June 10, 2010
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Communicating to Your Doctor
It was a bit of a struggle watching my dad during his annual checkup. He simply tells the doctor nothing is wrong, he is healthy as a horse. All the complaints he would tell me about bone pains and maladies are now gone. It’s as if he thinks the doctor is an auditor. “If he doesn’t ask, I won’t tell. The less he knows the better I’ll be.” So I’ll toss in a few reminders here and there. I ask the doctor about memory lapses. My dad insist his mind is still sharp. The doctor asks who does the banking. I say I do now. Dad would say I only handle the petty cash… anything below $10.
So the entire physical was like that. A three way dance between facts, fiction and forgotten truths. It was like watching a witness expertly handle an attorney at a trial. When we left the doctor’s office, my dad thought the doctor wasn’t thorough enough. I almost ripped my hair out when I heard that.
I think if you’re seeing a doctor – it’s got to be full disclosure no matter how embarrassing it
may seem to you. I think a patient needs to help paint his own health picture, tell it as vividly and fully as possible to help the doctor. If you have pain urinating, how long will you suffer before seeing a doctor because it can be embarrassing? If you notice blood in your stool (when you wipe or when you flush), will you tell the doctor or hope it wasn’t anything serious? Are you able to describe your symptoms? If it’s pain – is it a dull achy pain or a sharp pain? When did it happen (oh, I don’t know… a week, maybe months ago?), is it a recurring pain or a steady pain? (gee doc… I never really noticed). If I was a doctor, I’d let the patient experience some pain immediatelyDoctors are probably trained to properly interview their patients and draw all the facts out. They probably need to take into account cultural, age and all those things that can influence the answer. I just think patients also have a responsibility to help their doctor by providing clear and factual answers.
Comments (27)
Matt, I know exactly where you are with this. I have managed to strong arm dad into being a bit better about this, but mom is totally hopeless. Too far off into the mists of Altzheimer’s for anything to help… Sigh…..
@Toro69 - *hugs* I’m starting to put together a binder with more of his medical history, any complaints he’s had, my notes from doctor’s visits, meds, all his doctors, appointments etc… I’ve noticed quite a few patients carrying binders when they visit their doctors. Some seem to be very organized.
Oh, that’s so true, Matt. The last person to be embarrassed in front of is your doctor, as he or she is only going to be able to help you to the extent you are open and honest with them. I’ve already started making notes before I go to the doctor for myself, just so I remember all the details of symptoms, etc. and don’t blank out while in the examining room.
@christao408 - I’ve started to do that to but need to get more organized. I know my doctor is pretty busy and her waiting room is always jammed. So I want to make sure I get all my questions in. Thank you for recommending.
On the opposite end of the spectrum, there are also some patients who believe that everything is wrong with them. Some like the attention and feel important.
I recommend this book, “How Doctors Think” by Jerome Groopman, if you’re interested in thinking about this encounter from the doctor’s perspective. It’s a quick and easy but rather insightful (IMO) read.
Matt, your blog is very timely as I just got home from my annual check up. Your dad acts like my mom in front of the doctor. The only difference is that she does not tell me if there is anything wrong. Wonder what is worse, parents complaining to us what is wrong with them or hiding health problems from us. I cannot win, I guess.
Oh, I did not know your dad has a lady doctor. Maybe he does not want tell her about his pee and poo parts, lol, in case she wants to check? mmmm
@Senlin - I remember seeing that book being recommended but never thought I would need it. I think this is a timely recommendation – thank you. I think I would dread those kind of patients as well if I was a doctor.
@stevew918 - dad’s doctor is a man. my doctor is a woman and she has seen and felt everything. (it took me awhile to get used to this) I wonder if your mom feels awkward about all of these things. I have a funny feeling your mom gets a bit defensive when you bring things up. Thank you for recommending.
I observe my mom’s behavior instead of asking her. Several years ago, when I visited HK, I noticed that her eye sight was deteriorating fast. So I suggested my brother in HK to take her to an eye doctor. She kept refusing. So I made an appointment for her, flew to HK and personally brought her to see the doctor. It turned out that she lacked some vitamins and was losing her eye sight. By taking prescription vitamin, she is seeing great now. She has learned to listen to me more. Parents can act like a kid sometimes. Sigh! Long distance parent caring is very hard.
Is he maybe embarrassed to say those things with you in the room?
@Roadlesstaken - I doubt it… I remember he would go to the doctor’s office by himself. When I ask him afterwards if he discussed this and that, he would just shrug and say that wasn’t a problem. I did take that into consideration when I took him to the doctor’s office. Could I leave him alone with the doctor? But I knew his memory wasn’t that good so I had to sit in on the visit.
@stevew918 - oh wow… I wonder why she didn’t listen to your brother. What vitamin is she taking now for her eyesight? A and beta carotene?
