Talking to the doctor



Definition

Talking to the doctor is a fundamental requirement for an accurate exchange of information between patient and health care provider. It includes communicating private or potentially sensitive information, and requires a climate of trust. Without trust and accurate information, treatment and healing is difficult at best and impossible at worst.


Purpose

The purpose of talking to a doctor is to exchange information and obtain a cure or relief from pain and suffering. This outcome can only occur in an atmosphere of openness and mutual confidence.


Description

Talking is a basic human mode of communication. Talking to a doctor should be easy, but for many people, this is not the case. Barriers to straightforward communication include inhibition (shyness), fear and guilt. These barriers may be present whether the patient is an adult who can speak for him- or herself or a child or elderly person whose history and symptoms must be described by another family member.


Inhibition

People often hold physicians in high regard. The stated reason for this feeling is a difference in educational level. Doctors have more educational credentials than most people in the general population. This differential tends to make patients self-conscious and hesitant to offer information.

Inhibition is further fueled by the sense of hurry and urgency that many health professionals project. Patients feel uncomfortable when they sense that they are being rushed by their doctor. As a result, they are reluctant to speak freely.


Fear

Apart from vaccinations or routine physical checkups, people in the United States do not ordinarily visit a doctor when they are well. The norm is to make an appointment when something hurts or does not function or feel right. It is natural for people to feel anxious in these circumstances—they are afraid of receiving bad news.


Guilt

Many patients' health complaints are often the direct consequences of their own behavior. Obesity often results from a combination of overeating and inadequate exercise . The leading cause of lung cancer is smoking tobacco. Casual sex can lead to unwanted pregnancies and sexually transmitted diseases. Having to accept responsibility for choices that lead to undesirable consequences is painful. Having to tell a person who is an authority figure as well as a trusted confidant often arouses guilt feelings.


Establishing trust

Trust requires time to develop, but it is also a twoway interaction. People seeking the advice of a doctor may reveal only a portion of their symptoms at first. While it is the doctor's task to elicit relevant information, the patient who is answering the questions must be open.

Doctors often assume that patients do not give completely honest answers. Women typically understate their body weight while men overstate their strength. Smokers rarely admit to the true number of cigarettes that they smoke per day. Drinkers underestimate the amount of alcohol that they consume.

Preparation

An important element of any doctor-patient conversation is honesty and openness. Some people may have to make a conscious decision to be open with their doctors. To avoid wasting time and feeling pressured, people should decide to be completely frank before they enter a doctor's office. In addition, inaccurate or incomplete information may lead the doctor to make an incorrect diagnosis or treatment decision.

Bringing records from visits to other health care providers is very useful to a doctor. People who have known their doctors for long periods of time are a steadily shrinking minority. Providing a new doctor with copies of one's medical history saves time and usually improves diagnostic accuracy. For example, old photographs are especially invaluable when evaluating skin problems.


Results

The passage of time, repeated positive interactions, and good outcomes from the information provided by the patient help to establish mutual trust. Trust then enhances the therapeutic interaction. The result may well be better health for the patient.

Preventive care should be part of the interaction between doctor and patient. A frank exchange of information is one form of prevention. If a conversation with one's doctor accomplishes nothing else, it will reduce inhibition, fear and guilt.

See also Health history ; Physical examination .


Resources

books

Bickley, L. S., P. G. Szilagyi, and J. G. Stackhouse, eds. Bates' Guide to Physical Examination & History Taking , 8th ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2002.

Chan, P. D., and P. J. Winkle. History and Physical Examination in Medicine , 10th ed. New York, NY: Current Clinical Strategies, 2002.

Seidel, Henry M. Mosby's Physical Examination Handbook , 4th ed. St. Louis, MO: Mosby-Year Book, 2003.

Swartz, Mark A., and William Schmitt. Textbook of Physical Diagnosis: History and Examination , 4th ed. Philadelphia, PA: Saunders, 2001.

periodicals

Lee, S. J., A. L. Back, S. D. Block, and S. K. Stewart. "Enhancing Physician-Patient Communication." Hematology (2002): 464-483.

Nadelson, C., and M. T. Notman. "Boundaries in the Doctor-Patient Relationship." Theoretical Medicine and Bioethics 23 (March 2002): 191-201.

Nebel, E. J. "Malpractice: Love Thy Patient." Clinical Orthopedics 407 (February 2003): 19-24.

Thakur, N. M., and R. L. Perkel. "Prevention in Adulthood: Forging a Doctor-Patient Partnership." Primary Care 29 (September 2002): 571-582.

organizations

American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (913) 906-6000. http://www.aafp.org . E-mail: fp@aafp.org.

American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007-1098. (847) 434-4000; FAX: (847) 434-8000. http://www.aap.org . E-mail: kidsdoc@aap.org.

American College of Physicians. 190 N. Independence Mall West, Philadelphia, PA 19106-1572. (800) 523-1546, x2600 or (215) 351-2600. http://www.acponline.org .

American College of Surgeons. 633 North St. Clair Street, Chicago, IL 60611-3231. (312) 202-5000; FAX: (312) 202-5001. http://www.facs.org . E-mail: postmaster@facs.org.

American Hospital Association. One North Franklin, Chicago, IL 60606-3421. (312) 422-3000. http://www.aha.org/index.asp .

American Medical Association. 515 N. State Street, Chicago, IL 60610. (312) 464-5000. http://www.ama-assn.org .

other

Cable News Network (CNN). [cited March 2, 2003]. http://www.cnn.com/HEALTH/9906/30/internet.house.calls .

Emory University. [cited March 2, 2003]. http://www.emory.edu/WHSC/HSNEWS/releases/jun98/061898kaleidoscope.html .

University of North Carolina at Chapel Hill. [cited March 2, 2003]. http://www.med.unc.edu/wrkunits/2depts/medicine/fgidc/improving_relationships.htm .

YourDoctorintheFamily.Com . [cited March 2, 2003]. http://www.yourdoctorinthefamily.com/grandtheory/section11.htm .


L. Fleming Fallon, Jr., MD, DrPH

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