How to prepare for your Doctor Consultation

In my line of duty, all too often I see patients who feel ill informed, ill prepared and generally disappointed with the quality of communication they receive from Doctors. This is a trait not just here in the UK but also all over the world.

Falling ill is painful as it is. A visit to a Doctor should be productive, informative and restorative. How can we make this happen? How can we improve communication lines within the Doctor Patient contact?

In many parts of the world, Doctors receive minimal training on the most important tool they have to make a gather information and make an accurate diagnosis - their communication skills. In UK Family Doctors receive extensive training and have to pass exams that test the communication skills. They study consultation models, video their own consults and analyse them with their Trainers to seek improvement and excellence. However, this doesn't always guarantee a Doctor who deploys high level communication abilities. It is even less so in countries where medical education simply doesn't spend enough time on teaching communication/consultation skills.

In reality many patients feel nervous, afraid of such perceived authority. They may meekly nod their head to everything the Doctor says- they may keep information to themselves thinking it is not relevant. They may fail to ask important questions about their illness or treatment. They may keep their ideas, concerns and expectations to themselves.This could lead to the Doctor merely dictating what he or she thinks should happen without bringing in the patient as a partner and sharing the management plan.

At the other end of the spectrum, we also have patients who gather half baked information from all over the internet, from friends and neighbours and assume they know better. They may arrive to the consultation thinking they know exactly what they want and assuming that their role is to get what they think they need. This could be a dangerous situation where the Doctor may hands over control and prescribes a therapy that may not always be the best for the patient. There is then a lack of professional input and consequences can be disastrous.

The best way to shake up the system is to have informed, prepared and confident patient who will come as a skilled partner in solving the mysteries of illness and planning its management. If the Doctor is empathetic, willing to listen and explains the decisions carefully and with consideration, we have a joint partnership that will be very successful.

I am sure there are many instances where this happens and the result is a confident, concordant and happy patient.

Professor Cecil Helman, who was a GP and a medical anthropologist, proposed that everyone who feels ill has a right to have the following six simple questions answered.

• What has happened?
• Why has it happened?
• Why to me?
• Why now?
• What would happen if nothing was done about it?
• What should I do about it or who should I see to get help?

They may sound blindingly obvious but how often do you really get these answered?

The process of diagnosis is at the heart of practising medicine. The patient consults the clinician with symptoms that are abnormal or perceived as abnormal. The clinician takes a careful history, evaluates the symptoms, examines for signs, may order some investigations and then formulates a diagnosis. They may use their knowledge and experience to recognise patterns. They also use established hypothesis to arrive at the diagnosis.

The best diagnostic instrument we have is not a fancy full body scan, a state of the art blood test or a symptom check list. It is the human brain. It is capable of making extraordinarily complex analysis and is able to combine multiple strands of information to aid the ailing patient. To me a practising physician should be like Sherlock Holmes- an archetypal detective - with better bedside manners! They need to be alert to the possibilities and eliminate the improbable using expertise, experience and the ability to interpret information.

An empathetic clinician who is open, honest and accessible gets far more important information from his patient than someone who is cold and clinical. However, there are times when the clinician has to cut to the chase, bring in focus and hasten the diagnosis when timing is crucial.

The Doctor-Patient encounter can constitute of narrative texts that as a whole contribute to the diagnosis.

The General Medical Council in UK, recently published a guide to patients 'What to expect from your Doctor' - this is based on the principles of Good Medical Practice for Doctors and outlines these broad principles:

• Doctors must provide good care
• Doctors must put patients’ safety first and make sure the care they provide is safe and effective
• Doctors must treat patients as individuals
• Doctors must be honest and trustworthy

• Single symptom means a single diagnosis
• Doctor should know everything
• Most advanced test and most advanced medicine means quicker resolution
• I may have had the symptom for years but the day I go to the Doctor I will get a diagnosis and treatment
• Every symptom needs treating
• A Specialist knows better than a Generalist
• If I say too much he/she may dismiss my symptoms as related to something else
• If I underplay my symptoms he/she will reassure me and send me home ( which is what I want!)
• If I overplay my symptoms I will get better treatment

