Posted June 14, 2013, 10:30 am 
During visits with your doctors or other health care providers, do you speak up and ask questions? If the answer is “yes,” congratulations. You’ve taken an important step to getting the most out of your health care visits. You’re also in the minority. Most people have trouble asking their doctors questions. It can be even harder to disagree with health care providers, or make known your worries and preferences for care. It’s such a problem that several organizations have created campaigns specifically aimed at helping people talk more openly with their doctors.
There are many reasons for poor patient-doctor communication. One is what Timothy J. Judson and colleagues call the asymmetry of power. Writing in this week’s JAMA, they point out an obvious reason for the imbalance in this important—doctors almost always have more medical knowledge and experience than their patients. Another reason is that we don’t want to do or say things that might tick off our doctors, for fear that an aggravated doctor might not give the best possible care.
Medical lingo is another key barrier. It comes so easily to clinicians but is gobbledygook to the rest of us. When a person is quiet after getting information from his or her doctor, many doctors interpret the silence to mean the person fully understands what has been said. And that she or he doesn’t have any questions. In fact, write Judson and colleagues, the person may be thinking “‘I have no idea what you are talking about’ but is too embarrassed to say so.”
Judson and colleagues use the term “white-coat silence.” By that they mean a reluctance to ask questions or make suggestions in front of a clinician. The term plays on “white-coat hypertension,” a well-known phenomenon in which people have high blood pressure in the doctor’s office—but not at home. Such silence can get in the way of good health.
If you feel like you have trouble talking openly and honestly with your doctor, or asking him or her tough questions, two national campaigns offer help.
The federal Agency for Healthcare Research and Quality’s Questions to Ask Your Doctor campaign is based on the idea that doctors “know a lot about a lot of things, but they don’t always know everything about you or what is best for you.” The website offers a list of 10 general questions you should ask, along with questions to ask before, during, and after appointments. It also has an interactive page that lets you build your own list of questions.
The independent, nonprofit Joint Commission accredits more than 20,000 health care organizations and programs in the United States. Its Speak Up Initiatives offer free brochures and videos to help make the most out of visits to the doctor. The program is named after its seven key points:
Speak up.
Pay attention to the care you get.
Educate yourself about your illness.
Ask a trusted family member or friend to be your advocate.
Know what medicines you take and why you take them.
Use an accredited hospital, surgery center, etc.
Participate in all decisions about your treatment.
Your doctors may think that if you don’t speak up, you either don’t want a conversation or you understand completely what is going on. Either way, you won’t get the information you need. The June Harvard Men’s Health Watch offers some simple but effective tips for making sure you leave the doctor’s office with what you need. Here are a few of them:
Be prepared. Before the doctor’s visit, take some time to think about what information you need, and what is important to you if you have to make a decision about treatment.
Ask about options. If your doctor suggests a treatment, asking these three questions has been shown to lead to better outcomes:
What are my options?What are the possible benefits and harms of those options?How likely are the benefits and harms of each option to occur?Bring backup. Take a spouse, adult child, or friend with you for support. Sometimes an “outsider” can be very effective at making sure certain questions get asked.
We expect a lot from our doctors. Superb diagnostic skills, unfailing instincts for treatment, warmth and understanding, and excellent communication skills. Exactly what the latter means was spelled out vividly in JAMA by Dr. Abigail Zuger, an associate professor of clinical medicine at Columbia University College of Physicians and Surgeons who often writes about health:
So what communication skills will be required of the fully evolved 21st century physician? The physician will, of course, be fluent in standard clinical language, including ordinary medical terminology and the delicate phrases of care and compassion. The physician will be adept at translating medical jargon into comprehensible lay terms, knowing how to defuse words, such as obese or psychotic, that might cause alarm or hurt feelings. The physician will know how to explain statistical concepts both accurately and intelligibly with the patience and fortitude to answer patients’ questions about all things evidence-based, even the physician’s own competence.
The physician will know the highly technical vocabulary of relevant research agendas well enough to encourage patients to get involved. The physician will also keep up with popular culture, tracking popular direct-to-patient communications and incorporating them into the clinical dialogue. In addition, and most importantly, the physician will have virtuoso data entry and retrieval skills, with an ability to talk, think, listen, and type at the same time rivaling that of court reporters, simultaneous interpreters, and journalists on deadline. The physician will do all of this efficiently and effectively through dozens of clinical encounters a day, each one couched in a slightly different vernacular.
To quote Dr. Zuger, “That’s some physician.” If your health care provider lives up to that standard, let us know. We’ll give him or her a shout out.
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