There are three goals to accomplish during your limited time together with a doctor:

• Help the doctor fully understand your medical situation.
• Get answers to your questions and concerns.
• Understand the doctor's recommendations.

Following are guidelines and tips to help accomplish those purposes. Click on the links to learn more about the subject. 

Prepare for the meeting 

• Keep track of your symptoms: what they are, how long they last, the severity, what helps, what doesn't
• Make notes about your questions. Before going to the meeting, prioritize them in order of importance so you at least get to ask the important ones during the meeting. (We supply a prioritizer that allows you to make notes as you think of them, then prioritize them just before going to the meeting)
• Take someone with you as a patient advocate for support, to help ask questions and to discuss what happened after the meeting.
• Take a recorder with you (for example, in a smart phone) to record the meeting so you can review what was said later. Also take a pad and pen to make notes in case the doctor doesn't allow recordings
• Check your insurance to be sure approrpriate steps have been taken for the meeting to be covered 
• Check with the doctor's office before the meeting to be sure all test results and the like are received before the meeting.
• Look over our article about overcoming bumps in the road "just in case" any appear during the meeting, you'll be prepared with what to do.
• If you are uncomfortable discussing embarrassing subjects, write a script and rehearse it in front of a mirror. 
• For additional information about preparing for a medical meeting, click here.

Help the doctor fully understand your medical situation.

• Be open and honest with your doctor.
• Tell the doctor everything that he or she needs to know.
• Use medical terms whenever possible.
• If you are asked a general question, answer it precisely.

Get answers to your questions and concerns.

• Keep in mind that you are a consumer of healthcare. The best way to make decisions is to be informed.
• Ask everything you need to know.
• Be sure you understand what the doctor tells you.
• If you have done research about your condition or treatment from another source, give the doctor a copy or the citation. Ask the doctor's opinion about the information rather than using it to confront him or her. 
• Find out what to do if questions arise after the end of your meeting with your doctor.

Understand the doctor's recommendations.

To be sure you understand what the doctor tells you, consider the following ideas:

• Record the session if the doctor lets you. Patients "immediately" forget 40% to 80% of what the doctor told them according to a 2003 paper in Britain's Journal of the Royal Society of Medicine.
• At the end of the appointment, summarize your understanding of what you were told.

Additional helpful tips

• At the beginning of the meeting,
  • Make a human connection. Doctors are people. Maybe break the ice with something as simple as: "How is your day going?"
  • Let the doctor what you hope to accomplish in the meeting.
• Stay on point. Oversharing information which is not related to your medical concerns takes time away from the things you care about.
• Keep the playing field level so you feel as if you and the doctor are equal partners in your health care.
• Let the doctor know what you can afford. If you cannot afford a prescripton or treatment, perhaps the doctor can suggest an alternative. You can also ask him or her to help you prioritize your medications, so you know which ones you can skip and which ones you must take.(Also see: su#mce_temp_url#)
• Do not expect the same relationship with all your doctors.
• Be proactive.
• Do not avoid sensitive subjects.
• If your doctor suggests something that you know you cannot do, tell your doctor so he or she has an opportunity to come up with an alternative that works for you.
• Try to make yourself an individual to the doctor in whatever manner works for you. Telling about your personal life helps. So does showing concern for the doctor's life and schedule.
• Expect the best from your doctor.
• If you are over age 65, watch for doctors who think about your age before your symptoms.
• Learn how to deal with problems that may arise in meetings with doctors.
• If you do not accomplish everything you need to accomplish, ask the doctor when you can speak again on the telephone.
• If you are grateful to your doctor, show it.
• Follow up with whatever you are supposed to do, including filling prescriptions (and taking the drugs as prescribed), arranging for follow up tests or doctor appointments etc. 

NOTE: To watch techniques that can help when talking with your doctor, see Meret's Oppenheim's video: Talking With Your Doctor.

Medical schools do not teach mind reading.

Describe everything that is different about you since your last visit.

