It didn't surprise me when I received this e-mail following last week's post about concierge medicine:
I wish I could afford to pay my doctor's $2,000 fee for concierge service, but I can't. As a result, I'll be switching over to a new physician in a few months. It's so important to me to build the trust and relationship I have with my existing doctor, but I'm afraid it's going to be even more difficult since doctors are more and more rushed and pressured these days. I'd love to hear any tips on how to handle this dilemma.
It turns out that for some time I've had an interest in this topic as well, stemming mainly from my own past experiences with the health care system many years ago when I was in the position of having to navigate it during my own illness.
And today, because of the state of the health system, the doctor-patient relationship is even more precious as well as precarious. The average time we spend per visit hovers around 11 minutes—or even shorter. Add in the fact that you've probably already spent more time in the waiting room than you will in the examining room, where you sit barely clothed on a hard table with little more to do but strain your ears to hear approaching footsteps. By the time the doctor arrives, you're no doubt a mess and heap of emotion. (An aside: I recently visited my gynecologist. I was surprised—and pleased—to see a sign that read, "Please feel free to bring your own bathrobe for your visit." Sure beats that rough, itchy paper gown you have to wear. At least it's a step in the right direction, no?)
Most patients are united on these complaints: the doctor doesn't listen; rushes me through my visit; is too quick to order a prescription or a test (some reports estimate that from one-fifth to nearly one-third of all medical tests are unnecessary). That's worrisome—but it only highlights the fact that, while defensive medicine might bear partial responsibility, you, the patient, must also bear some responsibility and enter into the relationship as a partner in your own health care. And that doesn't require intricate knowledge of medicine. Rather, it involves some planning and some practical tips
- Make a list. Sit down a few days before your visit and organize your thoughts. Make a list of your top three concerns—the things that worry you the most. This helps organize the conversation. It also helps keep the conversation on track during your visit. It's too easy to veer off (and run out of time!) if you have a laundry list full of questions. You might want to ask the doctor, at the start of your conversation, how much time he or she has allotted for you.
- Ask questions. You do have a right to know; don't be afraid to ask. Questions don't have to be complicated: What do you think this could be? What do you/I hope to learn from this test? Why is this being ordered? What's the timeline—when will I get results, and how long should it be before my problem is resolved? What is the cost? (If your insurance company won't cover the test, there may be other tests available.) What are my other options? (You have the right to accept or decline, as well as get a second opinion.)
- At the end of your visit, repeat back what you've learned. By doing so, you'll avoid communication errors. It's easy to miss some things, whether that's because you're feeling anxious, rushed or overwhelmed. Before the doc runs out the door, do a quick, "So, I'm going to call you Monday afternoon to get my results, right?" or, "You want me to take the medicine on an empty stomach. Is that correct?" Making sure you have a follow-up plan in place will help you feel more confident going forward.
You might also want to read: Talking with Your Health Care Provider.