Questions patients should be asking their doctors

An excerpt from Top 5 Questions to Ask Your Doctor

by Sagar Nigwekar, MD and James Sutton, RPA-C

Tips for Talking to Your Doctor

Entering a doctor’s office can be like entering a different world. There are often “rules” and “protocols” that the doctor, nurses, and staff follow that you may not be familiar with. This book offers some very helpful questions for you to have an intelligent conversation with your doctor, but there are other things that can be helpful in making the office visit better.

When you think about the patient/doctor relationship, the word “relationship” is very important. The typical doctor has 2000 to 3000 patients, most of whom they see only once or twice a year. Seeing 20 to 30 of these patients each day, most doctors have only professional relationships with their patients and the majority of their patients are known by just a name and whatever information is in the medical record. This is worsened by the fact that you may only see your doctor for a few minutes a couple times a year. Therefore, you should be in “relationship building” mode from the minute you enter the office. The better the relationship you have with your primary doctor, the higher the likelihood you can have good and detailed conversations with him or her.

What do we mean by “relationship building?” Well, think of any relationship you have with people close to you and what you do to build those relationships. Think of your spouse, co-workers, casual friends, and family and the things you do to have good relationships with these people. Those same basic principles can go a long way to help build a relationship with your doctor. Here are a few tips.

Dress for success

Dressing professionally shows power and confidence. Doctors and their staff are people too, and even though you shouldn’t judge a book by its cover, we all do! If you were going for an interview, going to the bank to ask for a loan, or going out on a date for the first time you would try to look your best to make a good first impression. Dress up to see your doctor, and you will see the difference in your treatment at every step of the visit.

Bring someone with you

Doctors are used to having more than one person in the room at a time. A doctor will act differently with more than one person in the room, because most people function differently in group settings than one-on-one. Also, when you are sick or dealing with an uncomfortable diagnosis, having another person in the room to remember what was said is always helpful. Whoever comes with you can sometimes catch things from the conversation that you may have missed. One word of caution: make sure you are comfortable discussing personal information in front of the person you bring!

Connect with your doctor

Building a relationship is about connecting with the other person. Doctors normally allow a minute or two at the beginning of the visit for this connection. Take this time to smile, shake hands, make good eye contact, and use this time to “socialize” before the visit begins. Good opening lines are “Looks like a busy day today” or “I haven’t seen you in a long time” or “I like the changes you made to the waiting room.”

Set the agenda

Doctors have a limited amount of time for office visits. In order to use their time wisely they usually set the agenda and control the visit as much as possible. Because of this control you may realize that the visit is over before you got around to asking your questions. To prevent this, be involved in setting the agenda for the visit. Most doctors will start the visit with an opening question such as “How can I help you today?” or “What can I do for you today?” This is your opportunity to set the agenda. If you say, “I have had this headache for three days,” then the doctor will shift their brain into headache mode and that becomes the agenda for the day. Here are some ways to set the agenda:

Doctor: How can I help you today?

Patient: I am not sick today. I just want to spend a few minutes talking about my diabetes, and I have some questions to ask you about my illness.

Doctor: How can I help you today?

Patient: I have had a headache for three days. After you make your diagnosis, I would like to ask you a couple questions about my condition.

Most doctors consider the diagnosis as the end of the visit and then shift their attention to prescribing a treatment. If you don’t warn your doctor that you are going to finish the visit with a few questions, then he/she may not time the visit correctly and the visit may start to run overtime as you ask your questions.

Use your time wisely

Timing is everything. Be prepared to talk about your questions and issues in the least amount of time. Have your questions ready before the doctor enters the room. If you are there for a specific symptom, then as soon as a diagnosis (or possible diagnosis) is mentioned, open your book to the appropriate page and be prepared to ask your questions.

Allow for some silence

A well timed pause goes a long way. How many times have you tried to get something done while someone else is chatting away and breaking your concentration? Don’t ask your questions during the examination, or when the prescription is being written, or if the doctor is still asking questions to determine the diagnosis. Let the conversation flow naturally and allow the doctor time to “practice his craft” such as look in the record, perform an examination, and ask questions. Save your questions for after this is done.

