Does your doctor listen to you/why don't they listen?

In My Humble Opinion
1

What causes some doctors to listen intently to some patients, and completely ignore others?

My mom, husband and I all go to the same group family practice. Usually you see the same doc, unless they work you in then you see whoever is taking the walk-ins that day.

My experiences: 3 doctors, all male. One is great (my current one), one was decent, and one was just flat out evil.

My mom: both male and female doctors, all horrible. Just last week one sent her home with “either viral pneumonia or bronchitis,” according to him, with instructions to “just take some Ny-Quil and go to the ER if you spike a fever.” She’s spent the last week pulling muscles from coughing so much. (That’s just one of countless examples.)

My husband: both male and female doctors, all wonderful. They listen intently, ask lots of questions, thoroughly examine him.

So how do doctors decide if what you’re saying is worth listening to?

All 3 of us are overweight so I don’t think it’s a fat bias. (Although I’ve definitely had doctors in other places completely ignore the reason I’m there and spend the whole time talking about my weight.)

It can’t be a gender thing because I’m a woman and I have a doc that listens to me now.

I don’t think it’s education level, either. My mom is highly educated while DH and I are still in school. If it were education, it’d make more sense to pay attention to the educated patients, right?

Could it be illness level? My mom’s ill (diabetes and a really bad back). I’m healthy as a horse, DH is generally pretty healthy. Do doctors get sick of chronically ill patients and just tune them out after a while?

Is it ageism? The older the patient (mom’s 55), the less they supposedly know what’s best for them?

Finally, what can patients do to make their doctors listen?

2

Finally, what can patients do to make their doctors listen?

Get to the point.

I read several years ago of a study that showed that after about 30 seconds, most physicians aren’t really paying attention to what’s being said. Their minds have moved on to processing what they’ve already heard. I think this is probably a basic human nature thing, but is noticed more with doctors because of the importance we attach to their listening.

I see it in myself. My field is auto repair. Some customers lay out a spoken or written list of symptoms observed or services requested and in less than 30 seconds, I know what they want and what I need to do to get started. Other folks take 3 minutes to say 10 seconds worth of stuff because they throw in every meaningless detail associated with it (and some that aren’t). In those cases, after 30 seconds my thoughts are about how long-winded and useless this monologue is.

To what degree this relates to the experiences you’ve described, I don’t know. I do believe that everyone is well advised to get the key info to the physician succinctly.

I also assume that in medicine, as I know it is in car repair, the most helpful thing is a description of the symptom(s). The patient’s/customer’s thoughts on why or how the condition came about are usually not helpful, and you’d probably be surprised at how often they’re incorrect. Describe the symptoms clearly and accurately and the experts will know what to ask and what to do from there.

3

To add to what GaryT said, when I go to my doctor (whom I and many others like - he’s a busy guy) for a specific problem, I rehearse what I’m going to tell him, so I’ll be sure to convey what’s important efficiently.

4

Some relevant info from here: http://www.netdoctor.co.uk/editors_voice/index.asp?mode=showentry&entryId=53 (bolding mine)

Diagnosis depends above all on a patient telling a story and a doctor listening to it. This is not as straightforward as it might seem. A famous study of consultations by American physicians found that most
patients who were allowed to complete their opening statement without interruption took less than 60 seconds. None took longer than 150 seconds, even when encouraged to continue. The same study also noted that doctors frequently interrupted patients before they had completed their opening statement - after a mean time of only 18 seconds. Only 23 per cent of patients were allowed to complete their opening statement (Beckman, HB and Frankel, RM, ‘The effect of physician behaviour on the collection of data’, Annals of Internal Medicine; 1984; 101: 692-6).
And a tip for dealing with that from here: http://www.aarpmagazine.org/health/Articles/a2003-04-18-mag-medical-news.html

Make hurried doctors listen. You’ll likely encounter several doctors of different skills and temperaments during this journey. Remember that some of the best physicians are the worst communicators; prescription pads never talk back. To make her doctor listen, Rodgers practiced this line: “I need to say something, and if you promise to listen without interrupting, I promise to speak for 90 seconds or less.” It’s a surefire way to get silence. It sounds far more reasonable than “just two minutes”—which doctors hear as patient-speak for “a half-hour or so.” And, if you’re well-prepared, 90 seconds is enough time to say everything you need to say (the “Gettysburg Address” took scarcely longer than that).

