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.
Clinicians 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 us most. It can help to use the “magic question” early in conversation to ensure that the matters that get attention are the ones that matter to us.
Consider concerns about sharing concerns. Many people are inhibited by embarrassment, fears of looking stupid or of angering their healthcare team. Cluing clinicians into exactly what we hope or fear can focus attention on an issue critical to safety or understanding, and helps clinicians know what to address. By ensuring our biggest concern is heard, we may save clinicians the frustration of sharing information that is of no value to us and reduce the risk of stewing over our concerns when we want to be listening.
Try the “magic question.” The magic question is this: “Can I tell you my biggest concern?”
This is such a humble request. Attention, which may have been divided between us, the clinician’s thoughts, and the computer or any number of distractions, is often brought back to the right things if we just ask.
Notice and name emotions. It can help to name feelings — sad, angry, frustrated, ashamed, worried, etc. This is a mindful way to express ourselves, and it reduces the chance that those emotions will overwhelm us. It is normal to feel upset about losses related to illness and treatment, and naming that feeling out loud is more helpful than breaking down or raging at our care team or loved ones.
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 we fear our concerns could be misinterpreted, we can 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.” It is better to speak up, even if it is difficult. Relationships can be developed and repaired over time, but a relationship in which we feel unheard is not a real relationship at all.
Keep it relevant. Reading reputable websites from national organizations or garnering support from online patient communities can be helpful and empowering. Occasionally, information brought from outside sources can distract from conversations, so using good judgment is key. Bringing in a stack of printouts and asking someone to review it, or referencing specific individual cases to compare with can feel like a no-win situation for clinicians. If they delve into that type of concern, it may not help and shifts attention away from you, but refusing to do so seems disrespectful.
Asking about the issue more generally and mentioning that we’ve been trying to find good information lets us see where the conversation goes. Sharing specifically why we are asking can help the clinician address the issue in another way or decide to delve into the information at hand. If the concern seems to put the clinician on the spot, offering to discuss it in a follow-up visit or phone call may balance our desire for information with time constraints. Asking directly what online resources they feel are helpful allows us to gather more information while avoiding ones that are not aligned with the practice style of the clinician, or worse yet, information that is misleading or dangerous. If there are major differences in perspective, we can weigh whether it might be worthwhile to find a clinician who is a better “fit” versus trying to align perspectives.
Sharing concerns is the foundation of the therapeutic relationship. As human beings in an imperfect healthcare system, clinicians will have bad days or miss cues, but when a clinician repeatedly dismisses or minimizes our concerns, it can be a red flag. The role of healthcare is to help people, and feeling able to voice what matters is central to that mission.
Read the next post: “E” for Explore.
Learn more about the A-S-C-E-N-D framework in this introduction.