• All patients are too demanding
• All patients worry too much and ask for everything
• If I give them what they want they wont sue me
• Well informed patients are a threat
• Patients should just follow advice without questions
• If I say that it is not serious, they should always be happy

To get the best from your consultation, it is always better to be prepared. You may not be surprised to know how many patients turn up with no agenda - they come passively, unprepared and unclear as to what they expect from the appointment.While others can be too direct, they want a specific outcome and they expect the Doctor to just give them what they want. Both approaches can be dangerous to their health.

We understand that the Doctor - Patient encounter can be intimidating. It is difficult to remember everything that needs to be asked and to recollect everything that has been said.

While good Doctors can anticipate and expect some questions , even the best ones may not always have a telepathic understanding of what you may want to ask. As we know, some questions may not be directly related the illness. They could be about work, family, capability, other illnesses and medications etc.

To start with it is always good to :

Set an Agenda:

Be clear on what you want from the appointment- is it a diagnostic work-up, a treatment plan, a change in therapy, a result of an investigation, an explanation, a discussion on side -effects or a combination of things.

Write down a list of questions that you wish to ask at the appointment. Don't be embarrassed if some of them sound silly to you. If the question occurs to you, it is much better to ask it than to leave it unanswered. This may be about an idea, a concern or an expectation you may have.

Compile your Information:

Collate all the information about past illnesses, allergies, investigations, medications you may be taking ( both prescribed and over the counter), any new changes to your diet, lifestyle. It is better to be fully honest with your Doctor as they rely on you to be. If you have previous records, take them for reference. In some countries like UK there are electronic medical records for a registered patient. This is a useful compendium of information.

Take a support:

If you feel nervous and inarticulate, take someone who can be your advocate. Someone who can ask the questions for you, someone you trust with your confidential information. This could be your parent, spouse, your children, siblings or a friend.

Get written information:

When the Doctor outlines a treatment plan, get some written information or take notes. Some of the treatment plans are complex, dosage schedules can be confusing and investigations may sound scary. Get written information from the Doctor or seek a reliable/validated source where you can. Dont just Google when you get home!

Be Honest :

Honesty is the best policy when it comes to giving your history and symptom list. Some patient play up their symptoms to make sure they get what they think is best for them. Others may underplay their symptoms and signs out of fear.Both approaches can interfere with a clear diagnosis.

If you are unhappy, frustrated, unsure, doubtful and frankly do not believe in what the Doctor is saying or offering, do say so. A good Doctor would rather have someone challenging them and gives an opportunity for an adult dialogue then and there. It is always better than someone who nods their head and then goes home to not follow the plan ( you know who you are!)

Ask what YOU can do:

Some patients believe that the treatment that the Doctor prescribes alone will cure everything and they can just be passive recipients. They are wrong, there is always something the patient can do to help themselves... whether it is simple rest, a lifestyle change or seeking other means of support it is good to ask the doctor what you could do to help yourself.

Thank the Doctor:

Doctors have feelings too. They go from patient to patient dealing with a lot of stress, complexity and difficulties. Many Doctors go over and beyond their call of duty. They work very hard and very long hours. Remember to thank them for their support and understanding, it is amazing how a simple thank you can reinvigorate the long hard day and establish a good relationship. If for soem reason you feel dissatisfied, do give constructive feedback.

The Doctor - Patient partnership is an important one. If it is collaborative, co-operative and cohesive then there is mutual satisfaction to both parties. If it is conflict ridden, confusing and divisive there is danger to both.

I do hope some of the information given here has been of some help. Giving some thought and reflection to the consultation, being prepared and willing to collaborate will be a really useful step towards quick diagnosis and early resolution in many cases.

Some illnesses are frustrating, not because of the doctors but because of the sheer weight of the illness itself. Having a Doctor as an ally can be very helpful in these chronic debilitating conditions.