I’ve been thinking recently about Sir William Osler, the Canadian physician who is considered the “father of modern medicine.” Dr. Osler, who practiced from 1872-1919, said the patient will always tell you the diagnosis, if only you listen.
That “low-tech” approach to medicine is almost a bittersweet memory today, when patients typically spend more time in the waiting room than the exam room. In fact, a new survey of nearly 20,000 physicians nationwide found that a whopping 70 percent of all doctors spend just 10 to 20 minutes with each patient.1
Is it any wonder that patients feel the pressure to quickly spill their symptoms during these drive-by medical appointments? One study found that patients talked for only a minute and a half, on average, during their doctors’ visits.2
That certainly doesn’t give a doctor much time to listen to you—let alone probe for any less-obvious health issues you might have.
Even worse, the researchers noted that “the average patient visiting a doctor in the United States gets 22 seconds for his initial statement, then the doctor takes the lead. This style of communication is probably based on the assumption that patients will mess up the time schedule if allowed to talk as long as they wish to.”
“Mess up the time schedule”? The good Dr. Osler must be rolling over in his grave.
Tell me all your troubles—in 22 seconds or less
The sad fact is, in today’s medical environment, many doctors who truly want to understand a patient’s mind and body simply don’t have the time to engage in much meaningful dialogue during a typical office visit. And that not only leaves patients frustrated, but at greater risk of a wrong diagnosis.
But there are things you can do to get the most out of every doctor’s visit—even if your appointment only lasts as long as it takes to drink a cup of coffee (or two, if you’re lucky).
In this article , I’ll share my comprehensive guide on what you need to know the next time you go to the doctor or hospital. I’ll discuss the medical tests you really need (hint: they’re often not what your doctor suggests). I’ll also divulge the potentially dangerous secrets your doctor may not want you to know about your test results. In addition, I’ll tell you why you should be extra diligent about your physician’s visits if you’re a woman. And finally, I’ll reveal the one month of the year when everyone should avoid the hospital if at all possible.
But overall, the key to a successful doctor’s visit is to actually be able to talk to your physician. So let’s dive right into my list of questions designed to help ensure you’re getting the best diagnosis and treatment from your doctor—no matter how time-strapped he or she may be.
Eight important questions you can (and should) ask your doctor
- How are you? While the focus of your visit should be on your medical concerns, there’s certainly nothing wrong with a little ice breaker. In fact, I encourage it. Asking your doctor how his or her day is going, or even telling a joke, serves as a subtle reminder that you’re more than just another body to be examined (and potentially forgotten) during a doctor’s busy day.
- Will you please look at this list of my concerns? Talking about everything that ails you can be challenging—especially when your doctor is crunched for time. That’s why I recommend you prepare in advance.
Make a list of every symptom or concern you have (I’ve found that using bullet points can be effective). It saves time and reduces the chance of miscommunication, or incomplete communication, when you’re in the exam room.
And if you have a problem that has arisen since your last visit, make sure your list includes that. Don’t accept a new symptom as just another sign of aging.
- May I have a minute alone with you? The key to talking to your doctor is to be honest—and that can include discussing potentially uncomfortable topics like substance abuse, sexuality, or bladder and bowel issues.
But there’s no guarantee your doctor’s visit won’t be interrupted by nurses, interns, or a whole host of other healthcare personnel. So don’t be afraid to ask for privacy to make it easier to raise sensitive topics. Your doctor is a human being too, and may also be more comfortable delving into certain subjects alone with you.
- Can you repeat that, please? If you are unclear about any information regarding your diagnosis or treatment, ask your doctor to go over it again—and make sure to take notes so you can consult them later or share them with others.
You can also bring a family member or close friend to your appointment. A second set of ears is particularly valuable when your doctor is discussing a serious diagnosis or complication, as it’s common for patients to emotionally shut down in these situations.
And make sure you have clear instructions about any medications (and, preferably, dietary supplements) your doctor recommends. You should ask about any and all medication side effects, so you can anticipate whether certain treatments will make you feel worse before they help you feel better (if ever). This is particularly relevant for blood pressure and heart medications—especially statins, which you should not be taking anyway.
- Why do you recommend a certain test, prescription, or procedure? Doctors often want to subject you to unnecessary tests, or are cagey about their results. Do your homework by reading Insiders’ Cures, but also give your doctor a chance to explain his or her reasoning.
- What if I already know I can’t, or won’t, do what you recommend? As I have reported before, doctors may not be aware of the costs of follow-up treatments they prescribe. Or they may suggest onerous exercise routines or drastic diets that can feel impossible to achieve.
Further, as you know from reading Insiders’ Cures, most doctors don’t fully understand nutrition and lifestyle—and tend to repeat politically correct recommendations from public health or crony-capitalist medical organizations.