There are certain questions that are important to ask anytime you see your doctor. It is important to know and understand what your health problems are, as well as to understand your treatment. If your doctor has recently diagnosed a new medical condition, or is starting or changing a treatment, you will find these questions very helpful. In addition to the disease-specific questions in this book, you should also ask these questions about your treatment whenever you can.

Top 5 questions

How will I know that my treatment is working?

How will the medication or treatment you are prescribing treat my condition?

Is there more than one condition that could be causing my problem?

What exactly is my condition, and what caused it?

What symptoms should I look for that means I should contact you or seek immediate help?

Additional questions you may consider asking

Are there treatment choices that don’t involve medications?

How long will it take for me to feel better?

If my symptoms get worse, what can I do on my own before I see you?

Is my medical condition permanent or temporary?

Questions You Should Ask About Your Medications

Any time you are prescribed a medicine you should ask these questions:

Top 5 questions

Can I take a generic medicine or is this available over the counter?

Can you review my instructions with me?

  • At what time should I take this medication?
  • Should I take it with or without food?
  • Can I take it with other medications?

What are the possible risks and side effects of this medication?

What is the reason for taking this medication, and how does it work?

Will this medication interact with any other medication I am taking?

Additional questions you may consider asking

Can my medication be stopped suddenly or does it need to be stopped slowly?

Do I need to follow any restrictions (alcohol, driving, and work)?

Do you think a pill box will help me?

How long will I need to take my medicine?

If I do not tolerate this medication then what are my alternatives?

What should I do if I miss a dose?

Where do I store this medication at home?

Sagar Nigwekar is an internal medicine physician and Jim Sutton is a family practice physician assistant. They are authors of Top 5 Questions to Ask Your Doctor.

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  • Finn

    Mostly excellent tips, except for “dressing professionally.” What’s the point when the vast majority of the time, the medical assistant brings you into the exam room and tells you to change into a johnny before the doctor arrives? I refuse to do it with a new doctor — I will not meet new people when I’m essentially naked — but for the sake of not wasting time, I’ll put the hideous thing on when I’m seeing one of my regular doctors.

    • Jim

      You make a really good point. I hate those gowns too. Most doctor (at least those worth seeing), keep them in the drawer and only pull them out if a specific body part needs to be examined that requires un-dressing. You are right to refuse to wear that thing.

  • Laurie

    It’s really hard to develop a relationship with someone who leaves you in the hand of a physician assistant.

    As for dressing up-After I spent a week in a feverous stupor, I am supposed to put on a suit, makeup and fix my hair to see the doctor?-sorry, I mean physician assistant?

    • Jim

      You may not be giving PA’s their credit due. I have been a PA for 23 years. As the MD profession evolved over the last 200 years it because painfully clear that all that education was utilized about 10% of the time for very complicated cases. The rest of the time (common illnesses, chronic disease management, wellness visits, counselling, etc) didn’t require all that education. Thus the PA profession was born in the 1960′s. If I have a serious medical condition or a complicated case I want to see that highly educated MD. If I have your run of the mill diabetes, or sore throat needing some antibiotics I would rather see a PA. They will spend more time with me, talk to me on my level, pay attention to what I am saying, and I won’t have to wait forever to see them. In the end, I will get the same care…… A prescription written for Amoxicillin with a PA signing it or an MD signing it is still just a prescription for Amoxicillin. In the UK they decided that even PA’s are over educated for some of the tasks they perform and now have a provider classification below a PA that does basic “MD” tasks to free up PA’s and MD’s to take care of more complicated cases.

      I agree with you, though, about the dressing up part. I was the one that wrote that chapter and I should have mentioned that it more realistically applies to “well” visit such as physicals, not sick visit. My bad on that one.

      • Laurie

        I’ll repost my comment from the nurse practitiner thread here…How do you know I have a garden variety illness or something more complicated if you don’t see a doctor?