My younger brother is the baby of the family, my mom still treat him as a “baby”, lol. She tells him what to do instead of the other way around. Her medicine include carotene and a whole bunch of different vitamins special for the eye. Other than eye sight, she is very healthy, except I notice she is losing her hearing lately. When i called, she would say, “wei wei, wei” and hung up as she could not hear me over the phone
. Wonder if there is vitamin for hearing, lol.
hm….maybe as when grow older, we tend to become more embarrass when talking to doctors…remember I was a kid, I told the doctor all the details, and my mom didn’t even have to step in…
Excellent reminder to me. I am one who has all sorts of questions but forgets half of them by the time I get to the appointment. I am going to start writing them down and taking a list with me. Also a list of recent complaints. As I get older that may get longer. Went through the same thing with my dad. He was always fine but had lung problems and used to sneak cigarettes.
Perhaps, as we grow older, our ‘dignity’ and ‘privacy’ are two of the few things left that we can try to maintain control over. Or perhaps it’s just that we don’t want to have to face the fact that some of our ailments are a direct result of our ‘ageing’, something we don’t always want to be reminded of, so we try to put off that dreaded diagnosis by trying to ignore the symptoms. Meanwhile, sons and daughters (and doctors too) need the patience of a saint !
Doctors are so flooded with this sort of stuff on a daily basis that they really don’t even have the energy to pass any sort of judgement regarding that stuff. The human body is a complex machine, and many things that may be socially stigmatized can go wrong.
I think most people have a difficult time with being fully upfront with doctors especially if it’s about something that you are a little embarrassed about. I’m sure your father is self-conscious about some of his problems.
this reminds me of a discussion we had during one of my anthro classes, about doctors in a (latino?) community, who had to be trained in how to go about getting their patients to talk about their symptoms. i agree, doctors need to be culturally aware of their patients’ expectations and know how to connect with their patients so that they can effectively communicate. it’s a tough problem, but an important one.
i try to be upfront with doctors, but it is challenging sometimes. you wonder why doctors need to know such-and-such information that to you doesn’t seem relevant, but which in fact may turn out to be the much-needed clue for a proper diagnosis.
“I just think patients also have a responsibility to help their doctor by providing clear and factual answers.”
Definitely. I tell my doctor everything, if I ever had anything embarrassing I’d still tell them, it’s not like it’s nothing they haven’t seen before and I’d like to get it fixed plskthx.
It’s frustrating for the family member/friend of the patient as well as the health care provider when the patient doesn’t tell the truth.
It may be best for you to talk to the doc without your father present. See if you can phone him.
i rarely visit doctor now… thanks god!! hahaha but well, no matter how i described my pain to the doctors, they just didnt understand me >< i begged for injection but rejected T.T yeah… did i tell you i had lumbar disk hernia? luckily i won the battle alone when i was in japan…
as someone who asks these embarassing questions, i can’t agree with you more! i asked a man a cazillion questions just about his poop today.
I thought of your post today, and I’m surprised no one really mentioned discussing one’s sexual activity with the doctor. I’d imagine that this would be more uncomfortable for most people (esp. LGBT people) than discussing general ailments. Doctors are human. They can be religious and conservative (for example, that virulent Oklahoma Senator and physician, Tom Coburn). They DO judge their patients. Some things that I have heard doctors speak deploringly (or derisively) of are obesity, smoking, “men who have sex with men,” and alternative medicine. At least regarding the sex issue, you can find an LGBT-friendly doctor through this website.
Another book I’d recommend, on the topic of physicians’ cultural competence, is The Spirit Catches You and You Fall Down by Anne Fadiman. It’s a well-researched nonfiction book about the clash between Western doctors trained in evidence-based medicine and the cultural beliefs of a Hmong family with a child who experiences deadly seizures. It’s apparently a widely-taught book in medical schools and medical anthropology courses.
I have had to face patients like your dad. I always used to make a list of all the things they said, and when the patient thought i was done with him or her, i would go over them one by one again, and usually that made me get to the details of different problems, because they would forget what they had told me initially. It is really a three way dance for you, Matt. Hugs.
@stevew918 - I think she needs a hearing aid (so does my dad).
@agmhkg - I think I was the opposite, I was too shy to say anything to my doctor.
@Fatcat723 - you just reminded me of my last visit to my doctor, she was telling me the results of my blood tests. She sort of hinted that most patients will jot down some of the key tests. I just sort of sat there and nodded like a dimwit.
@Chatamanda - you’re so right about dignity and privacy. It’s tough when the bodies don’t do what we want them to do.
@secade - I do feel for a lot of our doctors. They rarely get a chance to simply sit down and think.
@TheCheshireGrins - I’m sure he is. On one hand, I want him to get the best medical care but on the other, I do want to protect his dignity and pride.
@kunhuo42 - yeah, sometimes I don’t follow the line of questioning from my doctor as well. But she’s good at explaining why afterwards.
@whoosh90 - I applaud your openness. It took me a long time to get to that stage.
@yang1815 - I’ve made a note of that – thank you.
@lcfu - ai ya… that’s gotta hurt. With you traveling so much, it’ll be difficult for you to find a doctor. So do take care Fufu.
@caki730 - Good for you… I hope your patient was equally open with his answers.
@Senlin - that’s an excellent point you raised. Thank you for the link to the GLMA and for the book… much appreciated.
@ZSA_MD - that’s a simple and effective way to gauge the patient’s answer. I noticed my dad’s doctor didn’t do this. He was however updated on all his recent medical visits to other doctors. Thank goodness all the doctors my dad visits are part of the same computer network. Appreciate the hugs – thank you.