And it looks like lots of good info here: http://www.managedcaremag.com/archives/9612/MC9612.listening.shtml

5

Whenever I go in for a new problem, or for a significant change in an old problem, I make a list of symptoms that have started and/or changed. I bring that to my appointment, and that helps a lot, too.

Robin

6

I’m trying to figure out what’s wrong with this. IANAD, but as far as I know they can’t do much for viral bronchitis/pneumonia. Virii pretty much have to run their course. And yeah, the times I’ve had bronchitis I’ve mostly just taken OTC medicine and coughed until my ribs ached.

7

My doctor barely acknowledges me, talks just to the nurse.
And she doesn’t talk to me but just reads the checklist the receptionist gave me.
And they make me wait an hour no matter if my appointment is for the time they open.
I’m sure they assume that if they make me wait I will be tired of them and want to keep it short. True.
But what do I care? I only go in because the company wants annual physicals.

8

I do the same. It works.

I treat the doctor’s appointment like a business meeting. I prepare for it. By writing out my list of symptoms and /or questions, I am making an “agenda.” Of course, I let the doctor do his thing, but by having a written list of problems and questions, I can easily make sure that all the points on my agenda are covered. And the doctor knows that I won’t ramble at him for an hour, because I’ve bothered to think through my complaints well enough to actually make a finite list.

I’ve noticed that if I have paper in hand, the doc always checks to make sure I’ve covered all my points, and won’t try to leave until I’m done with my list.

9

Here are a few suggestions:

–As others have suggested, organize your thoughts. What do you want me to address at this visit? Is this a routine checkup or are you having new problems? Write down any new complaints or any concerns you have about previous conditions.

People who have this (and a list of their current medications) are showing me that they’ve thought about this visit before I walked in the room. It also prevents what I call the “Columbo phenomenon”–when I’m walking out of the room after closing up the visit and the patient says, “Oh, just one more thing…”

–If you can (and it’s cool with me if you can’t or don’t want to), explain this agenda to the nurse. She might recognize that you’re going to need something done (say, an EKG or an x-ray, or some labs) and that can get done while I’m finishing up with someone else. It also helps me to start thinking about it when the nurse gives me the quick blurb up front.

–Don’t be afraid to shut me down if I’m interrupting you. I admit that I do this, but it is usually when patient’s stories are becoming tiresome. That sounds horrible, but you really have no idea–some people will give me the story of their sinus trouble beginning with the damned primordial soup. That said, if you’re convinced that your telling of the story is the best way to put it, ask the doctor to let you finish. If he gets pissed off about it, get a new doctor.

–Be as definitive as possible. For instance, I’ll often ask a patient with, say, a cold if she’s had any recent headaches, and she’ll say, “Well, I will take a headache sometimes…I did feel kind of dizzy the other day, but it wasn’t really a headache, and it was right after I got up really fast…I might have had a little something last week, but…” Look, if you have thought to yourself recently “Man, I have a headache,” then the answer is yes; otherwise, it is no. Don’t dig around for it.

–One of the primary tasks of the doctor, IMO, is teaching. People who don’t know anything about diabetes can’t be expected to take care of themselves. Try to let me know where you are in your understanding of your conditions–I don’t want to waste our precious time going over what you already know.

–In brief, the more concerned you appear to be about your health, the more concerned I’m going to be about it.

Can’t say for sure based on this alone, of course, but this is not at all inconsistent with viral pneumonia or bronchitis. If I were her, I’d call the doctor back and explain that the coughing is really troublesome, especially if it keeps her up at night, and see if he’ll give her a stronger cough suppressant. (Standard medical advice disclaimers apply.)

Dr. J

10

The vast majority of doctors I’ve had were very good. Since I can remember, only one doctor I’ve had has really done something mind-boggling.

I was at the doctor because lymph nodes in my genital area were acting up. I was at least 18 years old for this. The doctor, without asking my father to leave the room, asked me if I was sexually active. I told her I wasn’t. She then asked me if I masturbated. I told her I didn’t (truth there. I wasn’t too embarassed to tell the truth). I doubt she believed me. I don’t remember what happened after that but it was something to the effect of “well if you are [sexually active/masturbating], this stuff can happen.”

