Let me start by saying that we are all half-crazy, me included. It’s the human condition.
That is the first problem in the sometimes challenging communication (or miscommunication) between patient and doctor. Call it magical thinking. We all do a bit of it. This is the belief the there is a causal connection between what you think, and the outcome of some real world event. I come from an Irish and moderately superstitious family, so I know something about magical thinking! Shoes on the bed were a definite no-no.
The medical version of this is that if the doctor doesn’t find it, it isn’t there. One wonders, does it still work if the patient helps the doctor “not find” the disease? Apparently, many people think so.
Let’s take, for example, a patient who is coughing up some blood – a moderately alarming symptom. It seems perfectly reasonable to run, not walk, to the doctor and tell him, “I’m coughing up blood!” Based on a little magical thinking, the story may be presented more quietly: “Doc, I have had this little cough for a while.”
The doctor, lacking this important information about coughing up blood, never seriously considers tuberculosis (TB) or lung cancer, and assures you the cough will get better with antibiotics. This, to the patient, magically means, “You don’t have lung cancer or TB.” Antibiotics of course have no curative effect on lung cancer or TB. But, prompt diagnosis and treatment will definitely have an effect.
So the first thing a doctor wants is the unvarnished truth, including scary or embarrassing symptoms. The more information a patient gives me, the more likely we will arrive at the correct answer.
In this age of near universal access to information, many patients have studied their symptoms before going to the doctor. If you have done some research, I really want to know what you’ve found and what you think. My experience is that this information has to be dealt with sooner or later. If we don’t talk about it today, it will haunt both of us. I am only concerned with getting you better, and any help you can provide to a diagnosis is appreciated.
The next thing I really want to know is your life plan. What are your health goals, and how much change are you willing to make to attain them? Do you really want to enjoy your life, eat anything and everything, and live it up? Kind of a “Damn the torpedoes” or “C’est la vie” outlook on life, short but sweet?
Or do you really want to play with your grandchildren and great-grandchildren? Then we can spend some time talking about how to stay healthy. This would be a pleasant change for the doctor, and you would get health information in a concise package tailored to your needs, instead of factoids coming at you from all directions.
You and your physician are on the same side. We both have the same goal: the correct diagnosis and effective treatment to get you back to health as rapidly as possible. This most reliably comes from a frank discussion between us.
So help us help you, and give us as much information as possible when you walk into your next doctor’s visit.
Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic.
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