You have had that nagging back pain for several years now and mentioned it to your primary care physician. In the past over the counter medications seemed to work, but lately it interferes with your golf game and ability to hike on vacation. You schedule an appointment to see your physician, hoping to get an MRI scan of your back and maybe a course of physical therapy to set you back on track. However, after what seems like an all too brief encounter, you are told you aren't getting any younger, ought to lose some weight and maybe you aren't taking the medications as suggested.
You are upset, feel "blown off" and no closer to a solution for your problem. What went wrong? You knew what you wanted going in to the visit, why did you come out empty handed?
Sound familiar? It should, as the Centers for Disease Control and Prevention report 902 million office visits each year, or about three visits per year for every person in the United States.
The Internet is loaded with advice about always taking a list of all of your medicines; recordings of all your home blood pressure readings and a list of questions. All good advice, but I think there is something much more fundamental that determines success or failure for your doctor visit.
Perceptions and Expectations
Herb Cohen, negotiator and author of "You can Negotiate Anything," points out that it is always the "How" -- or emotional content of an encounter -- that drives the "What," or facts of the event. Have you ever had an encounter at wok that raised your blood pressure and had steam pouring from your ears? You couldn't wait to get home and tell someone about your awful day. You drive on the freeway getting even more agitated as you re-live the event -- blow by blow. At dinner you pour out the injustice of the events only to have your partner or family give you a pathetic stare and remark, "That doesn't sound so bad." It was the "how" of the encounter. In other words, you had to be there. In brief, it was your perception of the event and what you "brought to the party," that led to your emotional response. And, so it is with physician-patient encounters.
The physician has an expectation of how they "should" be treated by the patient/family and how the patient "should" behave. The patient has similar preconceived beliefs about how the visit "should" go. "Shoulds" are dangerous! Albert Ellis, the founder of Rational Emotive Therapy remarked, "don't should upon yourself."
Equally dangerous are unrealistic or unmet expectations that lead to stress, frustration and anger. The perfect patient experience is when the patient's expectations are recognized and are met by their physician.
Physician Patient Expectation Disparity ( PPED)
I like an expression coined in 1994 by the pediatrician, Dr. R. Sagall. He refers to the mismatch in physician/patient expectations. The patient enters the doctor's office with an expectation of what will happen and the eventual outcome. As a patient, when you go the doctor, do you expect to:
The list can be never ending and tailored to whatever problem you have on that particular visit. How to do we bridge this gap and teach patients to clearly express their expectations and physician's to "ask and listen?"
Danger-Unmet Expectations
Physicians would love it if every patient could give a brief, clear history that gave them just the information necessary to make the diagnosis and prescribe the appropriate treatment. It might help if we asked every patient, "What do you expect from today's visit," or "At the end of your father's rehabilitation stay what do you hope he will be able to do for himself?" We would be able to quickly determine not only the nature of the expectation but whether it is realistic. As a patient or family member have you ever left an office visit or physician conference and felt:
They all arise from the mismatch of expectations and the reality of what happens. So, what can you do to avoid this trap?
The Keys To Meeting Expectations
1. Ask yourself and tell your physician what you expect during that visit or hospitalization. This is not just a list of complaints, but what you would hope will be the final outcome.
2. Ask yourself, "Are these expectations realistic given the circumstances of the event? If I have symptoms of a typical cold , is it reasonable to expect antibiotics that won't really help?
3. If you are angry with the doctor or their staff, ask yourself "why?" If you are mad that you had to wait, ask whether you were "worked in" and if a wait is reasonable? Is there a patient with an unexpected serious problem who requires extra care- next time it could be you?
4. Focus on solutions not excuses. Frequently the patient or doctor are explaining why they couldn't do something rather than how to solve the problem.
5. Take someone with you if it is a complicated problem. They can take notes and be an extra set of ears to remember what was said.
6. Get copies of your lab work and MRI/CT scan reports. You can refer to them later to remember what was covered.
7. Accept responsibility for the problem. Are you expecting the physician to solve a problem that requires at least 50 percent effort on your part?