At that point I wondered why in the blazes she asked the questions if she wasn’t going to take me at my word.

Most of them have been quite competent. But this one just struck me as being extremely strange.

11

I find that telling the nurse what is happening or what additional treatment I need is very effective. She notes what I’ve said in my chart, the doctor refers to it, asks relevant questions and we are both out of there quickly. When I have waited to tell the doctor directly, it seems to take longer and feel more like I am rambling rather than conveying information.

BTW My mom and I have the same doctor, we both like him and his small town family practice. He listens when we say that a particular med isn’t working, offers alternatives and makes routine “healty living” suggestions without sounding like a condescending ass. And the best part, when I call to make an appointment they can generally see me within 2 days for non-emergency appointments and can always take a walkin for serious stuff.:slight_smile:

12

I can tell you what you can do at the doctor’s office to make the visit NOT go well. These are big pet peeves of physicians.

  When asked "What can I do for you today?" (polite way of asking "Why are you here?"), don't make some joke about "You should know....you're the doctor" or say, "I don't know....some other doctor sent me here."  You have no idea how often this is an answer and how unbelievably annoying it can be.  Know why you are there is step one.

   As much as possible, know the names of medicines and why you take them.  Men are actually horrible about this.  I can't count the number of times I've asked a man, usually elderly, what they take and their reply is, "I don't know....you'd have to ask my wife."  ANd know, this is not in Alzhemier's or demented patients, this is in patients who are just completely dependent on their wives for their care.  Hey buddy, its your medicine and your life, take some responsibility.  At least have SOME idea what you take it for.  I realize some people are on many medicines and it is tough to keep track of every single one.  I don't expect detailed information.  I don't even care about most dosages, just a name or what it is used for, but its amazing how many patients, again usually men, don't even know this much.

  On a related note, replies like "I take an orange pill and a purple pill and a red pill..." aren't very helpful either, especially if you have no idea what it is for.  Doctors cannot ID most pills by description.  Actually, the common ones of their own speciality they probably can or have a chart to look on to ID it, but don't count on it.  

    As stated by others earlier, get to the point of your symptoms and know the following things about them :  How long has it been present, how often does it bother you, how severe is it, when does it happen, what helps it, what makes it worse, what other symptoms happen with it.  If you can answer all those questions as best as possible and as coherently as possible (notice I did not say quickly because I realize this is not a speed contest and that it takes time to really describe some symptoms, but "coherently" is the key), your doctor is much more likely not only to LISTEN to you but also be able to help you.  Despite all the fancy technology and great tests available, you still can't diagnose anyone without a good history of the problem.

        Most people actually do fine with all this.  I can tell you for a fact, though, that it is the patients that either don't know this information or simply have not thought about this information enough beforehand that are the toughest to deal with and the toughest to treat simply because you end up not knowing their medical history and not knowing what exactly it is you are supposed to be doing for them.
13

Take your own notes during the visit, prefereably on your list of questions/symptoms/medications. And ask, “Should I ask to speak to you or to your nurse if I have questions later?” Then when you get home, look up what the doctor told you or prescribed.I’ve caught several presecriptions that were contraindicated in conjunction with my health or other prescriptions. Most doctors are happy to have you check their work in this way. If they’re not, consider shopping for a new doctoir–there are plenty who don’t have so much ego wrapped up in it that they have to be right at any price.

14

Another thing is, when I go see a specialist (or a different doctor outside my primary’s practice), I bring the appropriate medical records. Copies of test results (and the films themselves, if it’s appropriate), other specialists’ consult reports, and my own doctor’s observations are very helpful. I also like to bring a copy of my last physical exam so the specialist can get a complete overview of my overall physical condition. This has kept me from having to undergo multiple exams and tests, and also from having to duplicate specialities.

Robin

15

I think IUHomer made some really important points. My bet is that a lot of doctors are completely innured by patients who are unable to (literally) tell the difference between their elbow and @sshole. Most of the time I am able to completely (and accurately) diagnose myself and refer to my body parts and condition in the proper Latin terms. Doctors are usually very informative with me because they know I have boned up (as it were) on my medical terminology and they’re confident that what they say will be listened to.