So ask your doctor to suggest an alternative to a recommendation you can’t afford, or flat out just don’t want to do—for any reason. And if your doctor prescribes a drug, always ask if a generic is available. Generics are not only less expensive, but have also stood the test of time—meaning all of the side effects have been uncovered and evaluated.
- Do you have printed take-home materials or recommended websites? Ask for any information regarding the background and treatment recommendations for your condition(s). Many medical and health-library sources now make such materials available to doctors’ offices.
- Do you have a patient portal or an email address for additional questions? If you run out of time, think of something later, or were simply too uncomfortable to ask about certain subjects, find out if your doctor has an online patient portal or accepts emails from patients. That way you can send your questions privately and securely, and review answers in the convenience and calm of your own home.
Finally, remember your doctor works for you—not the other way around. If you discover he or she won’t answer these questions, or doesn’t appear very interested in hearing what you have to say, I recommend finding another physician.
Because although Dr. Osler is no longer with us, his philosophy of truly listening to his patients lives on. Even in today’s medical pressure cookers, there are still doctors who treat their patients as individuals—rather than putting them into a one-size-fits-all pigeonhole in order to just send them away with the right prescription.
I’m one of those doctors. Make sure your personal physician is too.
[SIDEBAR]
The real war on women’s health
As recently as a quarter century ago, researchers typically never included women in clinical trials—including studies of major chronic diseases.
And yet, women are biologically, metabolically, and medically different from men in key ways (regardless of what politically correct ideologues want us to think). In other words, some treatments or dosages that research shows may be effective for men could actually be ineffective for women.
While working at the National Institutes of Health in the mid-1980s, I tried to put a stop to men-only clinical trials by organizing what eventually became known as the Women’s Health Initiative—a study designed to evaluate major chronic diseases in women. And when I was working at the National Cancer Institute, I made the rounds to recruit researchers and funding from government organizations like the National Heart Institute and the National Aging Institute so we could study holistic health in women.
But it was not just the word “women” that was problematic in the study title—it was also the word “initiative.” After decades of my do-nothing bureaucratic bosses sitting on their hands, it seems I was suddenly showing too much initiative in trying to do the most for women’s health…not to mention making the most of institutional research resources and funding for taxpayers.
Disappointed, I went on to an executive physician position at Walter Reed National Military Medical Center, where showing some real initiative was part of my job description (something not unknown to the military, fortunately).
Eventually, those left behind at the NIH fumbled around and finally went ahead with the Women’s Health Initiative, which has yielded important results that I regularly report about decades later.
Of course, this study should have been done a lot sooner. But sadly, despite my hopes, it wasn’t the end of gender bias in clinical trials.
The more studies change, the more they remain the same
In 1993, Congress finally decided to order the NIH to include women in all clinical trials it funded.
(This was the same year Congress also required the NIH to study natural alternatives to mainstream medical approaches. From my position at Walter Reed, I worked with the new program before they even had a permanent office to host meetings and educational seminars. But since then, the NIH has made an almost complete botch of its “complementary/alternative medicine” research, effectively ensuring that promising natural treatments don’t make it into mainstream medical practice.)
The FDA made its own foray into gender inclusion in 1998, when it ruled that it can turn down a new drug application that doesn’t have study data showing efficacy and safety of the drug in both men and women.
And yet, despite these governmental actions, the majority of studies—even the most recent ones—still include more men than women.
A 2006 survey of research published in nine well-respected medical journals found that only 37% of the study participants were women.3 And a 2015 report cited studies showing that women are underrepresented in research on the two most deadly diseases—cardiovascular disease and cancer.4
But men, before you relax, gender bias works in reverse too. The International Osteoporosis Foundation reports that men suffer one-third of all hip fractures—and a jaw-dropping 37% die within one year after they break a hip.5 But almost all of the research on osteoporosis has been done on women (since mainstream medicine sees osteoporosis, or brittle bones, as a “female condition”).
The sad fact is that it may be up to you to make sure your doctor understands the differences, and the limitations, of recommending “standard” medical treatments (based on men) for women. Above all, don’t be afraid to ask for studies and handouts that are targeted specifically to women.
SOURCES:
1http://www.medscape.com/features/slideshow/compensation/2016/public/overview#page=1
2“Spontaneous talking time at start of consultation in outpatient clinic: cohort study.” BMJ. 2002 Sep 28; 325(7366): 682–683.
3“Adherence to federal guidelines for reporting of sex and race/ethnicity in clinical trials.” J Womens Health (Larchmt). 2006;15(10):1123-31.
4“Twenty years and still counting: including women as participants and studying sex and gender in biomedical research.” BMC Womens Health. 2015 Oct 26;15:94.
5http://share.iofbonehealth.org/WOD/2014/thematic-report/WOD14-Report.pdf