How NOT to Talk to Your Doctor

In order to understand how to best talk with your doctor (or psychiatrist, psychiatric mental health nurse practitioner, or other medical provider), you need to know one very important concept: Your doctor wants to help you!

However, as healthcare costs continue to rise, there is a push for doctors to see as many patients as they can. This can frustrate even the best doctors, and happens more often than not. Also, doctors are human beings and despite our expectations, they tend to dislike displays of unpleasant emotions, disorganized patients or those that make them feel as if they must “fix” everything, “or else”.

As a result, it is not uncommon for doctors to be limited in the time that they can spend with you. Because of this, we often leave our appointments feeling unheard or, occasionally, unwelcome. We end up putting off additional appointments, minimizing our symptoms or simply not presenting well when talking to our doctor.

Well-meaning patients can end up making things worse, despite our best intentions. Our expectations and frustrations with the healthcare system can end up making us anxious and, as a result, a “poor storyteller” of our problems and symptoms. Sometimes our fears of being judged or being thought of as a “terrible person” or being seen as “weak” or even “difficult” can keep us from sharing important details.

Or, as is often the case, we are simply exhausted by our suffering. We hold things together until our appointment, and then we end up “falling apart” in front of the doctor. Without presenting things in a straightforward and direct manner, we often run into problems getting adequate help for our symptoms.

So WHAT can we do to fix this? As with all things, you can only control the things you can control. We can try to “fix” the system, but this is difficult even in the best of times and would take longer than we want. When we need help from our doctor, the last thing we need is another problem. Since we can’t control the system, we can at least control how we talk about things with our doctor.

What follows, then, is a list of things that you should NOT to do when working with your doctor. Your mileage may vary, however these “rules” have been found to be true over and over again, both by patients and medical professionals.

Whimpering or Whining

When we’re sick and in pain, sometimes our voices take on a whimpering, whining quality. No one likes to listen to whining. If you have children, you know that you’re more apt to ignore the pleas of a whining child than one who makes his requests in a normal conversational tone. Even though we may not realize it, we tend to give less credibility to someone who whines – be it a child or an adult. You may not even be aware that you sound whiney at times. If you have any doubts, ask a family member who will be honest with you. When you talk with your doctor, you want your voice to sound calm and rational.

Stay Away from Exhibiting Behaviors

These are the behaviors that we do to show we are suffering, hurting or in pain. If we’re extremely depressed, we end up being very quiet and withdrawn. If we’re full of panic and anxiety, we tighten our muscles and start breathing rapidly. Those suffering from chronic pain end up rubbing their back, groaning, moaning or walking with a limp. While it is normal and natural to want to do these things while you are suffering, it gives less credibility to your illness.

However, this does not mean that you should hide your symptoms. The goal is to avoid making your doctor sorry that he or she stepped in the room. Overly excessive displays of emotion and pain take the focus away from the conversation and end up hurting you in the long run.

Don’t Over-Do It

Since your symptoms are invisible, it is important to remember that the physician is looking for ways to make the problems real. One of these ways is to ask you how you are feeling on a scale from one to ten: Typically, one being low and ten being the worst thing you have ever experienced. This can be done for depression, anxiety and even chronic pain.

Now, before you think this is a simple question… it is actually a test to bring credibility to your symptoms. Proceed with caution when answering this one. Ten should only be reserved for “can’t breathe, barely alive” types of symptoms. Many people will rate their symptoms above a ten… say, a fifteen. This is a red flag for your doctor because research shows that those who rate their symptoms at ten or above may be exaggerating how they feel.

On the reverse side of things, don’t over-think things. If you choose an answer of, “6.5” or “between a six and a seven,” your doctor may think that you are over-analyzing and may wonder if some of your symptoms are “in your head”.

