The Checkup: Talking Back To Your Doctor

Welcome to the The Checkup. Our sixth episode “Talking Back to Your Doctor,” opens with a question: Why do so many of us find it so hellishly hard to speak freely with our doctors? What is it about a white coat that makes even normally assertive people clam up?

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We begin with the dramatic story of Alicair Peltonen, an administrative assistant diagnosed with a rare cancer who had to have a chunk the size of a baseball removed from her thigh. Throughout her medical saga, she found that she often had urgent questions echoing in her mind, but felt too inhibited to voice them. She set out to find out why. The Checkup

We speak with Dr. Jo Shapiro of Brigham and Women’s Hospital in Boston about what she calls “Conversation Deficit Disorder” among doctors. And we hear from Dr. Annie Brewster, who has special insight into doctor-patient communication because she’s both a practicing doctor and a multiple sclerosis patient who decided not to follow her doctor’s recommendations about taking a particular medication.

Each episode of the Checkup features a different topic—previous topics included college mental health, sex problems, the Insanity workout and vaccine issues.

This is the closing episode of our first season of The Checkup. Please tell us what you liked and disliked and what you want more of. Like CommonHealth on Facebook or drop a note to podcasts@slate.com.

We’ll keep you posted here on all our plans for future podcasts.

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  • OldGreySteve

    I want different things from different speciasts. I want my surgeon to be focused and objective and not distracted by thoughts of my family or my personality. I want my primary to help me understand all the options and choose the course that is best for my situation.
    It doesn’t work out that way because often the surgeons tend to be the humanists with good conversational skills and the internists tend to be the science-nerds.(in my experience)
    It sounds like physician training is changing; perhaps I will check out one of these new young women when I choose my next primary.

  • J. D.

    This is a great podcast. I am a practicing Physician Assistant and find effective communication with patients as the foundation to delivering great medical care. I love it when patients ask questions. I take the same approach with my patients: ‘Have I addressed your concerns today’ and ‘it’s my job to provide you with information so you can make medical decisions that are best for you.’ These simple tools help initiate a back-and-forth conversation. It is equally important to use words and phrases suited to the individual patient — the practitioner may have addressed the patient’s concern, but if the patient doesn’t understand the information they are unlikely to admit this and will walk away with the same concerns and probably be dissatisfied and worse, even embarrassed. Yes, sometimes this takes longer (a concern for many medical providers), but it’s better care all around and it has been my experience that I often get valuable information that may be essential to the patient’s care that would not have been obtained otherwise.

  • BruceBacka

    Fortunately Alicare is at a great hospital. Try talking back to your doctor, as I did for my father, in Worcester. The response (to my third request) about alternatives was, “He’s an 82 year-old man with stage 4 cancer. He’s going to die. What do you want..?”

    My first and second requests had simply gone unanswered. As you will see, there is no insurance reimbursement code for consulting with the family…

    • hugitout

      What I find people want to magically insulate themselves from is that time is indeed money. They very often state that they want their physician’s time and that the doc should just be willing to give them as much as is “needed” to satisfy the patient’s desire. If the doc doesn’t give them that time, then they complain that “doctors are only focused on money”.
      If you feel that your doctor doesn’t listen to you because the insurance doesn’t pay him (or her) to do so then you might offer to set up a separate cash-pay “concierge” visit to discuss the things you want to talk about. Offer to pay the same as what that physician would charge during a deposition when attorneys want the doc’s expert opinion. If you are unwilling to do that because of cost, then I believe an equivalent argument could be made that you don’t want to because, “you are only focused on money”.
      The simple fact is that insurance will pay a certain amount of money for a doctor to see a patient for a certain amount of time or for a specific degree of complexity. Both the doctor and the patient effectively agreed to the insurance company’s policy when the doctor agreed to be a provider for the company and when the patient agreed to the terms of the policy’s coverage. The doctor has many patients to see in a day and has to satisfy them all to a certain minimum standard of care. One hopes that much more than the minimum is achieved on a regular basis but basically what you are asking for is a free-of-charge unilaterally decided renegotiation of your contract terms such that you can have more than you signed up for. If you do not like your current policy or physician, you have the option to switch either though you will likely encounter a similar experience elsewhere as your situation is not unique. Doctors do not like it either and that is why so many are leaving the insurance market and setting up concierge practices. But, just like having your own personal lawyer on retainer, it is expensive.
      All professionals will be expensive. There is no way around that. I have an amazing accountant and I pay boatloads to him and I would happily [pay him more if he raised his rates because I think it is the best investment I have going. His advice and work allow me to make much more money than his services cost. Yet, I realize every time I see him the clock is ticking and if I start waxing on about my weekend and my family relations, I am paying for every moment of that conversation. I go in prepared with my questions and documents, I give him the info he needs, he give me my options, I tell him what he needs to know and answer his questions, we exchange a few pleasantries, and I thank him for his time. I never have an issue whereby “he didn’t spend enough time with me”. He gives me all the time I want and not a bit more or less. That is because he gets my money directly and I let him know he is very appreciated. No third party controls his reimbursement for the time he spends with me and the guy makes significant 6 figures and I am GLAD that he makes a ton of money. Good for him! He’s doing something well and should be well-compensated for his expertise. I even send him a bottle of wine during the holidays though I am positive he could buy his own. It is a truly mutually beneficial working relationship that both of us value. I believe you might feel rewarded if you approach you physician in this manner. Chastising him or her and expressing disgruntled-ness will rarely get you what you want from someone who is positioned to simply disregard you as a complainer.