Communicating with Your Health Care Provider

Article taken from page 6 of the November/December Newsletter 2016

It’s 10:30 in the morning and you’ve already been waiting for an hour to see your doctor. You’re called back and complete intake questions with a nurse, highlight the main reason for your visit. Then you wait another 30 minutes before the doctor enters your exam room. You may feel rushed to answer the doctor’s questions and hesitant to ask clarifying questions or talk about uncomfortable issues. But, before you know it, you have a prescription in hand or next steps to follow, and your appointment comes to an end.

If this sounds familiar, you’re not alone. On average, doctors spend just 15 minutes with each patient, partly because of insurance reimbursement rules, and partly in an effort to fit more patients and procedures in to the workday. Happily, some data suggest that visit times have been lengthening in recent years.1 Longer visits don’t necessarily translate into improved patient experience or health care delivery, however. Instead, research suggests that improving doctor-patient communication could be the key to improved patient experiences and outcomes.2 When that communication isn’t robust, patients are left with unsatisfactory health care experiences or incomplete diagnoses.

Given the importance of doctor-patient communication, many efforts are underway to improve this relationship in clinical practice.3 For example, medical schools and hospitals are adding cultural competency courses, sensitivity trainings, and communications training courses to improve physicians’ ability to communicate with patients and help them view health care events within the rich complexity of patients’ lives.4 And, insurers are now paying more attention to patient outcomes, rather than focusing primarily on the amount of health care providers deliver.

Technological innovations also present new strategies for improved communication. For example, auto5 On-line patient portals enable patients to check their test results, update their medical profile, and submit questions to their doctor’s office at their convenience — rather than waiting on hold to leave a message for their doctor. Increasingly, doctors encourage patients to email and text them, as a way to improve communication. (These advances can help improve patient-provider communication, but remember that these conversations are not covered by Health Insurance Portability and Accountability Act (HIPAA) standards, which protect patients’ personal health information.)

Expanding communication options outside the exam room can improve doctor-patient communication; they can make physicians more accessible and less time-strapped, and prevent patients from waiting until their next appointment to get questions and concerns addressed.

Here are some additional strategies patients can use to have empowered, informative, and productive conversations with their doctors during an office visit:

  • Add your narrative. If your doctor asks close-ended questions, Baltimore City Health Commissioner Dr. Leana Wen suggests pretending you’re being asked “how” or “why” instead of “yes/no,” and add your own response.6 For example, if asked if you are in pain, answer by relating how the current pain started when answering the question: “I have pain right now in my leg, right here; it started after I really pushed myself playing tennis on Monday.”
  • Ask questions. If you’re unsure why your doctor’s question is relevant, ask about it. This can help clarify how seemingly-unrelated issues could be important to discuss with your doctor, or provide context for your doctor’s recommendations. Don’t hesitate to ask your doctor to restate or clarify any information or unfamiliar terminology. For example, if your prescription is “contraindicated for use with NSAIDs,” ask for clarification in terms you can understand. You’ll be safer knowing that the medication isn’t safe to take along with common over-the-counter pain medications, like ibuprofen (Advil, Motrin), aspirin (Alka-Seltzer), and naproxen (Aleve), to name just a few.
  • Say your piece. One study found that patients in primary care settings were interrupted after just 12 seconds — either by their provider, a beeper, or a knock on the exam room door.6 If you’re cut off when trying to answer a question, feel free to interrupt. Dr. Wen suggests patients pretend they’re having a conversation with their provider, rather than just answering questions. For example, if your doctor interrupts when you try to explain when a headache started, ignore the interruption. Go ahead and relay how the pain began rather than responding just with the time: “I woke up this morning feeling well, but on my walk to work, the pain came on suddenly like a lightening bolt striking me.” This approach provides context to your experience, and forging ahead despite an interruption can ensure that your entire answer is heard and your experience is described in your own terms.7

We hope that insurance companies will start paying for better communication. Until they do, use our tips to make sure your health care provider hears you, and that you get the high-quality care to which you are entitled!

Emily Capilouto, MPH, is currently a Master’s candidate in medical anthropology; her thesis explores physicians’ attitudes toward cervical cancer in Bangalore, India. Emily was an NWHN policy fellow in 2016.

1. Rabin R, “15-Minute Visits Take A Toll On The Doctor-Patient Relationship,” Kaiser Health News, April 21, 2014. http://khn.org/news/15-minute-doctor-visits.

2. Travaline JM, Ruchinskas R, D’Alonzo GE, “Patient-Physician Communication: Why and How,” J Am Osteopath Assoc 2005;105(1):13-18. http://jaoa.org/article.aspx?articleid=2093086.

3. The Experts, “The Experts: How to Improve Doctor-Patient Communication,” Wall Street Journal, April 12, 2013. http://www.wsj.com/articles/SB10001424127887324050304578411251805908228.

4. Gillian T, Sekeres M, “Can Doctors Be Taught How to Talk to Patients?” New York Times, February 27, 2014. http://well.blogs.nytimes.com/2014/02/27/can-doctors-be-taught-how-to-talk-to-patients.

5. Ostrov BF, “Hospitals Employ Email ‘Empathy’ To Help Doctors And Patients Keep In Touch,” Kaiser Health News, February 2, 2016. http://khn.org/news/hospitals-employ-email-empathy-to-help-doctors-and-patients-keep-in-touch.

6. Wen L, “6 Tips to Get Your Doctor to Listen,” Huffington Post, March 27, 2013. http://www.huffingtonpost.com/leana-wen-md/doctor-patient-communication_b_2527365.html

7. Rhoades, DR et al, “Speaking and interruptions during primary care office visits,” Fam Med. 2001 Jul-Aug;33(7):528-32. http://www.ncbi.nlm.nih.gov/pubmed/?term=Rhoades%2C+2001%2C+primary+care