What we often forget is that using numbers to describe how we are feeling is very useful when talking to a medical professional. Saying that you have been feeling “very sad for a while” is not as effective as saying, “on a scale of one to ten, I’ve been feeling about a 6 for the past two weeks.” Some patients even use an old- fashioned paper calendar to write down their numbers (whether for depression, anxiety, chronic pain, etc.) each day and then bring this in with them to their appointment for “show and tell”. Surprisingly, this is very effective and gives you both credibility and prevents you from not adequately describing how you’ve been feeling.

Crying

We all know that when we are suffering, we tend to become more moody, irritable and emotional. As true as this may be, the more emotional you are when talking with your doctor, the more he or she may label you as “histrionic” and discount your story. You deserve fair treatment, and to ensure this, practice deep breathing so you don’t cry during the office visit.

This can be especially difficult for those suffering from severe depression. If it can’t be helped, then it can’t be helped. However, it does take valuable time away from being able to tell your doctor about your symptoms so that he or she can give you the best type of care. Ask yourself, would you rather walk away with a hand full of Kleenex or a revised prescription that might be of help.

Your Doctor is not Your Best Friend

Even though you are getting to know your doctor quite a lot lately due to how often you see him or her, remember, they are still not your therapist or friend. This also holds true for psychiatrists and psychiatric mental health nurse practitioners. You are paying them to be your “medical professional”.

Worse, you end up putting them in an unrealistic position. They have a job to do, and if you start treating them as your “best friend,” chances are that they will disappoint you and you will end up with a “bad feeling” about the relationship as a result. Your doctor does care about your well being, but they are not in a position to be your “best friend”.

Explaining and Talking Too Much

As it was told to me by one doctor, “When I ask a patient about his or her symptoms, I am not looking for a long story… I want a short, to-the-point answer.” Just like the old show Dragnet, it should be, “just the facts Ma’am, just the facts”. This is where coming in prepared will help.

This also is important in providing documentation. If you walk in to your appointment with a five-page, single-spaced and typewritten description of your symptoms, how they have made you feel and how unfair all of this is, your doctor’s eyes will start to glaze over. Keep it simple and straightforward.

Keep your list just like a resume: It should be no longer than one page. Perhaps filled with single-sentence bullet points listing the important parts. You should assume that whoever reads it will spend on average only about 10-15 seconds on it. Your writing style should reflect, and not challenge, this reality. This can mean the different between walking out of your appointment with nothing changing and the doctor saying, “Hmm… I had no idea your symptoms were still bothering you. Let’s increase your medication.”

Another aspect of this is the “handwritten on the back of a napkin” approach towards documentation. NO ONE wants to be handed a napkin with potentially illegible writing on it. It looks rushed, as if you just made up your list of symptoms on a whim. Your doctor may consider this evidence of disorganization and approach you differently.

Finally, a new trend is for people to keep their list on their smartphones. While convenient, handing your doctor your phone doesn’t help him or her as well as a printed out piece of paper. Chances are they will glance at it and the majority of what you’ve written down won’t end up getting across.

The New Rules

After reading this, you might be asking yourself if there is a list of things that you should do with your doctor. Indeed, there is. It’s a short list, given that many of these items have previously been covered here. Some of the essential highlights to keep in mind are:

• Patients with the most success in working with their doctor tend to be the ones who are more “scientific” about their situation. They keep track of their symptoms, are organized, and are able to provide concrete and specific information without a lot of extra “jibber jabber”.
• Bonus points to those who bring this documentation with them to their appointments to show their doctor, whether this be in the form of a diary or simple markings on a calendar. Be organized, be inquisitive, and above all be honest with how you are feeling.
• Doctors tend to be encouraged when a patient is curious and inquisitive about their condition. This shows that you are taking ownership of your situation and are willing to do whatever it takes to make things better.
• Finally, if you have difficulty remembering what your doctor tells you, take notes. Again, bonus points if you bring your own pad of paper and pencil with you rather than having to ask the doctor to find one for you. This shows, you guessed it, ownership.