Can You Hear Me Now?

By Nissa Simon

Time is short--especially at the doctor's office. During each visit, you spend only 12 to 15 minutes with your doctor, the National Ambulatory Medical Care Survey has found. And when you try to explain how you're feeling, chances are the doctor will interrupt before you get 23 seconds into your recital, says an article in the Journal of the American Medical Association.

No wonder "My doctor doesn't listen to me" is one of the top gripes about medical care.

So how do you get the most bang out of your medical-insurance buck? The key, as in most relationships, is communication. "We've known for some time that good communication provides doctors with the kind of information that helps them diagnose and treat problems," says Dr. Dennis Cope, chair of internal medicine at the UCLA San Fernando Valley Program. But recent research shows there's another benefit: the better your doctor understands you, the faster you may heal. People with diabetes, rheumatoid arthritis and ulcers, for example, do better when doctor and patient listen to each other, Cope says.

The first step toward better health care is choosing the doctor who is right for you--someone you feel comfortable with, says Dr. Howard Hiatt, professor of medicine at Harvard Medical School. "You should be able to say, 'I'd like to have the time to talk with you, to express my concerns and to hear your response. And when it's necessary to make a decision, I'd also like to do that with you.'"

Don't wait to hunt for a doctor until the day you come down with the flu. Start the search when you're feeling healthy, advises Dr. Mack Lipkin Jr., director of the division of primary care at New York University School of Medicine. "You wouldn't buy a car the day you needed to get out of town," he says. "You'd want time to shop. You have to do the same when you choose a doctor." Although the concept of meeting with a physician before you sign on as a patient may seem a bit strange, Hiatt says, "there's no reason you can't interview a doctor and say, 'I'd like to consider your taking on my care. Here's the way I look at my medical situation. Can you work with that?'"

Once you have chosen a doctor and made an appointment, gather all your medical records, laboratory-test results, X rays and CT scans. If you don't have them, call your previous doctor and ask for copies.

If you have a doctor but feel the relationship isn't working, you can try to fix it, notes Lipkin, who is a principal investigator in a three-school project, funded by the Josiah Macy Foundation, to teach communication skills to medical students. It's a good idea to try to correct problems and misunderstandings as they arise. But if the frustration persists, the best medicine is to leave and find another doctor, Lipkin says. People often say they are unable to switch because they live in a small, one-doctor town. But for most Americans, that should no longer be an obstacle to finding someone simpatico. Noting that 90% of the population lives near an urban area, Lipkin concludes, "People do have choices."

You need to feel as though you can share all your concerns with your physician, no matter how absurd you might think they are. "Some of those imagined possibilities are so frightening that people feel embarrassed to share them," says Cope. "Your thoughts could run like this: This is probably only a cold; I hope it's not pneumonia; I sure hope I haven't got leukemia." If you don't share these fears with your doctor--and give him or her a chance to rule out worst-case scenarios--you may continue to have nagging doubts about both the diagnosis and your doctor's skill, says Cope.

Finally, if you have an appointment scheduled and you expect to receive bad news, prepare for it. Take along someone whose support you can count on to take notes and serve as an extra set of ears. Also consider using a tape recorder so you'll have a record of the doctor's explanation and instructions, counsels Lipkin. Sometimes anxiety makes it hard to absorb information the first time around.

"A lot of people have the idea that doctors prefer to be in charge," Lipkin says, "but we found that physician satisfaction was highest when patients took an active role in their own care."