16

I don’t know if doctors are less likely to listen to sicker patients (my gut tells me the exact opposite), but I do know that they’re less likely to listen to whiny patients. You know, the ones that spend twice or three times as long complaining as communicating.

And a lot of time, I’d say that’s the key: being an effective communicator. How do you communicate effectively? By doing as others have suggested and getting to the point with a clear, preferably concise, coherent history of why you’re here today.

Of course, for some doctors, that still doesn’t help. I went to Student Health once and told them “I’m exhausted all the time, I’m sleeping about 14 hours a day, my appetite is way down, and my skin is turning yellow.” They pulled blood for thyroid tests, mono tests, and a basic metabolic panel. The thryoid was at the bottom of the normal range, the mono test was negative, and my liver enzymes were elevated. My diagnosis? You’re too fat (I was maybe 15 pounds overweight at the time) and need more exercise to make you feel better. Quit napping and take a walk instead. Oh, and you might be depressed.

Then there’s my former FP. We were discussing birth control options and she asked if I wanted a referral to an OB/Gyn. I told her I didn’t have any gyno conditions, and we were never having children, so I didn’t see much point in having a specialist for pelvics and birth control. I don’t see how much clearer or more coherent I could have made that. Her response? “Well, in a year or two when you decide it’s time for a baby, we’ll get you a referral then.” Clearly she wasn’t listening to the part about never having kids. (That or she’s one of those insufferable “you’ll change your mind” twits. Of course, she could have been not listening and a twit.)

Why you wouldn’t listen to someone who knows what they’re talking about and is trying to take an active part in their own care, I don’t know. I think there is a tendency with some doctors to dismiss non-specific problems like tiredness and weight gain and general malaise in women as stress, or depression, or hormones, or poor eating habits. (This isn’t to say that this isn’t a valid diagnosis for some patients, just that some docs diagnose it for just about every female patitent.)

The best advice I can give is to know what the hell you’re talking about. “My hooha feels funny” is NOT a medical history. Know the names for your external body parts, and use them. So what if they sound too clinical? You’re in a clinical setting, for heaven’s sake. Have a basic understanding of how your body works. Know what pills you take, how much you take of them, and what you take them for. Know what kind of side effects they can cause. Know the dates of any major illnesses or surgeries you’ve had (and what the sugery was, and why you had it.)

Be an equal and active partner in your own health care, even if your doctor hangs on your every word. Help the doctor help you. You’re worth that much of your time and energy, aren’t you?

17

Very well put, CrazyCatLady.

   Another thing to keep in mind, although there is not much you can do about it, is that some symptoms are much harder to diagnose than others.  A complaint like "Fatigue", which is a billable ICD "diagnosis", has a differential diagnosis that is about 12 pages long.  It can be very difficult to come up with a positive diagnosis in cases like that.  What doctors can do is rule out the serious, common, treatable and reversible conditions that can cause the these symptoms, but to come up with a specific cause can be extremely difficult sometimes.  Similar problems are dizziness and generalized weakness.  In some cases its not so much that the doctor doesn't want to listen or help but instead the fact that they know its going to be hard to find a definitve underlying cause that can be treated.  They are harder problems to deal with for that reason, which can be frustrating for the patient and doctor.  In some cases, it may come down to accepting the fact that this is not anything life threatening or serious, its not going to get worse but there may be little to do to "treat" the problem.  These are the worst cases of all to have to work through because they tend to be the cases where the patient is most likely to come away with the feeling that a whole bunch of work was done and money speant, but they are no better off now than when it all started.  Basically, many times it comes down to really salesmanship by the doctor.  Many times, the real skill of being an effective physician comes down to how well you can convincing someone, "Yes I am listening and concerned, but at the same time I am confident that you are really OK and and we just need to watch this problem."  Its tough to do.  This is really the greatest skill a physician can have.  I have often thought that this should be tested on baord exams.  After all, most anyone allowed in med school can be taught to read an Xray/film, put some symptoms together for those rare but tough diagnosis and come up with the right treatment in a case with a clear cut cause.  However, not all physicians can effectively nurture and reassure patients through common, everyday things they see.  Its a weird dichotomy of the testing process that the items seen in everyday practive are not always typically the things tested on speciality board exams.