Your Doctor Has a Few Questions to Ask

Jason just had a showdown with his doctor.  As a result, Jason is feeling frustrated.  So is his physician.


Over the last week or so, Jason noticed a couple of symptoms that, while not interfering with his daily life, were annoying to say the least.  Jason did some research on the Internet, based on his symptoms.  His searching repeatedly led to the same result.  Concerned, Jason read about the test that would be required to determine the presence of this condition as well as two recommended medications.  After researching the medication options, he chose the one that he decided would be most convenient.


At this point, Jason made an appointment with his physician.


Given the amount of preparation he had done, Jason felt that he could make the best use of his doctor’s time if he took control of the conversation.


Jason began the conversation with his doctor by telling his doctor what he thought his diagnosis was.  He explained how his Internet research had led him to his conclusion.  He brought in printouts from the Websites he had visited to support his explanation.  Jason requested that his physician authorize the test that would support the diagnosis he suspected.


At this point, Jason’s doctor interrupted him.  “I’m not so sure this is what’s causing your symptoms,” Jason’s doctor said. “Let’s take a step back.  I need to ask you a few questions.”


His doctor began to question Jason about the intensity of his symptoms and how long he had been experiencing them, as well as other symptoms.  He asked Jason if he had experienced any recent changes in his daily life.


Jason was surprised at his doctor’s questions, as well as annoyed.  The Internet research he had done had been, in his mind, thorough and conclusive.  And it certainly wouldn’t be the first time he had been correct.  Why waste time?


Jason’s doctor, on the other hand, was attempting to follow professional best practices in determining a diagnosis, which is to take the patient through a thorough examination of his symptoms, to rule in and rule out potential diagnoses, to get to the most likely cause.  This might require further testing, or it might be immediately treatable.  His doctor would have a better sense of that after talking more with Jason.


If you could have placed thought bubbles over their heads, like in a comic strip, here is what you might have seen.


In Jason’s thought bubble: “I know my own body and I’ve done my research.  Doesn’t what I think matter?”


And in his doctor’s thought bubble: “I’m the one who’s trained to make the diagnosis.  Isn’t he here to find out what I think?”


Jason and his doctor have the same goal: To make sure that Jason receives excellent healthcare.  Jason wants to be an empowered patient through self awareness, research, and what he feels is effective communication with his physician.  Jason’s doctor, in turn, respects Jason’s desire to be actively involved in his healthcare, and welcomes all of his patients to do their own research.  But he still wants to be the doctor.


They ended up compromising.  Jason’s doctor agreed to a medical test that he wasn’t convinced was necessary, though he refused to prescribe antibiotics at this point.  They also shared the consequences:  Time spent with the doctor talking Jason out of his self-diagnosis that could have been better spent working together to understand his symptoms and discuss the options.  The potential for misdiagnosis, as well as unnecessary testing and treatment.  And tension between two people who have a solid working relationship.


Is there a way this situation could have been avoided?  The answer is yes.  And the starting place is to take a step back from the conflict itself and think about how doctors do their work.


Physicians are trained to explore their patients’ symptoms in a systematic manner.  Imagine this conversation in the form of a decision tree.  As you describe your symptoms, your doctor needs to know information like duration and severity, and this will lead to the exploration of further symptoms, some that you may or may not have heard of.  Your doctor is following a path that will ideally lead to potential conditions, some of which he/she may be able to diagnose immediately, others that may require further testing.


Like many other professions, physicians are most comfortable and effective when they are allowed to take this systematic approach to exploring symptoms.  Consequently, starting the conversation by presenting them with your self-diagnosis, regardless of how well you have done your research, along with your preferred treatment, can short-circuit your doctor’s process.


Doctors are human.  When you make demand, based on your own diagnosis, you place yourself and your doctor in a potential power struggle.  You defend your position.  Your doctor defends his/her position.  Communication grinds to a halt.  And keep in mind, you may make such a strong case for your diagnosis that you and your doctor risk missing other symptoms.


Working with your doctor includes letting him/her do their job.  And that doesn’t mean you can’t also do your job – and do it thoroughly – as an empowered patient.


You and your physician are a team.  Your doctor can’t do an effective job if you are not actively involved in your care, including all the self-awareness and research that Jason puts into his job.  But it’s a two-way relationship, so how about starting with two-way communication?


Here’s how the conversation between Jason and his doctor might have gone:


Physician: What brings you here today, Jason?


Jason: I’ve been having some symptoms lately that I am concerned about.  They include… (Jason provides his doctor with a brief overview of his symptoms).


Physician: Okay, Jason.  Let me ask you a few questions.  (Jason’s doctor questions him regarding duration, severity, and other symptoms that he/she wants to explore).


Jason: I’ve done some research on the Internet.  I am concerned that I might have…”  (Jason summarizes what he has learned in his research, supported by his notes.)


At this point in the conversation, Jason’s doctor has had a chance to think about Jason’s symptoms.   He/she may has most likely at least started the process of ruling in and ruling out possible diagnoses – including the diagnosis Jason is concerned about – as well as thought about potential next steps.  Jason gave his doctor space to conduct an open-ended exploration, in the way he has been trained to do, resulting in less risk of wasted time, wasted healthcare resources, and unnecessary tension.


When Jason met with his physician to discuss his test results, he decided to take a different approach to the conversation.  It was as simple as: Talk.  Listen.  Respond to questions.  Listen.  Talk.  Listen.  Ask questions.  Listen.  The basic guidelines for an effective conversation.  Both Jason and his doctor are open to what the other person has to say, both expecting to listen, both expecting to be heard.  Working together.


The moral of the story?  You are the CEO of your own healthcare.  But your doctor is an expert consultant you have added to your team.  Effective communication is about working together, not establishing who’s in control.


On a winning team, everybody is a team player.