• Include new medications and treatments - even if you they don't seem to relate to what the doctor i's treating you for. The change could be related to your medical condition or to a medicine you are taking. Let the doctor make that decision. 
• Describe all your symptoms since the last appointment -- including the personal ones or ones you find embarrassing that you may be reluctant to talk about.
  • Include how each symptom affects your ability to work or to do the activities of your daily living. [Be sure the doctor notes this information in your record. It will become important if you ever want to apply for Social Security Disability Insurance (SSDI), a disability program at work, or Disability Income Insurance].
  • Survivorship A to Z provides a Symptoms Chart which can help keep track of your symptoms. When you push a button, the information turns into a fast-to-read chart.
• Tell about any new stress you are feeling. Information about what is happening in your life may be useful medically, whether it's a major change, stresses, a divorce, or the death of a loved one.
• Tell the the doctor is you haven't been sticking to your agreed drug, nutrition, exercise or rest regimen. The doctor will otherwise expect that you have been sticking to the plan. 
• If money for treatments, tests, drugs or even the doctor is an issue --always mention it. There are lots of different things the doctor can do to help you save money -- including cutting his or her fee, giving you free samples or generic versions of drugs, and ordering less expensive tests.

Areas to talk about at least once

• Pain priorities: Let your doctor know your priorities when it comes to pain. For example, whether it is more important that you be clear headed at work, or that you have no pain if at all possible.
• Hearing: If hearing is a problem, tell your doctor. If necessary, explain whether you prefer your doctor speak louder or speak more slowly.
• Your prognosis (what can happen in the future and when): Let your doctor know how much you do, or do not, want to know about your health condition.
• Complementary therapies: How you feel about complementary therapies.
• Whether there are physical or nutritional changes you could do that would affect your health.
• End-of-life issues such as whether you are more interested in quality compared to quantity of life. Keep in mind that this discussion is not  about your diagnosis. Things happen. (See Enforcing Living Wills And Other Advance Directives.)

Guidelines for talking with your doctor

• Be brief. Let the doctor ask questions if he or she wants to know more.  
• Be direct -- not indirect. 
  • The doctor can't read your mind so don't ask him or her to. 
  • You may be used to underplaying your symptoms or your concerns with friends and people at work. Now is not the time.

Tell the doctor everything that relates to your health.

• Thanks to doctor-patient privilege, what you tell your doctor is confidential. The requirement to keep your personal information confidential is also codified in the federal law known as HIPAA. 
• Nothing is too embarrassing to discuss. We're talking about your health - and your life. 
  • If you are gay, lesbian, bi-sexual or transgender, be sure to let your doctor know.
• Some people think they make the doctor feel good about them if they downplay their symptoms. You can downplay the extent of your symptoms with friends and family if you want - but it is not advisable with your doctor.

When talking with your doctor:

• Be brief. Let the doctor ask questions if he or she wants to know more.  
• Be direct -- not indirect. 
  • The doctor can't read your mind so don't ask him or her to. 
  • You may be used to underplaying your symptoms or your concerns with friends and people at work. Now is not the time.
• Do not bend any facts because it is what you think the doctor wants to hear. The doctor needs truthful answers. For example, do not overestimate how compliant you have been with a drug program or how much you have exercise, or rested.

If you are concerned about how to say things, practice at home with a family member or friend - or just by talking into a mirror.

Suggestions For Making The Conversation Easier

If discussing a particular issue is a problem for you, perhaps one of the following suggestions will make it easier: 

• Tell the doctor up front that you have something embarrassing to discuss.
• If you have difficulty saying it in person, send the doctor a note by mail, fax or email.
• If you take a patient advocate with you to the appointment, ask him or her to bring up the subject.
• Tell the person in the doctor's office with whom you are comfortable. Ask him or her to tell the doctor for you.

Tell the doctor if you feel rushed, worried, or uncomfortable in the visit. Do it in terms that are not threatening to the doctor. For instance, it is better to say "I don't understand" than to say "You're not being clear." This is your health. Discomfort in the form of sweating palms and fear of reprisal or of being disliked is a small price to pay for getting the care you need.

