What Doctors Don't Tell You (But Should)
A top internist shares the insider info you need to get the best medical care—and the respect you deserve.
Getty ImagesHave you ever wondered what your doctor was thinking as you sat in your paper robe on the exam table? Or worried that you're not taking full advantage of those precious few minutes you have with her? As a doctor myself (I'm a general internist in New York City), I'm fascinated by the relationship between physicians and patients, and I am convinced that a deeper understanding of what's going on beneath the surface can benefit all parties involved. Here's what doctors like me would love you to know so you can get the most out of your time with us—and enjoy the best health possible.
1. Pick two or three top goals for your visit
Patients often come to my office with a list of 30 things they want to talk about, but it's just not realistic to cover everything under the sun in one visit. And I'm guilty, too: I may want to cram in every vaccination, blood test and pearl of dietary advice I can, while my patient has something else entirely on her mind. Making a list in advance is always helpful, but be sure to prioritize. You might even make clear at the beginning of the visit: "There are two things I want to make sure we talk about today."
On the flip side, do allow time for the doctor to address her top concerns. You can even ask her what they are. She might have something surprising to discuss—like a concerning blood test result, or a new medical recommendation for women your age—that's worth listening to.
2. Don't blow off yearly checkups
You might have read about the recent study showing that physicals don't yield head-over-heels benefits—patients who dutifully get them do not seem to be healthier or live longer. (They do, however, come out with more diagnoses and more possibly harmful tests—see No. 3.) Still, I feel that touching base in an annual or biennial visit is probably the most important way that doctors can keep tabs on how you are doing. When your physician takes a complete medical history, this is her chance to pick up subtle clues about impending illness—like changes in your sleep, energy levels or bowel habits—even if you may feel perfectly well.
The relationship you build with your doctor through repeated visits becomes especially helpful if and when illness does arrive. Carmen Martinez (not her real name) has been my patient for more than 15 years. One day, she came to my office saying she felt slower than usual. She answered "no" to the standard questions about chest pain and shortness of breath. Her physical exam wasn't much different from what it normally was. But she was insistent about the slowness.
This wasn't like the Ms. Martinez that I knew. I decided to order a chest X-ray—and it turned out that she was in the early stages of a heart condition that needed immediate attention. Her presentation hadn't fit the textbook, but I think we were able to catch this disease because we knew each other: She knew me well enough to press a symptom that might seem inconsequential, and I knew her well enough to sense that something was clearly off.
Next Page: More testing isn't always better [ pagebreak ]
Corbis3. More testing isn't always better
So many patients come to my office and ask to have "everything done"—more tests, more scans, more blood work. But too many tests can often do more harm than good. One of my patients recently went to an emergency room because she was experiencing abdominal pain. She was given a CT scan to figure out the cause. The scan found nothing in her stomach (it turned out she had gas pains), but did uncover an "incidental" nodule in the adrenal gland. Incidental nodules are benign 99 percent of the time—yet protocol requires three follow-up CT scans over the next two years to ensure the nodule isn't growing. It is estimated that radiation from unnecessary CT scans may cause up to 3 million cases of cancer in the United States over the next 20 to 30 years. Think about that! Now my patient has to undergo the risks of more radiation—which could actually cause her to develop a disease—even though it's exceedingly unlikely that we'll find anything serious.
Patients often become frustrated when doctors don't order every test in the book for them. But try to think about it in terms of being spared the risks of unnecessary procedures, not to mention the added cost to you. Of course, some tests will indeed be necessary, but your doctor should be able to explain clearly the rationale for every one. (Visit choosing wisely.org for a list of tests that are overused and should be questioned if they are offered to you.)
4. If something feels off during your appointment, don't ignore it
When a doctor and patient sit together in a room, they are not simply trading facts. How we think and process information is affected by emotions at every level. If you notice palpable feelings arising in yourself during a visit—frustration, fear, anger or sadness—it's a sign that something important is going on and needs to be addressed. You can stop the consultation and say something like, "I'm having very strong feelings about what we have just touched upon. Could we take a minute to talk about it?"
Though we expect physicians to be objective, they're people, too, of course. When I researched my new book, What Doctors Feel, I learned that their emotions affect the care they give. Doctors who have been burned by a lawsuit might be unfairly wary of patients who ask a lot of questions, for instance. Plain fatigue might make them miss details. If you notice something in your doctor's behavior that doesn't seem right—she appears distracted, or is being short with you—it's OK to say, "I'm not so comfortable with how things are going." Don't hesitate to switch doctors if yours is not addressing your needs.
5. No question is ever unworthy
If you get a new diagnosis, medication or referral from your doctor, or have a test being ordered, make sure you understand the what, why and how before you walk out the door. You can take notes during the visit, have someone with you to do it or ask your doctor to jot details down for you. Often, a diagnosis is not clear. But the doctor should be able to explain the possibilities and what will happen next, even if it's just watching and waiting.
If you still don't understand exactly what he's talking about, ask to speak with a nurse to review the information in more detail. One of my patients knocked on my door an hour after his visit, confused about a prescription. It turned out that I'd accidentally handed him a prescription that should have gone to the previous patient! His astute double-checking averted a medical error.
Next Page: Don't be afraid to follow up after a visit [ pagebreak ]
Getty Images6. Don't be afraid to follow up after a visit
Of course, issues can arise after you leave the doctor's office. So ask before leaving the room: "What's the best way to get in touch if I have any further questions?" (My own preference is the telephone, to avoid some of the privacy issues encountered on the Internet.) Just remember, most doctors aren't allotted time in their day to handle phone calls and e-mails; they may work through their lunch hour or stay late to take care of them. So it's helpful to consolidate your questions into one call or e-mail, and to state whether the problem is urgent or not. Understand that it may take a few days for the doctor to get back in touch. If you have a lot of questions, then it's better to schedule another visit dedicated to discussing them. If your doctor isn't the type to answer follow-up queries at all, though, it's time to find a new one. Everyone is busy, but a good doctor should be able to offer an option for continuing the conversation.
7. Remember: You and your doctor are life partners
Whenever a patient shares a story with a doctor, both of you become entwined in a relationship. Relationships may ebb and flow, but a good one is there for the long haul. Your medical needs will likely vary over time, and a good doctor-patient bond can adapt to this. Ms. Martinez and I often joke that we've outlasted most of our friends' marriages, not to mention presidential administrations, health care reforms, hurricanes and fashion trends. The political winds may shift every four years, but luckily for both of us, our relationship does not.
Danielle Ofri, MD, is an associate professor of medicine at New York University School of Medicine; her fourth book, What Doctors Feel: How Emotions Affect the Practice of Medicine, comes out next month.