by Karen Knops, MD
So far in this A-S-C-E-N-D series about visiting your physician, I’ve discussed “A” for Anticipation, planning ahead for your appointment. I then examined “S” for Summarize in the first moments of the visit, an ideal time for patients and providers to summarize goals for the appointment and begin to share information, creating a story about what has been happening and why. Before the conversation moves on to medical recommendations or treatment options, it is worth pausing to share your most important concerns.
Doctors often direct the conversation using specific questions, sometimes interrupting within seconds. It is easy to spend several minutes in conversation without really hitting on what worries you most.
The magic question is this: “Can I tell you my biggest concern?”
This is such a humble request that I have never heard it denied. This often gets the provider’s attention, which may have been divided between you, his or her thoughts about your problem, and the computer or any number of necessities and distractions. You can now share what matters to you most — be it an idea about diagnosis or treatment that is dominating your thoughts, a worry about why this has happened, or concerns for the future.
Address your concerns about sharing concerns. If you are someone (like me) who can be struck mute by fears of angering your healthcare team, take a moment as you anticipate your interaction to question your assumptions. Cluing your providers into exactly what you hope or fear can focus attention on an issue critical to your safety or understanding, and helps them know what to address. By ensuring your biggest concern is heard, you may save yourself and your physician the frustration of sharing information that is of no value to you, and reduce the risk of your mind wandering back to your concerns when you want to be listening.
Notice and name how you are feeling. It can help to name your emotions — sad, angry, frustrated, worried, etc. This is a mindful way to express yourself that reduces the chance that those emotions will overwhelm you or be misinterpreted. It is normal to feel angry about losses related to illness and treatment, and stating that you have anger is more helpful than breaking down or raging at your provider.
Frame the issue in your favor: “I want us to get the most from our conversation, and it might help if I let you know what matters most to me.” If you fear your concern could be misinterpreted, say so. For example, “I am concerned about the cost of my treatment, but I don’t want to seem like money is the only thing I care about.” If you still fear sharing your concerns, remember this: Relationships can be developed and repaired over time, but a relationship in which you feel unheard is not a real relationship.
Keep it relevant to your situation. Reading reputable websites from national organizations or garnering support from online patient communities can be a helpful way of empowering yourself, but information from outside sources can sometimes distract from your conversations with your physicians. Bringing in a stack of literature from the internet and asking a provider to review it, or referencing specific individual cases to compare with yours, can feel like a no-win situation for providers. If they delve into what you are asking, it can take large amounts of time and may not help you, but refusing to do so seems disrespectful. Try asking about the issue more generally and gauge your provider’s reaction. If your doctor does not address your concern, share specifically why you are asking and offer additional references. If this seems to put your provider on the spot, offering to discuss in a follow-up visit or phone call may balance your desire for information with time constraints.
Sharing concerns is the foundation of the therapeutic relationship. As human beings in an imperfect healthcare system, physicians will have bad days or miss cues, but if your doctor repeatedly dismisses or minimizes your concerns, it is red flag that you are not a good fit. The role of healthcare is to help people, and being clear about what matters most to you lets the right help find you.
Learn more about the A-S-C-E-N-D framework in this introduction.