Dr Liza Macdonald FRCR MA

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Things which can hamper
you in a consultation

  Getting The Best out of Your Doctor

Things which can hamper you in a consultation

It is very understandable that a medical interview engenders anxiety. Underlying this anxiety is the fear of what the consultation has in store....the fear of ill-health, disability and indeed death. Such worries can make people behave very differently from their normal selves. When facing the possibility of personal danger it is often difficult to order one's thoughts and describe your experience and concerns about this.

It is also difficult to concentrate on the conversation and to take in what is being said.
On the other hand speaking as a doctor who has practiced for thirty years both in the UK and abroad.... and in private practice as well as my principal commitment to the National Health Service.... I am constantly surprised and downcast by the attitude of friends, family and strangers to their medical advisers.

Almost without exception people are intimidated, even frightened by their doctors. The doctors may not be all that much respected as people but in their professional role they very often inspire great anxiety. People seem to feel a need to please the doctor and a reluctance to question what they say.. Most people seem to be afraid to do anything which might be seen to 'cross' their doctor. Most people are well aware that the label "Difficult Patient" is not to be recommended!

The medical profession is assumed to wield a great deal of power and indeed in theory a doctor may be in a position to with-hold treatment, delay referral or obstruct support services. It is very rare indeed for any of these fears to be justified.

Mistakes and delays do happen but these are not intentional. Rather they are due to overwork and being too busy.
Why not help the doctor out by being 'on the ball' and managing your own case well?

Elderly patients in particular can be almost obsequious to their doctor or indeed a senior nurse. There seems to be a fear that in some indefinable and probably undetectable way the patient will suffer as a result of causing some real or imagined slight, or discourtesy.

Something seems to have gone a bit wrong with the current form of the doctor-patient relationship. In its finest ideal the doctor's role is one of care, protection and advocacy on behalf of the patient.
However in place of this attitude of service, which entailed a sense of responsibility for the welfare of patients 24 hours a day, the practice of medicine has become fragmented. Now it may appear that the terms of the doctor's contract seem to 'trump' the patient's needs. Patients may feel like commodities which are the subject of contractual arrangements, a source of funding for the practice or clinic rather than a respected consumer. The loss of 'out-of-hours' cover on the part of GPs has led to more patients seeing an unfamiliar emergency doctor or attending A&E departments with relatively minor concerns which a familiar doctor could have sorted out speedily and dependably.

On a personal level what can you do to smooth your path through the process?
What can you do to prevent yourself being hampered in your relations with your doctor?
First, as we have said, prepare a list of questions for your doctor. Beware of waving this too obviously as many doctors can get irritated if they think a long time-consuming list of questions will ensue.
Keep it as a mental list if you can or write short notes to jog your memory.
Then develop some techniques of questioning which can be perceived as self-deprecating but nonetheless assertive without being aggressive.....a way of asking rather than telling the doctor what to do.
If for example you really feel that you need an x-ray or a scan to clarify a problem (and have good grounds for thinking this) you could say:
"My wife would really like me to have an x-ray." It's hard to argue against a caring relative!
Or use a few seemingly hesitant phrases like "I may be being a bit neurotic but ....."
Or "Oh silly me I may be wrong but....."
Or "a friend of mine had just these symptoms and he turned out to have a brain tumour."
From the doctor's point of view how much better it would be to give the patient an x-ray request form and tell the patient to cancel the appointment and tear up the form in a week's time if the problem has disappeared.
As a patient you do need to be clear-headed and rational.
As a first gambit if you disagree with the doctor's approach it may be sensible to accept the doctor's suggestion e.g. for a simple remedy. But if this does not work in a reasonable period of time be prepared to go back to the doctor and say so and press for something else.

This hesitancy apart what other issues may complicate the consultation from a patient's perspective?
Some people are too shy or embarrassed to discuss personal matters with a doctor. Remember however that doctors have seen it all before. They are only interested in you professionally and will not be spreading tales about you. Try talking things through first with a sympathetic nurse. It may be easier to find the right phrases together.
Some people have difficulty in finding the right words to express themselves. Try looking up a problem on the internet and find out how to go about describing it.
A minority of patients just don't speak English and this is difficult both for the patient and the doctor. Interpreters are better than no translation but communication through a third party is not ideal! (see topic later on using an interpreter).

Problems which hamper the patient

1. Too shy
2. Too embarrassed/ashamed
3. Not thought through/no list
4. Too inarticulate
5. Does not speak English
6. Patient is deaf or partially sighted/blind

Counter measures:
Remember consultation is private/confidential
Remember doctor has seen or heard it all before from other patients
Remember doctor is interested in you only as a patient and in a professional way
Do not forget to make a list and get your terminology right

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