Good doctor-patient communication is essential to your health care. Here’s what you need to know
By Wendy Haaf
Communicating clearly with your health-care provider arguably becomes simultaneously more important and more complex after the age of 50. Not only do recommended screening tests for various diseases increase in number, but we’re also more likely to be living with at least one health problem that, while it can’t be cured, requires ongoing management and surveillance. According to a 2015 Statistics Canada presentation based on data from StatCan’s Canadian Community Health Survey, nearly half of respondents aged 51 to 60 were living with at least one “high impact” chronic condition (such as diabetes or arthritis), with roughly 12 per cent reporting two such issues and five per cent saying they had three or more. (The presence of three or more health conditions is referred to as “multimorbidity.”)
While this makes care—and conversations about it—more complicated, “the time available between you and your doctor is not necessarily going to expand,” notes Distinguished University Professor Emeritus Moira Stewart, who works with the Centre for Studies in Family Medicine at Western University in London, ON.
Evidence suggests that a doctor-patient partnership characterized by frank back-and-forth exchanges can improve the patient’s treatment follow-through and contribute to his or her sense of control—itself linked with benefits ranging from higher levels of functioning to better mental health—but not all doctor-patient relationships are partnerships. The “Patient Experience in Canadian Hospitals” survey report, released by the Canadian Institute for Health Information in 2019, found that one in three hospital patients didn’t feel completely informed about their condition, treatment, and medication.
A study published in the journal Health Affairs in May 2016 points to one of the culprits behind this information gap. Researchers who conducted focus groups with 48 patients in five primary-care practices in a suburb of the San Francisco Bay Area found that even educated, affluent patients often avoided asking questions or voicing misgivings about a recommendation for fear of disappointing or displeasing their physician.
But probing to ensure that you understand what a care provider is saying and letting him or her know if you’ll have difficulty following his or her advice are key factors in coming up with a care plan that fits your needs. And since the reason most care providers entered their profession in the first place “is to be able to provide the best quality care they can, they would actually welcome that information,” stresses Tammy Hoefer, the director of patient and public engagement with the BC Patient Safety & Quality Council. (One of the organization’s missions is “empowering people to take control of their own health,” Hoefer says, “because at the end of the day, they’re the only ones that can make the change, whether it’s to take a medication, move forward with a procedure,” or make a shift in lifestyle.)
So how can you overcome a reluctance to come clean with your doctor? And how can you lay the groundwork to do so effectively and efficiently within the time allocated for an appointment?
A Team Effort
A shift in mindset is a good first step. “Remember that this is a team effort,” says Lene Andersen, a Toronto-based patient advocate and author who blogs at theseatedview.com. “Your doctor is a highly specialized expert. And while you should definitely listen to your doctor’s recommendations and have a full discussion about each point, the patient is the person who makes the decision, so it’s his or her life that should inform that decision,” Andersen stresses.
Preparing questions and comments you may have for your doctor in the weeks prior to a visit can help make the most of your time together. This may also help your doctor arrive at a diagnosis or decide on a course of treatment.
“Write down the questions you want to ask,” Hoefer suggests, since otherwise, you’re apt to forget something. Keeping a record of symptoms can also be helpful, Andersen says. While you’re at it, give some thought to how any symptoms or even medications may be causing you distress—for instance, by impairing your ability to do an activity that gives you joy—and make note of that, too. (The BC Patient Safety & Quality Council and its Patient Voices Network have excellent resources that can aid in this process, including a free e-booklet called A Guide to Having Conversations About What Matters; see “Resources” below.) And if you’ve experienced a major change in your life or health, your care provider needs to know about that, as well.
“Thinking about what kind of life you want and what your health goals are seems to me to be some of the most important preparation that an older patient or one with multimorbidity can do,” Stewart says. It’s worth emphasizing that doctors can make incorrect assumptions about your priorities if you don’t give them input to work with. For example, when a group of researchers asked people with chronic kidney disease what was most important to them, the top answer was something much of the medical community had dismissed as insignificant: the intense itching that can accompany the condition.
Closer to your appointment time, “think about what your priorities are,” Stewart says. “There’s a lot the doctor has to do in checking up on this and that and monitoring your various conditions, but the things that are going to be focused on should be those that you’re most interested in—what you’re hoping will be provided for you and your goals.”
Lene Andersen echoes this recommendation. “When I go to see my doctor, I’ll write down my top three priorities,” she says. (This also gives you a printed record that you can keep in a binder or folder for future reference.) “It’s like any committee meeting: if everyone knows what you’re going to be talking about, you’re all more focused,” Andersen says. “And it’s the person who sets the agenda who controls the meeting.” Keep in mind, however, that there might be time to deal with only your most pressing concern in a given session.
It’s a good idea to bring a copy of both this list and—if applicable—your symptom diary to give to your care provider. “Doctors like data,” Andersen says. If you’re seeing a care provider for the first time, a complete list of your medications and a short form of your medical record are huge time savers. “That can cut an hour appointment to half an hour,” Andersen says. (The US National Institute on Aging website features a set of worksheets for tracking medications and discussing health changes with your doctor; see “Resources.”)
When you do go to the doctor, “bring a friend or family member who can take notes,” Andersen suggests, “because appointments can be intense, or you may be nervous or your doctor may be rushed.” A companion “can also subtly remind you of something you forgot,” she adds. Having served in such a capacity for family members, Tammy Hoefer says, “I know it’s been very welcomed by their care providers.”
Alternatively, bring a pad and pen to jot notes yourself, or ask if you can record your meeting. “Some doctors are becoming more comfortable with patients recording during an appointment, using their phone,” Andersen says.
To help ensure you understand what your care provider is saying during the visit, try summarizing and repeating it back in your own words: “So what you’re saying is…,” for example. Asking clarifying questions—for instance, “You say this might cause mild side effects. Can you elaborate?”—is another useful strategy. (The “guide to having conversations” e-booklet noted previously also features a list of questions you can ask when your health-care provider suggests a test or procedure.)
When your physician, nurse practitioner, or other care provider proposes a plan of action, it’s important to speak up if some aspect of it isn’t feasible for you. Perhaps the cost of a medication doesn’t fit your budget. Or perhaps you can’t make alternate arrangements for a person you’re caring for, and consequently, will have difficulty attending weekly physiotherapy sessions. It might even be that you think your partner will resist or resent your changing your style of cooking, or that you’re afraid of a certain treatment because you know someone who suffered serious complications related to it.
Your doctor can put the risks associated with a particular procedure in context or work with you to find an alternate treatment or a way around a given obstacle. Your goals come into play here, too. For instance, perhaps a medication your physician is considering causes drowsiness, which would rule out a cherished activity such as being the driver for your grandkids’ class trips. If you ask how the medication might affect your ability to do something, “then your care provider has the opportunity to say, ‘Let’s go with this other medication because you’ll still have the ability to drive,’” Hoefer says. Other options might be changing the timing or dose.
And it goes without saying that a confrontational approach—“No, I’m not going to do that”—is counterproductive. “Another way,” Stewart says, “would be to say, ‘I need to let you know how complex and problematic this is going to be for me; I can do some things, but some are not so easy for me to do. Do you have any other options that might take that into account?’”
Being able to find common ground in this way yields benefits beyond the obvious. According to Stewart, when a care provider and patient set incremental steps aimed at reaching a larger health goal that’s a top priority for the patient, “patients are really energized,” she says. “They can see that they don’t have to get there tomorrow, but they can see a way of getting to the point where they are able to do whatever it is that they want to do.”
Photo: iStock/SDI Productions.