        …I spent two years being cared for by midlevels for what seemed like a complications from a common cold. The only time my doctor had time for me was during a physical, and she never saw me when I didn’t feel well, only relied on the notes of the nurse practitioner.

        After research at WebMD, thanks to Dr. Enright, I referred myself to a specialist. I wonder if I would have received a more timely diagnosis if my primary care doctor had been involved with my care? I don’t waste time in primary care anymore….

        All those prescription written for Amoxicillin prolonged my suffering and in the end, I aquired an respiratory infection usually reserved for hospital patient taking long term antibotics.

  • Jim

    I am sorry that you had a bad experience, Laurie. There are some of us out there in primary care that are trying to make the patient experience a good experience and trying to make sure that what happened to you doesn’t happen to other people. It sounds like you were connected to a doctor that was working from the opposite play book. I hope you can understand that there really are good PA’s and NP’s out there and really good doctors out there….. unfortunately, though, it looks like you weren’t dealing with one. Best of luck and I hope you keep fighting for your right to be treated with respect and dignity when you are ill…. that is your basic right in life.

    • Laurie

      Why is it when something is missed, the doctor or PA or must have been bad and all my problems would be solved if I found a good doctor? I was just in that 10%. My guess is that the midlevels I saw considered only the episode at hand and didn’t consider my history. The midlevels didn’t know my case was complicated because they were not qualified to make the diagnosis. I will never choose to see a NP or PA again, even for the simplest problem.

  • greencat

    Sorry….time’s up…used my whole 10 minutes….

    Seriously, the answer to many patient / doctor issues, from safety to patient satisfaction to error prevention is just more time with the patient..That is the thing I cannot get…

  • http://www.howardluksmd.com Howard Luks

    Physicians are under pressure to see patients in a timely, effective, and efficient manner. Take a little time, organize your thoughts, come prepared and your visit could be much more productive.

    What to bring:

    Pad and pen… you will likely receive recommendations and many patients forget them as soon as they leave the office.
    A list of your medical problems
    A list of your medications
    A list of your prior surgeries
    A copy of pertinent studies (MRI, X-ray, etc)
    A copy of pertinent medical records (valuable for second opinions).
    Dress appropriately. The physician will need to see the area of concern.

    Organize your thoughts: A new orthopedic history will include…

    When did the problem start?
    What were you doing?
    Have you started taking any new medications?
    Have you changed your exercise program?
    What makes the pain worse?
    What makes the pain better?
    Do you have pain at night?
    Does it awaken you?
    Any numbness, tingling or weakness?
    Any morning stiffness?
    Pain getting up from a seated position?
    Pain walking on hills?
    Shoulder patients consider what motion causes your symptoms.
    Do you have any mechanical symptoms (catching, locking, clicking, etc)?
    Do you have any instability (does the joint feel loose)?
    Do you have any swelling?
    How does the pain affect your quality of life?
    What have you tried so far to obtain relief (physical therapy, injections, medications, exercise, etc)?
    After the exam and discussion of the findings, your doctor will likely present you with alternatives….some thoughts you should have.

    What are the possible diagnoses?
    Is further testing necessary (If the test will not change the plan of care, then it is possible that you do not require further tests)?
    Is an MRI or expensive imaging necessary (many times it is not)?
    What are the non-surgical, surgical alternatives available to treat my condition?
    What are the possible risks, side effects of the treatment?
    What will happen if I choose not to have surgery?
    What does the literature or research recommend (many physicians still practice based on anecdotal experience [which might be appropriate, depending on the situation])
    Specific considerations for surgical patients.

    What are reasonably forseeable risks of the surgical procedure?
    What are the realistic goals of the procedure (relief of pain, functional improvement, etc)?
    What is my “expected recovery time (recovery means different things to different people… be VERY CLEAR about your goals)
    When can I use my arm/leg?
    When can I l use my arm/leg for activities of daily living?
    When can I use my arm/leg against resistance (lifting objects or putting weight on your leg)?
    When can I drive?
    Do you know what I do for a living? When can I return to work?
    Hopefully this will help you on your next visit….

