I’m not sure what I expected from doctors before I became a person who spends an unreasonable amount of time in their exam rooms. I suppose I pictured fictional characters from books and TV: kindly, wise old practitioners who’ve seen it all before or whip-smart young ones eager to get to the bottom of medical mysteries. I definitely did not expect to feel largely invisible.
Doctor-patient communication is a two-way street. I’ll get to the patient part, but first I want to talk about the doctor part. I rely on my doctors to order tests and review results, but I’d kind of like to discuss them, too. In appointments, the balance is heavily tilted in favor of data over dialogue. Doctors rarely have questions for me. My presence in the exam room sometimes seems superfluous. In the doctor’s race to record interactions in the electronic record, eye contact is scant. Conditions are not ideal for offering or receiving the human context for the information on the screen.
What I want from doctors is both social skills and medical expertise. I’m not looking for a friend. I’m looking for a sense of shared purpose, namely improving my health. When I get the feeling the doctor’s purpose is to bring our appointment to the quickest conclusion possible, it’s hard not to take that personally.
I once spent regrettable time and effort second-guessing myself on this front. I have good social skills. I’m not used to feeling personally disregarded. Was I doing something wrong? How could I make them care? I took pains to be personable. I tried to make them laugh because people notice you when you’re funny. I downplayed my own suffering (which is weird, since alleviating suffering is the whole point of medicine). It was a cringe-worthy exercise. It was also a straight-up reflection of the power differential between patient and doctor. They hold the levers to information, diagnoses, and treatments. I need them to care.
Over time I came to realize it’s not personal. It’s systemic. They do care. Doctors are struggling. They never asked for too-short appointments and unsustainable caseloads. Even if they did have time to talk, I suspect that communication skills are neglected in medical school. Interpersonal instincts are considered more gravy than meat, as if we are born knowing how to make people feel comfortable, how to draw them out, how to interpret subtle cues. Today’s doctors lack the time or support for old-school conversations with patients.
I can’t give doctors more time or better listening skills. What I can do is adjust my expectations and cut to the chase.
I once heard a pediatric specialist greet my young teen with this question: “What do you hope will happen at today’s appointment?” I love this question. Instead of asking what the problem was, she started by asking what outcome he wanted. It is an elegant reframe. When the patient gets to prioritize, the doctor can start there. Doctors can’t read their patients’ minds any more than we can read theirs. It’s a fool’s errand to try.
In that spirit, I now approach every appointment ready to articulate a bite-sized outcome.
- My most pressing concern today is …
- I’d like to hear your opinion about …
- I have a question about …
I know we’re not going to solve everything in one appointment. I have chronic conditions. They don’t get solved, they just get managed. I can save us both time by saying what I want. That may just leave a sliver of room for some eye contact, a laugh, a little something to make us both feel seen and heard.
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