Have you ever heard that pain is an “invisible” problem? Well, it’s true. The nature of pain makes it hard to describe, hard to communicate, and as a result, very hard to treat. In my practice, consulting to doctors and patients in a medical setting, I noticed another, bigger invisible problem. Expectations.
Expectations are also invisible and can be equally, if not more, damaging to your well-being as untreated pain.
Doctors and the people they see often never have a chance to stop and discuss expectations. Do you have unspoken expectations that might be causing you frustration? Today you can take some time to examine the impact of expectations on your life. Expectations (both spoken and unspoken) affect our relationships, our work life, our perceptions of ourselves, and our relationships with doctors and medical professionals.
This upcoming series is going to be all about communication. It's a huge topic, and today we're going to take a look at how expectations can either help or hurt in the exam room.
Good communication can make a huge difference in managing your health. Practice good communication with your doctors. If you do, both you and your doctor are likely to be less frustrated and much happier with each other. If both you and your doctor have a healthy, positive working relationship, you're much more likely to get the help you need when you need it.
To get us started, let's take a look at common expectations from the doctor's point of view.
What do doctors expect?
Dealing with doctors is the ONE thing that everyone who has a chronic medical condition has to do. If you want a diagnosis, tests, and maybe a treatment plan, you're going to be spending time in doctor's offices. So when we think about expectations, let's start there.
What's going on behind the scenes in your doctor's office? I have spent most of my career working in medical centers. My closest colleagues have always been medical doctors, physician assistants, and nurse practitioners. So I can speak with a fair amount of confidence on what their unspoken expectations are.
Doctors expect certain things from the people they see in their offices: truthful reports, “compliance” with all their recommendations, honest communication, payment of bills. From a doctor's perspective, these things are usually a given. Doctors expect that when they make a referral, you'll follow through with that referral. Doctors automatically think that if you haven't mentioned something, then it must not be bothering you. If a doctor writes a prescription, s/he usually assumes that you'll fill that prescription and that you'll take all the medication as prescribed.
A peek into a doctor's day
Doctors often don't have much time. Most doctors in the US and the UK see over 25 patients a day. Thirty-five percent of doctors see between 25-41 patients a day. That averages to 5-10 minutes per person, and that's on a good day.
They are usually loaded with responsibilities. A doctor is responsible for greeting you, evaluating your condition, and recommending an effective treatment. (Of course that's assuming there IS an effective treatment, which is another problem entirely.)
On top of that, they are responsible for documenting everything in your medical records, evaluating test results, making phone calls. The phone calls are invariably to deliver bad news. Has a doctor ever called you and said "Good news! That test was clear!" Probably not. Oh yeah, and if they work as part of an organization you can bet your bottom dollar they have to spend at least one or two hours a week in staff meetings.
All told, that does not leave a lot of time for second guessing or slowing down enough to notice you seem reluctant to mention a problem. Doctors operate on the assumption that you've told them everything and you'll contact them with a problem.
Is this true? Not always.
What do patients expect?
In a medical setting, my experience is that patients also expect two things: a diagnosis and a cure.
When an otherwise healthy person starts experiencing a new problem, they make an appointment with the doctor. They expect the doctor will listen and prescribe a cure. In an ideal setting, these expectations are met from both sides, and everyone is happy.
But the real world, as we know, is far from ideal.
Patients often think that a prescription equals a cure. This pill will “cure” my [insert your problems here: pain, depression, sleep problems]. When doctors prescribe something, however, they are usually looking for improvements in symptoms, not a total cure.
What if there isn't a cure? What happens when doctors have to make their best guess?
What is actually happening?
Doctors often think that silence means success. If you ask a back surgeon how often surgery is successful, she is likely to reply, “Very successful! I hardly have anyone return.”
And if you ask a patient? “I had a really bad experience. I never went back because it only made things worse.”
What happens when the problem doesn't go away? Both sides get frustrated and the working relationship starts to break down.
Miscommunication, or simply a lack of reflection, can hamstring even the best efforts at help.
How to Communicate Better With Your Doctor
Communication is a two-way street: speaking and listening.
You can communicate better during medical appointments in the following ways.
Set Your Own Expectations: Ask Yourself What You Need Before Your Appointment
Before you make an appointment, take a few moments to think about your expectations for this medical visit. What are you hoping to get out of the visit? A diagnosis? A new treatment plan? Just a simple refill? More information? Reassurance about a new symptom? Then ask yourself how realistic are your expectations. If you're not sure, it's something you can definitely bring up with your doctor, and ask "I was hoping that [your expectations] from you; do you think that's reasonable?"
When you make the appointment, if there is anything special you want to discuss, tell the person who is making the appointment. Ask them if there is a way to make a note the doctor can see in advance. Doctor's schedules often have places for notes and many doctors check these in advance.
Speak Truthfully (and at the beginning!)
Doctors can't help you with what they don't know about. Sometimes the old social pattern of answering the question "How've you been?" kicks in and people blurt out, "Fine!" in response. But when a doctor asks that question they really mean, "Tell me about your symptoms. What's been hurting you? What's been going better? What are you really concerned about?"
Telling your doctor what's really been going on is not a sign of weakness or neediness, it's part of a healthy working relationship.
It's also super tempting (especially for us introverts) to wait for a doctor to ask you what you expect. Or to wait until the end of the appointment to gather your nerve and say what you're really worried about. Fight this urge!
Speak up at the beginning of the appointment. "Hi it's nice to see/meet you. Today I'm here because…" If you're at all concerned about a doctor pre-judging you based on your medical chart or history, speak up! "I know I'm on pain medications and I have regular pain, but I'm not here today about that. Instead, I'm worried about…" or "I know I have a history of [X] but today I'd like to focus on [Y]."
Try to narrow down your concerns. Doctors usually want to know how long a problem has been going on, how severe it is, and what you've tried already. Most doctors only have 5-7 minutes to spend in the room with you, so use it wisely.
When a doctor provides a referral to another specialist, ask, "What can I expect from this new doctor?" When a doctor provides a prescription for a medication, the following questions might be useful.
- What can I expect from this medication?
- Will this medication be a cure for my condition?
- How long will it take for this medicine to start working?
- Will there be any side effects from this medicine?
- What should I do if I run into problems or it's not working?
Doctors often swoop into the room with their own agendas in their head. Oftentimes, before they even enter your room, a good doctor will have reviewed your medical chart, checked up whatever information they have, looked at the reason for the visit, and spoken to the nurse who took you back to the room. They'll have a short agenda in their head and at least a rough idea of what they plan to say, ask, and recommend for you.
Having a doctor who prepares for her visit with you is great, except when her expectations and your expectations are a total mismatch.
Part of healthy communication is being assertive. Being assertive means respecting both the other person and respecting yourself. It's disrespectful to your doctor to yell at or speak over him or her. But it's equally disrespectful to yourself to ignore your own needs.
So be assertive. Be honest. Make simple requests. "Can you speak more slowly?" "Could I get that in writing?" "I am disappointed that this last treatment didn't work; what can I really expect from this new treatment?" Said in a calm, steady voice, those are all assertive statements.
Do you struggle with communication? I'll be completing more resources on good communication. Click here to get advanced copies and special content on communication.