I recently read a book entitled, “The Art of Medicine:  What Every Doctor and Patient Should Know,” by Kevin J. Soden, M.D.  (I would highly recommend this book to everyone!)  Dr. Soden had a lot of good information for patients, and it got me thinking that we are never really taught how to be a good patient.  So, the purpose of this post is to give you a few tips, mostly from Dr. Soden, but I’ll throw in my two cents as well.

It is important to think about the doctor-patient relationship as just that – a relationship. Oftentimes, how successful this relationship is can determine whether or not you get well. And, with all relationships, communication is key.  According to Dr. Soden, “History taking alone accounts for the correct diagnosis 70% of the time,” with hands-on exams and laboratory work making up the remaining 30%.  So what does this mean?  It means that the chances of your doctor making the right diagnosis is almost completely up to what you tell him.  If you withhold information for whatever reason, your doctor won’t be able to help you in the best way possible.

One of the sad things about modern medicine, for both doctors and patients, is that doctors don’t have enough time to spend with patients.  (Yes, doctors WOULD like to spend more time with you!)  This is an unfortunate symptom of some of the greater problems plaguing medicine today.  In the past thirty years, HMOs have taken over health care, and, to make a long story short, doctors only get compensated for procedures.  That means your doctor makes more money if he orders more lab tests for you, even if you don’t need them, while he won’t make more money for just spending the extra time with you taking your history, which, as I said before, is usually a more useful diagnostic tool.  I.E., doctors are less satisfied with their jobs because they get less time with patients, and patients are less satisfied with their doctors because they don’t feel like they’re getting listened to.

So, what can you do about it?  Well, there are a number of things Soden recommends.  Here is his top 10 list for helping your physician make the correct diagnosis:

1. Think about your problem before seeing your doctor, and write down all the pertinent facts so you don’t forget the most important things.
2. Decide what the key issues are that you want answered and prioritize them.
3. Think about your symptoms – when did they begin, how long do they last, and what changes them for better or worse.
4. Tell your story succinctly so that your doctor can ask questions to clarify your concerns.
5. Don’t be afraid to tell your doctor about the signs and symptoms that are bothering you even if he doesn’t specifically ask about them.
6. Do mention anything that is difference about you since your last visit because the change could be related to your medical problem or to a medicine you are taking.
7. List all the medications and supplements you are taking.
8. Be honest about the level of pain that occurs during the physical examination.  Downplaying this may cause the doctor to underestimate your problem.
9. Don’t wait until the doctor is leaving the room before mentioning a particular concern  you have or the problem might not get the attention it deserves.
10. Be sure to tell your doctor if you’ve had something like this previously or what you think your problem may be.  (Patients are often right.)

Some of these may seem fairly obvious, but it’s important to prepare yourself to go to the doctor.  I mean, we all know the questions they’re going to ask, so why not be ready for them to maximize our time?

I would also highly recommend listening very carefully to the instructions your doctor gives you, especially in regard to prescriptions.  According to Dr. Soden, “Nine out of ten patients don’t take their prescription medicines properly.”  Furthermore, “Fifteen percent of patients never get their prescriptions filled once they leave their doctors’ office.”  Ask questions if you don’t understand, and be honest if, for whatever reason, you don’t want to take the prescription.  Your doctor isn’t your mom, and he can’t make you do anything you don’t want to do.  Oftentimes, there are multiple treatments for an illness, and your doctor could provide you with alternative solutions.  Unless you’re my grandma, and you’re just too stubborn to your pills.  

I also think it’s important to have realistic expectations.  There is nothing wrong with researching your malady on the internet before going to see your doctor, but know that there are many unreputable sites on the internet, so at least try to find universally accepted and accredited ones.  Bring up what you find with your doctor.  Another interesting thing to note is that our country is one of the few that allows drug companies to advertise directly to consumers (probably not a good thing).  There are tens of thousands of drugs on the market, so for every commercial you see, there are most likely a hundred other drugs for the same thing, that are probably cheaper because they aren’t advertising on television.  So, while it’s okay to ask your doctor about a specific drug, know that he might have good reason to suggest a different one.  Finally, a note on antibiotics.  Patients, as well as doctors, often have an unrealistic idea about what antibiotics can, and should, be used for.  These “magic bullets” are only useful to treat bacterial infections.  Whenever we get a cold, we just assume we need antibiotics, when, in reality, you might have a viral infection.  Patients usually go to a doctor with the expectation of getting antibiotics, so physicians usually comply.  However, there is such a thing an antibiotic resistance.  The more antibiotics being prescribed, the easier it is for the bacteria to become resistant. Physicians should know better, but in today’s day and age, drugs are usually the first thing they pull out of their bag.  Many times they will prescribe a number of antibiotics “just in case,” when you could really try different kinds or smaller doses before bringing out the big guns.  To be the “best patient you can be,” I strongly recommend asking questions before your doctor gives you antibiotics.

In the end,  you are the patient.  It is your body and your health at stake.  While doctors do generally know more about diseases and medicine, you know more about what is best for you.  If you are uncomfortable with a specific medicine or treatment, don’t take it, or at least ask questions to assuage your concerns before proceeding.  Every person is different, and what is right for one person may not be right for the next.