  • eRobin

    Telling someone to dress up to see a doctor – and comparing a visit to applying for a loan or going out on a first date – is offensive. But maybe I’m just too evolved to understand what you’re talking about. After all, I don’t stop seeing a doc b/c someone on her staff has ugly hair or weighs too much or can’t put a sentence together without making an error in grammar. And I look past waiting room and exam room decor that doesn’t suit my taste. And I will return to the doc who had posters for a GOP candidate for Congress placed around her office. And I have even been known to continue to see docs who have FOX News on their waiting room tvs, although in that case I usually wait outside the office for my appointment.

  • http://pulse.yahoo.com/_ZHIJGDKBXXQODIMEJJMH2SFPNM Jessie

    I would have to add — be very  very careful to hide any knowledge you may have about your condition. And if you have managed to diagnose yourself, try to somehow lead the doctor into guessing what you already know. I made the dreadful mistake of thinking it would be helpful to a new doctor I was seeing, who was late and obviously rushed, if just I told him why I was there. HUGE mistake. He stopped listening at the first sign that I knew something about my own health condition. And ended up diagnosing me with, essentially, hypochondria.

    I had failed to understand how fragile doctors’ egos are. (I should say male doctors’ egos, and only of that subset I have met with personally; there are no doubt some exceptions. And this has not been a problem with my woman physician; I just couldn;t find a female specialist in the area I needed.) He needed to make the diagnosis because his omniscience falls apart if he learns something; that implies that there are things he does not already know. I take that for granted — unless I come in with an ax in my head, I can’t think of a way a doctor can determine what is wrong with me without my telling him a little bit about, well, what is wrong with me. At least enough to give him a general idea of the rough kind of diagnosis to accept, reject, test for, etc. And this particular fellow was so rushed, there seemed no way he was going to guess from looking at me — I look very much like a person — that I without doubt had a severe trematode infection and why there was no doubt that was the case. Trematode infections are nowhere on any US doctor’s top 5,000 guesses list, as Western MDs are famously and very oddly resistant to the idea that white people can get, in this case, an Asian foodborne parasite; if they travel to Asia and eat sushi or freshwater crab or watercress, etc. Tho’ I can’t be the only American who ever went to Japan and decided to try genuine Japanese sushi. But the disease is far down the list of what usually brings someone even to an Infectious Disease specialist with a practice in travel medicine, and he obviously was not going guess it if I didn’t tell him why that line of thought was the fruitful one to pursue, however little traveled. But he bridled with the insult of being told by a patient what was wrong with the patient, and no amount of hasty groveling and demurrals to his superior wisdom and telling him of course he would know and I was only making an educated guess (based on the dead trematodes I had been passing in my stool and the medical mystery I had just been released from hospital with, to which trematodes are the only answer that had not been eliminated yet. I couldn’t help being able to make the diagnosis given that it was impossible it was wrong. One does not excrete dead liver flukes unless one has liver flukes. You wouldn’t eat them and they wouldn’t be whole if you had; they’re chewy. So I was doomed. But if it is possible to feign ignorance and still lead the doctor in the right direction without him noticing you are leading, for God’s sake do that. Not only did he refuse to consider trematodes after that despite their inevitability, he became more purely nasty than any doctor I have ever dealt with, and spent the rest of the appointment putting me back in my place by diagnosing me with mental illness.

    I learned from that and before I went to another doctor, I called a college friend who is now a doctor and got her to “refer” me with a tentative diagnosis of trematodes. (I sent her photos so she could see I was right and  not be doing anything unethical by diagnosing me with them, although she lives across the country and I didn’t visit her, of course. But she is a personal friend who knows I can figure out the obvious, and female and can also stand that I know how to Google the CDC Parasite Image Library and learn what doctors know who do the same thing.) The doctor had no problem with a fellow doctor knowing doctor things; so that went fine. But I would have saved myself quite a lot of money and having to bite my tongue while I was verbally abused if I had known I knew more than many, many doctors want patients to before being lifted from the slough of their ignorance by the doctor.

    So learn from my mistake.

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