Getting the information you need is important for your health. Ask:

• Your list of questions and concerns, with the most important items first. Don't wait until the end of your appointment -- bring them up right away. Don't just ask such a general question as "What will happen?" Narrow the focus of your question. For example: "What symptoms can I expect?" "Will it affect my ability to work?" etc. Don't be put off if you don't get to ask all your questions. If there are some left over that seem important to you, ask the doctor when the two of you can discuss them. (Survivorship A to Z provides a Prioritizer to help keep track of your questions or concerns as they arise, and then to prioritize them before your doctor's appointment).
• About anything that does not seem clear. If you don't say anything, the doctor will assume that you understand, or already know the answer or that you don't want more information. There may be uncertainty in medicine, but something is wrong if there is mystery. For example, you can say: "I want to make sure I understand. Could you explain that a little more?" or "I did not understand that word. What does it mean?"
• Perhaps the doctor can show you a model or point you to a graphic or draw something for you. This would be particularly helpful if you are a visual person: a person who understands better when you see things.
• If the subject is changed before you understand, then return to the subject before the end of the meeting, or call afterward for an explanation. The easiest way to confirm you understand is to repeat what was said, but repeat it in words you understand.

Too often there is miscommunication between doctor and patient because the same general words mean something different to each person. It is better to be overly detailed than to be too general. If you are getting into too much detail, the doctor will let you know.

To provide an example: If you are asked about your appetite, you may say it is much improved. To the doctor, that is likely to mean that your appetite is normal - like his or hers is. However, let's say that you were only able to eat a few spoonfuls at meal time. Now you are able to eat a half a meal, twice a day. If the doctor asks about your appetite and you say it is "much better," the doctor may hear that you are eating normally. If you stated the facts instead of your perspective, the doctor would know what is actually happening and can make suggestions. 

As another example: Say you were only able to walk up and down the stairs once a day. Now you can do it three times a day, but are still too weak to leave the house. If the doctor asks about your energy, to say it is "okay" would mislead the doctor. It is better to describe what you can and cannot do so your true condition is understood.  

Learn the medical terms relating to your condition, the markers and side effects to watch for. Using medical terms has the following advantages:

• It makes communication between you and your doctors more efficient.
• It allows more time for your questions or concerns.
• Doctors are more likely to consider you an ally with an understanding of the condition instead of than a layperson to be educated.

• It makes it easier for you when you do your research because your level of understanding will be increased.

An easy method to be sure you understand

Repeat what you think the doctor means in your own words and then ask a question to confirm you understand, such as: "Is this correct?"

Record the meeting

Experience has shown that it is helpful to record what happens at your appointments.

• You can replay the conversation later to be sure there isn't anything you missed or didn't understand.
• Recording devices are inexpensive. You may even be able to make a recording on your mobile phone.
• Recording works particularly well if you want to share the details you've learned with others.
• Ask the doctor's permission before making a recording. 

If you don't take a recording device,or if the doctor doesn't allow you to make a recording: you can take notes or ask the doctor to write down the main points for you. If you can't write while the doctor is talking to you, make notes in the waiting room after the visit. 

If you want more information

Ask for written or recorded materials such as brochures, DVDs, CDs, cassettes or videotapes. If the doctor doesn't have the materials on hand, ask the doctor to recommend other sources of information for lay people (non-professionals).

If you bring up information or questions about research you've done, it makes the conversation more constructive if you can give the doctor a copy of the research. If the information is lengthy, at least give the doctor a citation where he or she can find the information. 

Ask the doctor what to do if you have questions that come up after you leave.

• Can you e-mail the doctor with questions? If yes, get the e-mail address.
• Can you call with questions? 
  • If so,when is the best time for you to call? 
  • Some doctors have their staff collect questions all day, and then return calls during a set time in the evening. Does your doctor work this or a similar way? If so, when can you expect a call back?
• Does the doctor want you to speak with a staff member instead of the doctor? If so, what is the name of the person and the best way to reach him or her?
• Is it better to set another appointment to ask your questions?

Always tell the doctor what you hope to accomplish during the meeting. Listen to what she or he wants to accomplish. The two of you should then set an agenda. The doctor can pace the time you have together.

If the doctor isn't interested in your half of the agenda, it could be cause to find a new doctor.

If you aren't comfortable with the privacy of the space, ask to talk in a private room, where you can close the door. Failing that, you can settle for any private space.