8. Recognize you and your doctor can only control the controllable and you cannot eliminate uncertainty from your life.
Here's to the expectation that your next visit will be a better one. Do you have any tips that you use to make the most of your doctor visits?
Follow Richard C. Senelick, M.D. on Twitter: www.twitter.com/RichardSenelick
Dr. Cindy Haines: Are Primary Care Physicians Going Extinct?
I have a number of friends that tell me that their family doctors are all too dismissive when they bring health issues up and just tell them it is nothing serious and offer to write a prescription.
Some people are also intimidated by doctors and afraid to speak up even when they feel that they are not receiving the proper treatment. I am afraid that that is a difficult dynamic to change once it is set up.
I for one will not go to a doctor that won't hear me out and I recommend the same to friends. Find another doctor who listens to you and wants your input.
Your doctor is like a safari guide- if he tells you not to get too close to the lion cubs, don't pull out a leaflet of internet "facts" you've found telling you it's perfectly okay to do so- and then sue him after you're mauled.
When I look at the picture of this article, I figure the woman is a very rich lady. This pleasant scene is miles away from the reality of an office visit. The doctor has a deadline to meet, and you only have 15 minutes to get your story out and answer the doctor's questions. They don't want to talk to you--they want to make their 15 minutes and get on to the next patient.
I do know at least one doctor that has a very cool system for making the office visit effective. Through an insurance change, I had to go somewhere else. Those special doctors are few and far between. Each patient needs to go to the visit with the thought in mind that the doctor is only interested in money, if only to defend yourself from quackery. If it turns out that it is otherwise, enjoy!
Doctors should just do their jobs and quit expecting the patient to self diagnose, research, and present their findings to the doctor. THAT is the doctor's job. Do it.
Like it or not, physicians are NOT magicians, nor are they mind readers. They need you to carefully report your specific symptoms so that they can appropriately care for you. To expect it to be so one sided is blatantly unfair to all involved.
fanned
If this guy did take Medicaid , he'd have to close up after he went bankrupt and the patient STILL wouldn't get seen !
1. If you are experiencing symptoms which bring you to the doctor's office, log the frequency and severity of the symptoms prior to your visit. Bring a printout to your appointment so your doctor can add that to your file if he or she wishes.
2. Be on time for your appointment and realize there may be a wait time before you see your physician. Bring your laptop or iPhone or Blackberry so you have something to occupy you in the waiting room.
3. Bring a current and complete list of medications. Your doctor can look at your chart but you may be taking meds and/or supplements which your doctor doesn't know about but should. Have this printed out as well.
4. If you have the option to communicate with your doctor by e-mail, write brief, straight to the point messages which are clear and complete. Always include your return e-mail address and a cell phone number in case your doctor needs to reach you.
5. Prioritize your complaints and review them with your doctor in that order.
6. Say what you're really worried about. If you let your doctor know your worst fears they can be addressed head on (e.g., I am worried I may have a brain tumor).
7. Drink before your visit so that you can provide a urine sample if one is requested.
Patient " Awhile!"
Doctor - " What medicine do you take ?"
Patient - "Some white pill"
ad infinatum...
This is why your doctor often runs behind at the office.
I bring along a list of my medications and how I take them. I always ask for generic medications. When I go to pick up my medications he always tries to sneak in a brand name, due to all the Big Pharma representives always coming in to his office giving him gifts. I make the pharmacist call his office for a generic med to replace the brand name.
Then my doctor always has the telephone aid in his ear. Really anoying.
Then at times he sends in the medical assistant to try once again to get my blood. She always says, your veins roll. I tell her if you knew how to draw blood the veins would not roll. Go get more experience on someone else. Then the real Phlebotomist comes in and drays the blood 1 2 3.
On my next visit I am changing doctors.
"Big Pharmacies" are FORBIDDEN to give doctors gifts- unlike your congressman or woman. Doctors do not get kickbacks at all- that's also very illegal.
Phone in the ear ? Most patients do too, and make the doctor wait while they talk to Aunt Myrtle.
Sneaking in brand name ? Sometimes the pharmacist does that to up the price- I've switched pharmacists after catching mine doing that several times ( he works in a small private pharmacy)