It’s a strange paradox: As medical science has advanced, actual medical care—that is, interaction with patients—has taken a nosedive. The average doctor appointment is now 15 minutes long, and practitioners often spend the entire appointment looking at computer screens.
This is a problem for more than one reason, physicians and patient care experts Saul Weiner and Alan Schwartz say in their book Listening for What Matters. The book is the result of a 10-year study, in which the authors sent more than 1000 patients and patient actors into doctor appointments with hidden tape recorders. Reviewing the tapes, the authors found that the doctors’ most frequent mistakes were not medical (like prescribing the wrong medication), but contextual, like failing to pick up on the fact that a patient with asthma could no longer pay for his medication. If a doctor simply prescribed more medication or a higher dose, that patient would still be unable to take his medication, and his health would continue to worsen.
“So much of the way we measure quality in healthcare is based on what’s in the chart,” Weiner told us, "and if you had looked at the chart of that patient and many, many others, you would say, ‘That was great care.’ But if you were there and listening in and asked the right questions, you’d realize it was terrible care.”
Patients can’t make their doctors better listeners, Weiner says, but we can meet them halfway. Here are six ways to ensure you’re getting the best possible care.
1. FIND THE RIGHT DOCTOR.
“One of the things that was really interesting in our work was that we discovered that even in that 15-minute window, there were big differences across physicians in how well that time was used,” Weiner says.
If a patient has a doctor who talks over them or ignores important information, “I think they should find somebody else," Weiner says. "I know that sounds harsh, but we underestimate how important the non-chemical parts are to how we do in our health. There’s such a myth that it’s all about getting the right pill or the right procedure. In fact, being healthy and feeling comfortable about how you’re managing your healthcare goes far beyond that. It really requires having a doctor who you feel comfortable with and who you feel does not talk down to you.”
2. DO YOUR RESEARCH, AND BRING IT WITH YOU.
“When you go in to talk to your physician, it’s perfectly appropriate to share with them what you’ve learned on the Internet. I would be concerned about any physician who’s dismissive," Weiner says. "If your doctor says, ‘I don’t want to see that,’ that’s not a good sign. A physician should be open to seeing what a patient wants to share.”
At the same time, Weiner says, there’s lots of misinformation out there, and it’s often hard for non-doctors to know which sources are reliable. If your doctor tells you not to trust the material you found, you should probably listen.
3. TAKE STOCK OF YOUR LIFE.
“Most medical care doesn’t happen in the doctor’s office. It happens when you get home. So: Are you having trouble remembering to take your medicines? Are you having trouble understanding what you’re supposed to do when you go home? Are you having trouble paying for it? Are you overwhelmed because you have other responsibilities that are getting in the way of making it to appointments? Have you lost transportation or someone who used to help you with your care? If your doctor is aware of these difficulties, it’s often possible to accommodate them. Being up front about these issues is critical. If you don’t, doctors are sometimes judgmental and they just assume that you don’t care.”
4. RECOGNIZE THAT YOUR DOCTOR IS HUMAN.
“It’s important for patients to recognize that doctors need help, and if you have stuff going on in your life that you’re struggling with, like you’ve lost your health insurance, or you’re having trouble managing your medication because you’re going to school and there’s no place to take it—whatever the issue is, speak up. Before I became a physician, I kind of thought doctors were all-knowing and would figure this stuff out, and they don’t. You have to help your doctor.”
5. RECORD YOUR APPOINTMENT.
Weiner recommends that everyone tape their appointments to review later. It’s a great way of making sure you hear and understand everything your doctor is saying. “I’m very comfortable if a patient wants to record our visits, because I think that’s terrific. It shows that they are trying to get the most out of it, and I see it in a positive way.”
Unfortunately, not all doctors are so accommodating. If yours refuses, Weiner says, “it’s reasonable to let them know that you’re hoping you’ll get more out of the visit by recording it. If they flat-out refuse, I find that a little troubling. Because if your goal is to get the most out of your visit and they’re so concerned about being recorded that they won’t let you, it seems like they’re putting their needs above yours, which is concerning.”
6. BE RESPECTFUL, BUT DON’T HESITATE TO STICK UP FOR YOURSELF.
Your doctor may be the one with a medical degree, but it’s your body. “I think of a doctor visit as being two people working together to share and solve a set of problems. When you go in there, it’s important to relate to your doctor the way you’d like them to relate to you, which is being respectful, but also open. You share with them what you’re thinking, and you’re also on the lookout for evidence that they’re willing to do the same.”