If you feel you and the doctor are working together as partners in your health care, you will feel more in control. It also stands to reason that your time together will be more fruitful. Here are some tips for keeping the playing field level:

• Discuss with the doctor what to call each other. For example, by your last names or first names. It's hard to be on an equal footing when you call the other person "Doctor XYZ" and the doctor calls you by your first name.
• In many meetings with a doctor, the patient is naked under a flimsy cloth or paper gown while the doctor is in business attire and possibly an imposing white coat. To help level the playing field:
  • Sit or stand up when you're not being examined.
  • Wear two dressing gowns so nothing is hanging out.
  • Practice being in an examining gown at home. Create a gown on your sewing machine or with a few hand stitches.
  • If you don't have a sewing machine or aren't handy with a needle, wear a large men's shirt or bathrobe backwards. Don't close the back. Leave it open just as normally happens with a hospital gown. Spend a couple of hours going about your normal activities inside the house. It helps to do this in front of close friends or family members. The key is to get comfortable with this kind of exposure -- like a rehearsal for a performance.

It is likely that you have a long term relationship with your primary care doctor. Over time, your doctor learns about your life, and you learn about his or hers. 

Don't expect the same relationships with a doctor for a single situation. 

Specialists may be more focused on your health condition than you. 

As Consumer Reports reported in 2004: "…research shows that patients who work actively with their doctors tend to feel more in control, to tolerate symptoms better, and to take greater responsibility for improving their health. More important, they're more likely to be diagnosed accurately, to respond to treatment, and to recover quickly."

Gather enough information to make decisions based on facts -- not to become a doctor. Facts are your friend , especially if you are planning to say "no" to the doctor's suggestion.

As Dr. Julia Wellin says: "In today's medicine, if you don't ask, you don't get. You're not a pain. You're a self advocate."

NOTE:  If it helps you to assert yourself, let the doctor or nurse you understand the pressure they are under by saying something such as "You really seem to be working hard today. I hope you don't mind me asking the questions that are concerning me."

To help foster the feeling of a partnership , it is helpful if your doctor thinks of you as an individual. The more the doctor knows about your life, the more he or she can consider whether there are non-medical factors affecting your health condition.

One way to make yourself an individual is to talk briefly about non-medical parts of your life  - such as the financial stress you feel, or the stress you may be under at work. Ideally this would occur while you're telling your doctor about what's happening in your life so you don't take more time than the doctor has. It may be helpful to rehearse how to say what you want before your appointment with the doctor.

Also let the doctor know how your illness affects your work. Ask that the impact be noted in your medical record in case you decide to file for disability.

Expect that your doctor will want to do a good job, to try to stay on top of things, and never make a mistake. At the same time, as wise as your doctor may be, all doctors are human. From time to time they will mix up facts and memories, be rushed, distracted, impatient, and make mistakes. It's all those reasons combined which makes it important for you to question things before you make a decision.

Also:

• Expect that the doctor will tell you everything that relates to your care, in language you can understand, so you can make informed decisions.
• Expect that you will be involved in decision making to the extent you want to be.
• If you are using or want to use a complementary therapy, expect that the doctor will know, or at least learn, enough about it to let you know if it could be damaging to you or if it could interfere with your overall treatment plan.

• Assume that your intuition is right. If your relationship with your doctor feels uncomfortable - consider changing doctors. This is not something to do lightly, but can be done if necessary.

Older people often get short shrift from their doctors. Doctors often assume that certain problems such as depression, how well your brain works, or that you are no longer able to have sex are results of aging. Therefore they don't suggest a treatment or look to prevent these situations. There may also not be enough pain relief or comfort.

If your primary care doctor is not a geriatric doctor, consider switching. For a list of geriatric doctors in your area, you can contact the American Geriatric Society 212. 308.1414 or www.americangeriatrics.org

Several problems that are fairly common and proposed solutions are listed below.

Problem: The doctor keeps interrupting you.

Solution:

• Ask for a chance to finish.
• Have your list of subjects you want to discuss to help you keep on track. (We have a prioritizer to help you compile your list, and then prioritize it).
• If interruptions continue, mention it politely. For example: "I want to hear your thoughts, but I'd appreciate if you'd let me finish. I will try to say this as briefly as I can."

