A Doctor's Prescription for the Primary Care Visit
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Bernard Katz, MD, a UCLA primary-care physician, discusses how simple communication strategies can ensure that patients get the most from each visit.
The abundance of health information on websites, social media and other sources has changed the nature of doctor-patient interactions. Today, when patients visit their primary-care physician, they are much more likely to bring questions based on what they’ve read about symptoms they have experienced or strategies for improving their health. But the time with the doctor is limited, and too often the patient leaves without answers to important questions, or with an incomplete or inaccurate interpretation of the doctor’s advice.
How has the availability of so much information about health affected doctor-patient interactions?
Decades ago, the physician would dictate care instructions and the patient would follow those instructions. Today, it’s much more of a partnership — people are engaged and actively involved in their healthcare. That’s a positive trend, but it makes it important for patients to clearly communicate their thoughts, concerns and goals so that they and their physician are on the same page.
How can patients maximize the time they spend in the doctor’s office?
We have to start with the premise that often the time is limited and that both the patient and the physician may have different agendas for the visit. If the physician is planning to use the time to discuss something he or she thinks is important — a review of tests, a new diagnosis — that should be stated at the outset. In the same way, if a patient has an agenda, he or she should be sure to bring that up at the outset as well. Sometimes patients have a number of questions that they will bring in writing so they don’t forget any of them. For those patients I will suggest that we look at the list first and see what we can get to. Patients need to recognize that there may not be time to discuss everything, but this allows the patient and physician to prioritize.
Some patients may be uncertain about what details to provide in discussions about their health and symptoms. What advice can you offer?
The physician should ask open-ended questions, and the patient should try to give as complete answers as possible, staying on the topic but not filtering what he or she thinks could be relevant. Sometimes I see patients who have already diagnosed themselves. I find it more helpful to have a discussion about their symptoms and try to figure it out rather than jumping to a conclusion. Other times patients may be embarrassed to talk about something that they know could be relevant. In such cases, the physicians needs to ask questions in a way that makes the patient feel comfortable, while the patient should understand that the doctor is not there to judge and that this is a confidential environment. Patients should also not hesitate to share any barriers that affect their ability to follow through on recommendations and acknowledge when they haven’t been doing so. I would rather have a patient tell me he isn’t taking a medication than to wrongly think he’s been taking it and it hasn’t been working.
Isn’t it also common for patients to forget or misinterpret what their doctor has told them?
Definitely. Taking notes can be helpful. And despite the time limitations, patients should always ask their doctor to repeat or clarify anything they don’t understand. I also recommend that at the end of the visit, patients take a moment to summarize what their doctor has told them. If the visit is for something that could result in a lot of emotion or anxiety, such as a diagnosis of cancer or a major treatment plan involving surgery, it can be a good idea to bring a family member or friend as a second set of ears. There is a tendency to tune out or have difficulty focusing once we hear news that is disturbing.
What are your recommendations for proper communications after the appointment?
It is best to schedule any follow-up visit at the time the patient is leaving the office so that everyone knows when it’s going to occur and it isn’t dropped. Patients should also know that they are entitled to the results of any tests that are ordered. They should never assume that no news is good news. If they don’t get results within a reasonable period of time, they should call the doctor’s office and pursue it. Finally, as part of UCLA Health’s new electronic-medical-record system, patients will be able to log on to a website to review events following the visit and to communicate with the physician.