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When it comes to doctor visits, you know the drill: An eternity in the waiting room, and then a few precious minutes with your physician who rushes in and out.
Never think of that brief time as just small talk you make before you get to the blood test or MRI, said Dr. Danielle Ofri, associate professor of medicine at New York University and an attending physician at Bellevue Hospital.
The doctor-patient conversation is the most important diagnostic tool, she noted.
“But the system is set up to provide the poorest environment for communication,” said Ofri, author of the new book “What Patients Say, What Doctors Hear.” “The reality is… some doctors have as little as 10 minutes for a patient.”
Are you getting the most out of your visit? Here are seven mistakes to avoid:
1. Not prioritizing your questions
Making a list of questions for your doctor is smart, but some patients come with dozens of questions, Ofri said. That means you’ll get only superficial answers, or the doctor will simply run out of time.
Prioritize one to three of most important things you want to ask. You might even want to ask your doctor which questions she thinks are the most important.
2. Not honing your story
“I have some patients who will come in and will tell me the story starting when they were 5 years old and bring it all the way up to the present and there will be a lot of time lost on things that probably aren’t relevant,” Ofri noted.
At the other end of the spectrum, some patients simply tell her to read their chart. But that may not be an accurate reflection of what’s going on, she said.
Doctors want to hear the problem in your own words. Really think about what’s important. Work on your story so you can get the key points out in a few minutes.
3. Expecting the doctor to solve it all
Not every pain can be diagnosed in the way you might want, Ofri said. There are some things doctors can’t specifically explain.
Many health issues relate to what you do in your life — diet, exercise routine, amount of stress — and that's not easily “curable” by a doctor or a prescription. Realize that getting better may require major changes in your lifestyle.
4. Thinking good medicine is defined by tests
“There’s a common expectation that every problem will merit some kind of thing — such as a CT scan, or a blood test or an endoscopy or antibiotic — and if you don’t get that thing, then that wasn’t a visit,” Ofri noted.
If your physician is taking a good history to ferret out the problem, many of those tests can be avoided. In the U.S., doctors over-order tests excessively, partly because they fear malpractice suits, but partly because patients expect it, she added.
That approach can be dangerous because every test has side effects. It can also lead to false positives: if you do enough tests on a healthy person, something will eventually come up as “abnormal,” Ofri said.
“Good medicine is when your doctor takes careful history and maybe picks a single important test or maybe no test at all. Maybe there’s a watchful waiting or collecting more data,” she added.
5. Not asking about side effects
Most medications have a long list of side-effects because drug manufacturers are required to include everything anyone has ever reported, Ofri said. Doctors won’t discuss each one.
“If you multiply a complex illness times many complex medications and each one of those has many complex side-effects, you’re talking about 500 data points,” she noted. “The doctor may have told you about 300 of the important ones, but left out the one you end up with.”
So ask: Are there any important side-effects I should know about?
6. Not telling your doctor you cut your pills in half
For some medications, it's fine to cut the pill in half; for others, it’s critical not to do it. Some patients divide pills because of costs, or because they’re worried about side-effects like sexual dysfunction or headaches.
Whatever the reason, Ofri wants to know.
“I’m not going to get angry at a patient; in fact, I’ll be grateful that they told me,” she said. She can tell a patient whether it’s dangerous to cut the pill in half or not, and she can look for alternatives if the drug is too expensive or has too many side-effects.
7. Expecting a precise prognosis
For doctors, giving a diagnosis is different than providing a prognosis.
“The science of prognostication is very imperfect,” Ofri said. “To say ‘You have six months to live,’ that’s a very hard thing to do… no one has the crystal ball for a particular patient with their genetics and their environment and their diet.”
For someone facing a terminal illness, she’ll say: On average, here’s the range people with your condition live. Let’s hope for the best, but let’s also plan for the worst.
“That to me is the most honest I can be,” Ofri said.