• If interruptions still continue, let the doctor know what you are feeling due to the constant interruptions and to ask that s/he consider that.

Problem: The doctor intimidates you.

Solution:

• Humanize the doctor by thinking of him or her at a vulnerable, human moment -- such as sitting on the toilet.
• If you can pinpoint something specific that the doctor does which intimidates you, let the doctor know. Even if it doesn't change the behavior (after all, we are who we are), it may take the sting out of it for you.

Look at our videos by Meritt Oppenheim, How To Talk With Your Doctor for additional tips.

Problem: You feel overwhelmed during the appointment

If an appointment becomes overwhelming, tell the doctor you need to take a short break. 

• Ask what is the maximum amount of time you can take without unduly disrupting the doctor's schedule.
• Ask how to get hold of the doctor when you are ready to start again.
• Consider going to another area such as the bathroom or waiting area. 

Problem: The doctor does not explain your condition or treatments in a manner that you understand.

• Let the doctor know you are having difficult understanding what he or she is saying. It is better to say "I don't understand" instead of "You are not being clear about..."
• If the doctor uses a word you don't understand, ask him or her to define it for you.
• If you think you will understand better with pictures, ask to see X-rays or slides, or have the doctor draw a diagram.
• To be sure you do understand what you are being told, you can repeat it back to the doctor starting with: "To be sure I understand, let me repeat to you my understanding."

NEW SUBJECTS

This is not the bset time to bring up a new subject because the doctor is likely running out of time. If a new subject cannot wait until the next appointment, ask the best way to contact the doctor about another subject that you'd like to discuss.  

RECAP

At the end of each appointment, restate the following so you both know you understand what was talked about:

• Your understanding of what was discussed during the appointment
• What should happen next, and by whom. Include any agreed dates by which the agreed actions should occur.
• Review screening tests that need to be ordered, medications which are being prescribed and lifestyle changes that you have agreed to make.
• Ask the doctor if he or she has anything to add.

FOLLOW-UP APPOINTMENTS

Make follow-up appointments before you leave the doctor's office -- even if it isn't for months from now. You'll have a better shot of picking a time that works for you (first thing in the morning is best). You won't waste time calling for an appointment.

MORE INFORMATION

If you would like more information about what is discussed during an appointment, or in general about your condition, symptoms and/or treatment, ask the doctor if he or she has any literature you can take home.

In addition, ask the doctor what website he or she would point you to. While Survivorship A to Z provides information about how to do medical research, the doctor may have a favorite site or sites for your particular situation. (See "To Learn More.")

If you are uncertain about what was discussed, or what to do next, let the doctor know. 

If additional questions come up once you get home, communicate with your doctor or the doctor's office to get your questions answered.

OTHER DOCTORS

If you have more than one doctor, keep each one of them to date every time you see each doctor. One doctor may notice a change that is not important to what that doctor is treating, but may be important to another doctor. He or she may also want to change your drugs or treatment in a manner that another doctor may not find acceptable. We provide a System For Keeping Your Doctors Up To Date. If the system works for you, or you create one on your own, ask the doctor for a summary of the meeting to send to other doctors. If you do not want to use the system or one of your own, at least ask the doctor to send a report of the visit to your primary doctor. (If you have other suggestions for keeping doctors to date, please let us know by e-mailing to Survivorship A to Z)

If you're happy with the doctor, show your gratitude and let him or her know.

Everyone likes to feel appreciated.

Think about:

• Saying something such as: "When you (fill in the blank), I feel (fill in the blank).
• Sending the doctor a note of appreciation.
• Taking small, inexpensive gifts for the doctor and/or his or her staff.

It may not be comfortable talking about the following sensitive subjects, or any other subjects that are sensitive to you. However, it is critically important that the doctor know as much as possible in order to treat you correctly and to the max:

• Sexual issues
• Discussion about your private parts.
• Bodily functions
• Alcohol or other drug use
• Emotional difficulties
• Sleep problems
• Memory problems

If discussing these issues, or any other, is a problem for you, consider rehearsing in front of a mirror or in front of a family member or friend. Keep in mind that family and friends are part of your team.