Questions are interesting: They are not facts. They aren’t necessarily based on anything tangible. And they often mean much more than the literal meaning of the words used to form them.
As a doctor, I have discovered over many years that questions can reveal as much about a patient’s condition as lab tests. Doctors get a lot of questions, and these are worth paying attention to because they are a window into what someone is thinking and how someone is feeling.
A perfect example of this is a simple question I often hear from patients: “Am I going to be on this medication forever?” This seems like a direct question at first. They want to know if there is an end point to their prescription. But this question can also mean many other things, such as:
- Am I ever going to get better?
- Am I always going to feel sick without this medication?
- Is this medication a cure or just a cover for my symptoms?
- Will I have to budget for a lifetime of this medication? Can I afford that?
- Has my life changed irreparably?
Ultimately, what they are really asking is: “Am I going to die?”
Questions like this are gifts. They are a gesture of true intimacy from patient to doctor. If the doctor really listens, she or he can respond in kind, addressing that intimacy by continuing the conversation and offering real information rather than platitudes. But that takes vulnerability on the part of the patient and a willingness to really listen on the part of the physician.
On the other hand, all too often, patients don’t ask the burning question. They may not think their question is important enough to bother their doctor about. They may believe their question doesn’t matter or is “stupid.” Sometimes, they don’t know how to ask the question the right way, so they don’t try. And in many cases, they don’t really want to know the answer.
A new patient recently came in to see me for a second opinion. I looked in her chart and saw that she had been deemed “noncompliant” by another doctor. She had atrial fibrillation but was not taking the blood thinner that doctor had prescribed for her. Atrial fibrillation is a major risk factor for a stroke if it isn’t treated, so doctors try to impress upon their patients the importance of taking this medication. When the patients don’t follow this advice, the chart often gives the reason why. But there was no reason in this chart. Why was she “noncompliant”? I couldn’t tell. The doctor had noted that she wanted a second opinion, so I could only guess that she wanted to know if she actually needed a blood thinner. Maybe she wanted to know if it would cure her, and if not, she wasn’t interested? Was she completely uninterested in taking care of herself? I couldn’t know without asking a question.
But when I met her, I decided not to wait for her to ask me a question. I opened the conversation with an open-ended question: “How can I help you?”
I could have said other things. I could have been judgmental or given her a lecture. I could have asked, “Do you realize the danger in not taking your blood thinner?” But this kind of question takes the power away from the patient. It implies that the doctor doesn’t care about the patient’s feelings or respect that she may have a reason for what she is doing. I could have asked, “Why wouldn’t you take a blood thinner, if you knew you could get a stroke?” That kind of question is scary and intimidating. Instead, I asked a question that opened the door for her to direct the conversation, and her answer revealed to me that this was the right choice.
As much as I have talked in the past about the doctor-patient relationship and the need for communication, I continue to see this connection disintegrating. As we head full steam into a world increasingly governed by technology, including doctor visits over the Internet or even over text, through apps, or via e-mail, the opportunity to take advantage of the nuances of these subtle exchanges gets lost in the digital shuffle. Everyone wants to move faster, get things done more efficiently, and move on to the next thing, but with a quick-and-dirty question like, “No meds? You are noncompliant!” the subtext gets stamped out. There is no room and no time for the question, “Why?”
The more you know people, the more you understand who they are and the greater chance you have to discover what they really need. What could be more important for a physician? But one of the most important qualities this kind of exchange requires is empathy. Without this ability to understand how someone else is feeling, asking questions is like throwing rocks into the ocean. It’s a longshot whether or not you’ll hit on anything important.
But doctors, hear this: If you can allow yourself to feel empathy and let your questions arise out of that initial framework, you will not only ask better questions, but you will be better able to interpret the meaning behind the answers and the questions that may follow. Instead of judging the questions or the answers, you will be more open to understanding their true intent. (By the way, this is good advice for any communication. It’s not just about doctors and patients.)
But back to my “second opinion” patient. As it turned out, she was a lovely woman and not “noncompliant” at all. Her insurance company had changed her blood thinner to a new drug that she was not familiar with, and she was concerned to take it because of all the side effects she had read about in the materials that accompanied the medication. This is a sensible and natural response from a patient who is not willing to take a new medication blindly. She had opted not to take the medication until she could speak to her doctor, but when she tried to talk to her doctor (more than once), she got only the question: “Are you taking your medication?” When she answered, “No,” the doctor documented it and labeled her in a way that made me, the next doctor down the line, question her motivation to take care of herself because she was not following her doctor’s recommendations.
You can see where this communication broke down, resulting in the mislabeling of a patient who had all the best intentions. Words have power, but even more dangerous than words is the inability to listen to the words of another—the inability to ask the right questions and to receive and listen to the answers with an open mind and an empathetic heart.
You won’t always have a doctor who is good at this, but I suggest that you find one if you want the best care. A good doctor will not expect your questions to be perfect or exactly on target or even obviously relevant to your condition. A good doctor will listen and get to the bottom of the “why.”
Considering all of this, here are some guidelines for communicating with your doctor:
- Don’t be afraid to ask your questions. They are critically important!
- To get your thoughts fully together, write down your questions before your doctor’s visit. If your doctor tells you not to read the list and just ask your questions, explain that you are nervous and don’t want to forget what’s important for you to understand.
- Doctors sometimes fear that patients will have an extremely long list of questions. They prefer to deal with issues one at a time, so keep your questions focused on the reason for your visit. For other issues, make a separate appointment. However, don’t be afraid to bring up issues you think might be related to your primary issue, even if you aren’t sure.
- If the answers you get to your questions are not direct enough or you don’t get the answers you need, ask again in a different way. You can always say that you aren’t sure you fully understand. Don’t be afraid to continue a conversation after a short and insufficient answer.
- Sometimes your doctor might be busy, overwhelmed, or have another patient who might be on her/his mind. Give your doctor the benefit of the doubt and ask again. Doctors get distracted sometimes, but they should never be rude.
- If you have a question that’s hard to ask, say so, but then get up the courage to ask exactly what you need to know. Even if it is embarrassing!
- Bring someone with you for moral support if it will help you to stay focused and be braver.
- Know that you are not alone. Your doctor has probably heard your questions many times before. Humanity is funny like that, so ask away! Your doctor probably has good guidance for you, once you understand each other.
Finally, you must advocate for yourself always, and asking questions is where this begins. It is essential, so don’t be afraid to do it! This takes some bravery, I know, but your doctor works for you and is there to help you. Questions are the perfect way to get the help you need and to foster a healthy doctor-patient relationship. And that’s one of the most important ways to achieve wellness.
Click here to buy Dr. Suzanne Steinbaum’s book, Dr. Suzanne Steinbaum’s Heart Book: Every Woman’s Guide to a Heart-Healthy Life, or visit her website http://drsuzannesteinbaum.com.
