MAKE THE MOST OF A VISIT TO THE DOCTOR

For many patients, a visit to the primary care physician tends to be a one-sided conversation. Patients begin by stating one medical problem, and immediately the doctor takes over. It doesn't have to be that way, said Richard Frankel, professor of medicine and geriatrics at the Indiana University School of Medicine and a senior research scientist at the Regenstrief Institute, Inc.

Frankel has studied patient-physician communication and ways to improve it. He said research shows that patients who take a more active role in their own care have better medical outcomes, including improved blood pressure readings in hypertensives, resolution of chronic headaches and lower blood sugar values in diabetics.

"Ask questions, and don't be afraid to ask," Frankel said. "Doctors are trained to question their patients. But questions are pretty rare from patients, so they need practice in asking them."

Frankel offers the following suggestions for patients and their doctors:

Patients

* Make a list. Patients can write down their questions before going to see the doctor so they will have something to prompt their memory.
* Practice. Frankel suggested practicing questions with a friend or family member to figure out the best way to ask them. This saves valuable time at the doctor's office, and it may make a busy doctor more inclined to listen than if the patient seems to be tongue-tied.
* Stray from the list. At some point during the visit to the doctor, the patient probably will need to improvise. A common example is when the doctor's instructions are not clear. Frankel's advice is the same: ask questions.
* Ask how to interact. If it is the patient's first visit to a particular physician, it can be very helpful to ask, "How do you work with your patients?" "In the long run it will be a tremendous time-saver," Frankel said. "Many doctors will offer a free first visit for this reason."
* Give feedback. One of the great gifts patients can give their doctors is to help them improve their communication skills by giving them feedback, Frankel said. "Tell the doctor, 'It really bothered me that I couldn't get a word in edgewise,' for example," he said. The common practice if patients have a bad experience is to say nothing about it, because people don't want to be rude or insulting. But then doctors have no way of knowing that they need to improve their communication skills.
* Supplements. If patients are taking nutritional supplements or alternative medical treatments, they need to mention these because the doctor is not likely to ask about them."In addition to listing current prescription medications during a first visit, the patient needs to raise these other topics along with any questions he or she may have. It may feel awkward and difficult, but it is critically important to avoid harmful drug interactions that could occur if the doctor is unaware of all the medications that are being taken," Frankel said. "In return, the doctor should be respectful about nutritional supplements -- not say, 'You're taking what?!'"

Physicians

* Listen and then ask. Physicians need to do their part for a genuine conversation to take place. "Listening skills are really helpful for doctors," Frankel said. "If a patient comes in and begins by saying, 'I don't feel well' and then pauses, don't immediately quiz him or her, because then it turns into an interrogation. Keep listening and wait for the patient to say more. This is counter-intuitive, because doctors are taught as professionals to ask questions to bring out relevant details about the patient's condition. In terms of timing, there's a small difference between an interrogation and a genuine, open-ended question that lets patients say what's on their mind." He suggested that physicians try counting to five before beginning to respond to a patient's statement of concern. "It's surprising the difference in quality of information and patient satisfaction that follows from this simple communication technique," he said.
* Anything else? The final question is also important, he said. "At the end of the session, the physician should ask the patient, 'Is there anything else we should talk about or that you didn't understand?'"