by Karen Knops, MD
Each meeting with a physician or other healthcare professional is a shared journey. It can be healing and affirming, or a source of confusion and mistrust. There is increasing evidence that communication often falls short in healthcare. A few thoughtful steps can help: preparing for the visit, having a concise summary ready to share, prioritizing your concerns to make sure they are discussed, exploring anything you don’t understand, getting the clear next steps, and writing or recording the visit. Those steps can be summarized in A-S-C-E-N-D.
An introduction post shares what inspired the ASCEND. This post shares the first step: “A” for Anticipation.
As a teenager with scoliosis, I logged hundreds of hours waiting at doctor’s offices. Between waiting to check in, waiting to get my X-ray, and waiting for the doctor, 3 hours of zoning out on wilted tabloids and talk shows could be racked up on any given day. When my name was finally called, I’d stumble from my chair like a bear cub awakening from hibernation, groggy, surly and disoriented. I coined the term “white coat dementia,” because the anxiety of doctor visits invariably caused me to forget my questions. I’d feel ashamed and stupid, nodding like a dashboard bobble head, not wanting to waste the doctor’s time, but invariably walking out baffled. I could cram a lot of suffering into a 15-minute office visit.
My experience as a less-than-graceful patient is instructive in my alternate life now as a physician for patients with serious illnesses. Call it post-traumatic growth, but I’ve never lost my awareness that commonsense can easily go on hiatus when we are gowned and vulnerable. Taking notes should have occurred to me as a straight-A student, but never once did I try that. I would log hours practicing for a youth symphony audition, but preparing for a doctor visit never crossed my mind.
It is puzzling to me that we health care professionals have not done more to give patients an edge in those exam rooms. In courses on communication skills for health care workers, there is something missing. There are always two parties involved, and communication skills are only provided to one.
As hard as many conversations may seem for us as clinicians, we are the participants who don’t have health of ourselves or our loved one on the line. Considering who, what, where, when, why and how medical conversations occur is the first, unseen step in this shared experience, and it is equally important for both patient and provider.
While we cannot reduce the complexity of the human body, the mental and spiritual impact of disease, or the societal factors, we can reduce the complexity of communication itself.
Studies have shown that patients who are given guidance about what to expect in healthcare environments have better outcomes. Knowing how a doctor or other clinician will talk to you provides a small lever of control in the vast machine of healthcare.
We need to have tools to convert places of waiting into places of anticipation. While you may wonder if there is an app for that, my feeling is that we are more likely to be distracted by our phones (Words with Friends, anyone?) than to be helped. I’m sharing my solution: a patient checklist that mirrors the model of narrative co-creation often taught to healthcare providers.
Even now, I need to be reminded to empower myself as a patient.
Tips for Anticipating Your Doctor’s Visit
Before any visit, appreciate that you are doing the best you can. Let go of things you cannot control, and remember that medical providers are also doing their best.
Who will you be speaking to? Are you new to this person? If not, when was the last time you spoke? Do you need to bring a friend or family member with you to this visit, or put someone on speakerphone to help you take in all of the information?
What are your top three priorities for this visit? Write down a list so you won’t forget, and if there isn’t time today, you know what to cover next time. What might the medical provider want to discuss? What forms or specific information might you need to bring?
Where and when is the visit? Give yourself time to get there so you aren’t rushed. If there is something that needs to be discussed with other loved ones present, is there space for that to happen? Time of day can make a difference, so identify the best time for you.
Why is this visit important, and how do you best give and receive information? Is this part of a bigger picture? Can you quickly summarize what you want to discuss? Remember that you can take notes or ask to record parts of the visit. Some of us do better with pictures or models, or with written information to take home — don’t be afraid to ask!
Coming up next: “S” for Summarize.