during the appointment, add these to your list. Some doctors are frustrated that patients spend time researching symptoms, medicines, and treatments on-line prior to an appointment. Given the amount of unreliable data available on-line, this is understandable. The key to being a good patient questioner is to base your questions on valid, reliable data, and your own symptoms and responses to treatment. The National Institute of Health is a great place to understand your medical condition, and what questions you might ask.
It is also critical that you have listened to your doctor throughout the appointment. Use questions to fill in gaps that might not have been addressed during the exam. Let’s go back to my friend and her daughter. The Mom wanted to ask the doctor if surgery would fix her daughter. I cautioned against asking this question. While mentioned as a cure for SMA on some websites, this is not a standard approach to resolving SMA. Also, based on information shared during the appointment, this question might not be relevant.
Finally, avoid questions that begin with “Why?” Why questions invite defensiveness. Why is my daughter sick? Why didn’t they fix her at the hospital? Instead, ask collaborative questions. What do you recommend?What would you do if you were in my shoes? Do I understand that you want me to…? These questions draw on the doctor’s expertise, invite thoughtful response, and focus on problem resolution.
To maximize time spent with your doctor, focus on the portion of the physician – patient interaction that you have control over – how you speak to your physician. If you prepare for the appointment, focus on what you would like to achieve from the office visit, and formulate meaningful, collaborative questions, you’ll help yourself and your doctor create positive health care outcomes.
Dr. Whiting consults for health care organizations and providers across the United States on leadership, communication, and management issues. Contact: @docwhiting vickiwhiting.com, or vwhiting@westminstercollege.edu
Mind The Gap 
These are all excellent recommendations. Personal experience tells me that individuals should be prepared IN ADVANCE of doctors visits. Thus maximizing the potential for viable communication from both parties.
Thanks, Judith. You are right, preparation is key. I hope we can help more patients realize this, and, perhaps more importantly, to help health care providers to learn how to train their patients to prepare for appointments.
I have had several surgeries, and I started writing my questions down to make sure that I’m not asking the same question in different ways.I’m not shy about bringing my notes with me, because before I started doing this, sometimes I would forget an important question, or think of one later. I have even done this at my visits with my internist when I have several things going on. My doctors seem to not mind at all that I have written questions, and have helped me check them off, have even just looked at the list with me. I spend some reflective time before my appointments to make sure I think of everything that concerns me. It’s helped me a lot to stay focused on my issues, and I’ve left my appointments with my primary doctor, my gastroenterologist, allergist, two different orthopedists, oral surgeon, ear nose and throat doctor, anesthesiologist, dermatologist, general surgeon and vascular doctor generally feeling adequately informed and satisfied with the appointment. Out of all those doctors, only two seemed rushed and were somewhat abrupt, one was the anesthesiologist, and the other was the vascular doctor, so I think that overall I’ve had excellent experiences. Several of my doctors have responded to my questions by actually teaching me about the issue, even drawing pictures. I think it’s really important to prepare for an appointment. I used to rely on the doctor to lead the appointment, and just ask random questions as they popped into my head. As I’ve started to be more proactive, it’s taught me to learn so much more about what is going on with my symptoms. And after all, how can doctors know what you might wonder about, if you don’t thoughtfully figure it out yourself. I think your article makes great points for helping people learn how to do this.
Joyce, I am glad to hear that your doctors are open to your coming to appointments prepared with questions. Indeed, I think that most doctors are – especially if the questions are as well thought out as it appears yours are. Sounds like you have had an unfortunate number of doctors with which to judge the effectiveness of this approach. Here’s is to continues health and healthy interactions with providers.
This is a really good post, I shall use it when encouraging clients at antenatal classes (in the UK) to think about decision making in response to medical scenarios.
Do you have any advice on how to have meaningful discussions in acute situations? For example, I think of induction of labour as a chronic situation, with plenty of time, even when there is some concern about mother’s or baby’s health, for discussions such as the one above. In contrast, what about when a woman is in labour and her midwife or doctor is concerned about her baby’s heartbeat?
Rachel, Thanks for your kind support for these ideas. Acute situations are difficult, particularly when a newborn’s life hangs in the balance. Research suggests that a gentle touch can do more good to create a listening environment than can any words. This non-verbal communication allows the patient to know that the doctor or midwife is present. A hand on the shoulder, direct eye contact, coupled with forthright information about critical symptoms and the associated health concerns will help to maintain an environment of open communication and free up parties to focus on the best course of action.
Any advice on trying to get clinicians to understand a sense of urgency because of other life events. For a 28 or 38 or 48 year old spending two or three years going back and forth for further bits if diagnosis or to tweak medication is frustrating and annoying and debilitating in the extreme – but for an 18 year old it means the difference between going to university when your mates and peers go, so that you fit in socially when you are there and you aren’t left behind at home – or going later after two years of miserable isolated delay when you don’t fit in with the peer group – or even not going at all because financial resources have dwindled during the delay…. It all seems so very very hard on her!