Reprinted with kind permission from Toni Bernhard.
By Toni Bernhard, J.D
Published on July 1, 2013 by Toni Bernhard, J.D. in Turning Straw Into Gold
If you’ve read How to Be Sick or my post, “The Stigma of Chronic Fatigue Syndrome,” you’ll know that I’ve had my share of unsuccessful experiences with doctors, including being intimidated by them. Yes, this former law professor can allow herself to get intimidated by doctors! But after twelve years of chronic illness, I’m happy to report that I’m doing better in this uncomfortable setting.
Here are six strategies to help minimize the odds you’ll be intimidated and to help ensure you make the most of the short time allotted to you with the doctor.
1. Remind yourself that the doctors and the staff work for you, not vice versa.
I don’t mean to suggest that you can order them to do whatever you want. But they work for you in the same sense that an attorney or an accountant or even a hairdresser does. Why is it so easy for us to forget this? For me, it’s due to a combination of factors. First, I’m in their “house” not mine and am forced to put on a nightgown-looking thingy that makes me look like a child. Second, because I’ve come seeking help, it can feel as if they have all the knowledge and all the power, even though I often know more about my medical condition than they do. Third, I’m often at my weakest in the doctor’s office. The trip to get there, followed by the typical waiting times—first in the waiting room and then in the examination room—can take its toll even if I’m having a relatively good day.
Add to these three the fact that sometimes I’m too sick to sit in the examining room chair to wait for the doctor, so as soon my temperature, pulse, and blood pressure have been taken, I lie down on the examining table to wait. In this position (and in that silly gown), it’s hard to feel as if the person who comes in the room and towers over me…works for me!
To help me remember who works for whom, as I sit (or lie) waiting, I often repeat to myself: “He works for me”; or “She works for me.” I also practice mindful attention to what’s around me as a way to take my mind off any anxiety about the upcoming interaction. I’ve found that every setting is interesting if I bring all my senses to bear on it.
This mindfulness practice helps to keep me from feeling intimidated about the upcoming interaction with the doctor because I can’t simultaneously be paying careful attention to what’s presenting itself to my senses and, at the same time, be worried about the future. When I find my mind begin to wander from the present moment into thoughts about my relationship with the doctor, that’s the sign to repeat whichever phrase applies: “He works for me” or “She works for me.”
2. Consider taking someone with you.
Before I got sick in 2001, I had no idea that I could have my husband accompany me into the examining room. In twelve years of illness, no one has ever questioned his presence. Occasionally I have to go on my own to an appointment, but when possible, I take him.
His presence is beneficial for several reasons. I feel less intimidated because I know I have an ally with me. In addition, I’ve noticed that when doctors see him, they become more attentive to what I’m saying and are also more forthcoming with information and explanations. Doctors will often look over at my husband as if they’re talking for his benefit. Sure, I could say: “Hey, I’m the patient here, talk to me!” But I’ll take a doctor who’s more communicative any way I can get it.
Finally, on the way home, I get a second opinion on how the appointment went: Did I feel listened to? Did the doctor involve me in the decision-making? Was he or she open to treating a “can’t give you a pill and fix you” patient?
You need not take a partner. Take your adult child or a cousin or a friend. Tell them ahead of time what you’re hoping to get out of the appointment and what you’d like them to be looking out for on your behalf. An extra pair or ears and eyes…and an extra brain…has been invaluable in helping me to not feel intimidated by even the most curt and brusque of doctors. For one thing, after the appointment, my husband can confirm that what I perceived as less than caring treatment was not in my imagination. This validation enables me to stop second-guessing myself. In fact, it encourages me to treat myself with compassion over a disappointment that was not my fault.
3. Bring a list to the appointment.
I read that seven minutes is the average amount of time you get with the doctor under managed care. Thankfully my regular doctor gives me more time than this (I haven’t figured out how, given his packed schedule), but I’ve encountered other doctors who are clearly working “on the clock.” You can sense it when they walk into the room. In my experience, the best way to manage this is to bring a list of what you want to raise and have it visible to the doctor when he or she enters the room.
I make a list of what I want to raise, in order of priority. The list serves several purposes. First, it helps me manage my own time so I don’t linger on one item too long, or stray off onto something I’d already decided wasn’t important enough to raise at this appointment. (As my family well knows, I can easily go “off topic”!)
Second, when doctors see my list, they often prompt me from it by saying, “Okay. What’s next on your list?” Most doctors appreciate that I’ve thought about the appointment ahead of time and structured our time together. It keeps us both focused on the task at hand, and they know that when we’re done with the list, we’re done with the appointment.
