During my eight years seeing patients as a family physician, I've found that their individual health beliefs often played a big role in important decisions such as starting a new medication or undergoing an invasive test or procedure. Some patients were more willing to endure potentially risky procedures in order to learn their diagnosis quicker, for example, while others preferred "watchful waiting," or monitoring symptoms that were unlikely to be a sign of anything serious. Unfortunately, in a typical 15-minute office visit, I barely had enough time to establish a friendly rapport with my patients, much less probe them deeply about their beliefs. As a result, I'd often find myself making assumptions about the care they preferred.
Unfortunately, it turns out my assumptions, and those of other doctors, were more likely to be wrong than right. In a recent study published in the Journal of General Internal Medicine, researchers found that physicians' and patients' beliefs about conditions and treatments often diverge. Patients typically assume that they're somehow to blame for a disease, like diabetes or heart failure and that the disease can be managed with non-pharmaceutical treatments; they also assume that they'll partner with their doctors in making treatment decisions. Doctors, on the other hand, often see the conditions they diagnose as unavoidable and requiring a prescription to treat with little input necessary from the patient. The study's surprising finding was that when physicians were asked to fill out surveys expressing their own beliefs and what they thought their patients' beliefs were, they gave pretty much the same answers. In other words, doctors thought that their patients' beliefs were basically the same as their own.
This study brought to mind a young female patient, whom I'll call Jenny, who came to my office several years ago complaining of pain in her lower abdomen. Jenny had a history of ovarian cysts, a fairly common condition that often causes no symptoms and is rarely life-threatening. My physical exam, though, suggested a pulled muscle, so I prescribed a pain medication and, to be on the safe side, scheduled her for an ultrasound scan at a local hospital several days later. My patient didn't say a lot during the visit, but she left me with the uneasy sense that I hadn't adequately addressed her problem.
I call Jenny a few days later to follow up and she told me she had taken my ultrasound order to an "express" radiology center and had the scan later the same day; she underwent surgery to remove the cyst the following day and was already at home recuperating. "What were you thinking," she demanded to know, "when you asked me to wait more than a week to diagnose what I knew would be the problem? Didn't you understand how important this was?" She told me angrily that she had no intention of ever visiting my practice again.
Colleagues with whom I later discussed this situation felt that I had handled it appropriately from a medical perspective. But I think I mistakenly assumed her beliefs and values were essentially the same as mine resulting in a communication failure that ultimately led her to seek care elsewhere. From her standpoint, I didn't view her problem as particularly serious or significant, nor was I bothered by a few days delay in diagnosis. She wanted a quicker course of action than the one I put in place. In hindsight, I should have asked her specifically if she was comfortable with the diagnostic and treatment plan and, if not, what she preferred for follow-up care.
So how can you, as a patient, avoid similar misunderstandings with your doctor? Here are three communication tactics I try with my doctor when I'm the one being examined.
1. Speak up. The authors of the recent study discussed above found that doctors were more likely to be aware of their patients' individual health beliefs when their patients "asked questions, expressed concerns, and stated their opinions." I might start a conversation by saying something like "let me make sure I understand correctly what you're recommending…" because I know when I hear these words from my own patients, it's a clue for me to step back and make sure that I understand the patient's point of view. The aim is to be polite but persistent in making sure your doctor understands your personal preferences.
2. Don't be afraid to disagree. If your doctor seems to be shrugging off your symptoms as "all in your head" or suggesting what seems to be an unreasonable course of action, make sure you fully explain why you disagree. Perhaps this pain feels different or lasts longer than the usual aches, or perhaps you can't comprehend how your doctor reached a particular diagnosis based on your medical history. Sometimes challenging your doctor can reveal mistakes. And doctors, like everyone else, make them from time to time.
3. Write out your questions in advance. It's common to forget what you wanted to discuss while you're undergoing a quick exam. If possible, try to write out some questions before your appointment concerning your preferences for follow-up and treatment. If you don't know what kinds of questions to ask or how to ask them, check out the Agency for Healthcare Research and Quality's website. The bottom line: While your doctor's knowledge of medicine may trump yours, you have a vaster knowledge of your own beliefs and preferences—and satisfying care requires a knowledge of both.