We have all seen those long faces on their way out of the doctor's clinic: frustrated, disappointed or just plain angry! Not getting what we want from our doctor, feeling that we haven't being listened to -- we have all been there. What most people don't know is just one minute's reflection about our problem can help make the most of our time with the doctor. Read on for an insider's tips on how to get the best out of those 10 minutes. Trust me. I'm a doctor.
Believe it or not, communication skills are an essential part of medical training. I have known the brightest academic students to fail medical exams purely due to their poor communication skills. For family physicians -- or general practitioners, as they are also known -- communication is fundamental to a good consultation with patients in the community. These doctors will often see patients in the most challenging times of their lives including terminal diagnoses and bereavement. Gaining a quick insight into how your doctor's brain is ticking away during the ten minute consultation will equip you to get more of what you want from your doctor. Don't believe me? Just try it.
There are many models of communication that are used to train doctors in patient communication. A common one that we will use to demonstrate today is called the ICE model: ideas, concerns and expectations. A doctor will ask many open questions to establish what each of these three words mean for you before formulating a joint plan that is ideally acceptable to both doctor and patient. The more you can help them, the better. So let's go break the ICE!
I for Ideas
What do you think is the problem? It is astonishing what a simple sore throat may mean to two different people. It can be easy for doctors to take basic medical knowledge for granted. Unless you tell them what you think is wrong they may not be able to address your personal needs which may differ from the next patient who has exactly the same problem. Let me give an example: "Doctor, I have a sore throat, and I think I have an infection" is different from "Doctor, I have a sore throat, and being a smoker, I think I have cancer."
One patient I saw recently I noted had been attending our clinic repeatedly for the same problem of a neck lump. Each time she had been told it would go away itself, but she kept coming back. It was the first time that I had met her. On delving deeper into her ideas, I learned that her best friend died of a lymphoma. As she hadn't shared this before, the previous doctors were unable to duly reassure her. After my consultation with her, she didn't attend for the same problem again.
C for Concerns
Okay, so we have established what you think is wrong. What is your concern about your problem? A lot of patients feel they cannot cross the fine line between a medical problem and its social impact. Many patients will take great deals of personal stress affecting their mental health, family life and work without mentioning it to the doctor. Concerns vary and may be seen by patients as too insignificant or embarrassing to even mention. I promise you, you cannot shock a doctor. Whatever your concern is, they would have heard something that you would consider as more insignificant or embarrassing.
One example that comes to mind is of a male bus driver with sleep apnea where ineffective breathing at night was causing him sleepiness during the day. He was too scared to mention this, as he thought he would lose his job. When he did eventually share his symptoms and concern, he was referred to the specialist urgently instead of routinely and within a month was treated and back at work. Sharing concern may change the outcome of the consultation. You may be offered alternative treatment, quicker referrals, contact numbers for helpful organizations or follow up appointments. Most of all, you will the doctor's surgery feeling a lot lighter than when you came you in.
E for Expectations
Almost all of us have some idea of what we want to walk out with when we leave the doctor's room. One of the most common is antibiotics! Some patients are extremely vocal about their expectations and it may be the first thing that they say, even before they tell the doctor the problem. Others will have a constant "do I don't I" battle in their minds and walk out eventually without having shared what it was that they wanted, only to kick themselves later. Both situations are less than ideal. Doctors are trained to manage your expectations. A good doctor will ask you questions such as, "What were you hoping for from today?" Before you see the doctor, reflecting to yourself about what you expect from the consultation can equip you for this question. Equally, if you are not asked this question by the doctor and your expectations are not met, you may choose to say something like "this isn't quite what I was expecting," which should then lead to exploration of your expectations.
Very recently, I visited a family at home at night during an "out of hours" work shift. An elderly patient with dementia had become very aggressive and hard to restrain by his family. On speaking to his family, I learned that they had visited the doctor a few times but had not shared their expectation of an adjustment in medication. They felt that the doctor would've mentioned it himself if it were an option, despite this being a consistent and solid expectation in their minds. If they had shared this expectation then perhaps a medication review, specialist input, alternative care or further support may have been explored.
So there we have it, the ICE model: ideas, concerns and expectations. The three simple questions to ask yourself before you next visit the doctor. You would be surprised at the difference it can make. Who knows, the doctor you thought didn't care may just become one that you recommend to a friend.