Third, I learned in a book called How Doctors Think that most doctors decide on a diagnosis and treatment within minutes of seeing you. I think that my list makes them less likely to jump to a quick conclusion, because the list forces them to see me as more than a body with a symptom that requires a quick fix.
All in all, with my list, I feel like an equal participant in the interaction and, that alone, is an effective counter to feeling intimidated.
What if the doctor says: “I don’t like lists.”? Fine. Put it down. Here’s your secret weapon though: be sure to memorize it before you go to the appointment. If the list is too long to memorize, it’s too long for one appointment anyway.
4. Let the doctor be the expert but don’t be afraid to ask questions.
Although doctors work for you (always remember that!), you are seeking them out for their expertise, so go with an open mind and with the assumption that they are knowledgeable and are seeking the best outcome for you. That said, don’t be shy about asking questions, including what alternative treatments are available. There’s a practical reason for doing the latter. Doctors are often thinking about alternatives—just not out loud! When you ask questions, it encourages them to talk to you about what’s going on in their heads and that’s something you want to be a party to.
I don’t recommend regaling the doctor with information from other sources (unless the doctor has encouraged to you do so). You’re likely to lose a doctor’s attention if you say: “Research on the Internet shows…” If you have information that you think is important, share it in a way that communicates that you think of you and your doctor as partners in your healthcare. Hand it to the doctor, while saying something like: “Doctor, I found this article that I thought might interest you.”
5. Repeat back your understanding of the plan of action.
When you sense your time is up, briefly feedback to the doctor what you understand has come out of the appointment. For example, you might say: “To be sure I understand you correctly, you want me to start this new medication, get a blood test in a week, and return in two weeks.” I’ve had too many appointments where I get to the car afterward and neither my husband nor I can remember some important detail of what happened. The risk of this is even greater, of course, if you’ve gone to the appointment alone.
6. Don’t write off a good doctor because of one disappointing visit.
Let me set the scene. You’ve seen this doctor before. The rapport was excellent. She was a good listener and involved you in the decision-making. You feel fortunate to be in her care. But then you have an appointment at which she rushes you and isn’t focusing on you as a flesh and blood person.
When this used to happen to me, I’d jump to the conclusion: “She doesn’t want me as her patient anymore; my illness is just too much of a hassle.” But I’ve learned that if I’ve already established a good relationship with a doctor, this reaction is off the mark. Life can be stressful for doctors too. This may have been a day when she was badly overbooked, or tired from lack of sleep, or worried about a family member. I used to feel hurt—personally hurt—when a doctor I had a good relationship with wasn’t “present” for me like I’d become accustomed to. Now I chalk it up to he or she having an off-day and, in every instance so far, the next appointment has gone fine.
It’s also possible that an unexpectedly disappointing visit was due to your doctor’s frustration about not being able to “fix” you. Doctors learn in medical school: examine, diagnose, fix. But that isn’t how it goes for people with chronic pain and illness. So, if you have a good relationship with a doctor, I suggest that you give him or her some slack and accept that on some days, a hard-to-treat patient is simply too difficult for the doctor to handle gracefully.
I had an insight into this about five years ago. I had a circular, itchy rash on my knee that wouldn’t go away, so I made an appointment to see my regular doctor. He took a scraping and went off to look at it under a microscope. When he returned, he was so excited that I had something he could actually diagnose and fix that he took me down the hall to look through the microscope myself. He explained exactly what I was seeing: a simple fungus that was treatable with over-the-counter ointment.
This interaction—seeing how happy he was to have helped me—gave me new insight into how difficult my illness must be for him at times. He’s an exceptionally caring doctor, so it’s understandable that once in a while he gets frustrated that he has a patient who’s been sick for twelve years and there’s been little he can do about it.
Those are my six tips. Some of you may already be employing one or more of them, and you may also have some good tips of your own. I hope you’ll share them with all of us. I’m ready to learn from you.
Toni Bernhard is the author of the award-winning How to Be Sick: A Buddhist-Inspired Guide for the Chronically Ill and their Caregivers. Her new book, How to Wake Up: A Buddhist-Inspired Guide to Navigating Joy and Sorrow, is available for pre-order and will be released in September. Until forced to retire due to illness, Toni was a law professor at the University of California—Davis, serving six years as the dean of students. Her blog, “Turning Straw Into Gold” is hosted on the website of Psychology Today. She can be found online at www.tonibernhard.com.
© 2013 Toni Bernhard www.tonibernhard.com