I never go to see a doctor. Unless I have to. I’m guessing most people feel the same way. So when you do feel you have to visit a doctor, how do you get the most out of your visit? There are many ways to consider that question but I want to share three small drawings with you here. You might want to use one or more of them next time you go to see a doctor.
If you’re going to see the doctor because you feel something is wrong, then it’s pretty likely your first goal is to find out what the problem is. In medical terms, that’s a diagnosis, but in more general terms, it’s an understanding. You want to understand what’s going on. The point of asking the doctor is that doctors are well trained in doing exactly that – they are specialists in making diagnoses. At best, they specialise in understanding people and understanding peoples’ experiences. But you don’t just want a label for your condition. It’s not like naming flowers or trees. You want to know what that’s likely to mean and whether or not you should do anything about it. Here’s the first drawing –
The question is “Do I need to do anything?”
You can figure that out by asking your doctor first of all how serious this problem is…..in other words “how much of a threat does this pose to me?” If the pain you are experiencing is likely to be a pulled muscle, the threat level is low. If it’s angina (heart pain), it could be pretty high. So where, along the left to right axis of this drawing would you place the threat level? Second, how rapidly is this likely to get worse? This determines the urgency of action. If the condition you’ve got changes over minutes, something needs to be done right now. If it changes only over many years, you can take your time and consider what to do about it.
Having understood this, you and your doctor will be thinking about possible treatments. Before you leap into any treatments however, maybe you should consider whether or not ANY treatments are necessary. This second drawing might help you figure this out.
The question is “How much of a problem is this for me?” And the answer to that depends on how much you are suffering. There are at least these two aspects of suffering – restriction and distress. Health is a kind of flow experience. When things are flowing you’re pretty much unaware you even have a body. When something’s wrong, there’s usually disruption of flow. You get stuck, or inhibited by pain or stiffness or weakness or something. The more you feel restricted, the less able you are to live your life. So, it’s worth thinking where you’d place the degree of restriction you are experiencing on the axis from left to right. How much is this suffering inhibiting, preventing, impeding my life? That restriction contributes to the amount of distress you are feeling but I think distress is more than that and you should consider it as a separate aspect. How great is your distress? The more you plot yourself up and to the right of this little chart, the greater the suffering you are experiencing, and the more important it is to you to do something about it to change the quality of your life.
We don’t just visit doctors for an understanding though. We are probably seeking change. We’d like something to be better. So the second main priority of the doctor is to consider which treatments to offer. This isn’t as straightforward as it might appear and the doctor can’t decide this all by himself (or herself). That’s because different treatments will be best for different people with the same problems.
Most treatments offered are drugs or surgery. All drugs and all surgical interventions carry risks of harm. So here’s my third drawing to help you work out which treatment you’d like to try.
The focus here is on harm. The old adage “First do no harm” is still of great relevance to the practice of medicine. It’s unlikely your doctor will offer a treatment unless he or she believes that treatment has the potential to help you. Doctors use both clinical epidemiology (“Evidence Based Medicine”), their knowledge of YOU and your condition, and their own clinical experience to work out what treatment to offer you. But it’s always worth considering the aspect of harm. First of all, what potential has this treatment to harm? Has it ever killed anyone? How seriously can it do damage? Secondly, what’s the chances of that harm occurring? That is what is the risk – to me – of that harm?
Having considered all of these issues there’s still a lot to decide and it’s still the very beginning of a journey for you. A good working relationship with a doctor is a continuing conversation. It’s not an event, or just a series of events. As things move on and change you’ll be in continuing conversation with your doctor and both understandings and treatments will change as a result.
I hope you find these helpful.
What about you? Have you found any ways to make a doctor visit more successful for yourself?
Heroes Not Zombies 
There are actually many things that one can do about their health before seeing a doctor. It is called health promotion. Health education and public awareness are the key.
When you do see a doctor it is beacuse you have done as much as you can and the problem is stiil around.
There are individuals thoguh who may seek out a doctor just for medication or a prescription when neither is necessary.
Although visits to a doctor are not wrong, they may not be the best decsions.
Other options can be considered.
Bob,
Long time no talk to. Apologies. You hit the nail on the head with this post. It’s clear and concise. I tend to go to the doctor once a year, because my (US) insurance says I can. The doctor was a minor deity to my parents generation, but I have less faith. I feel for many of them working under such tight time constraints. And of course, anyone in a rush is more likely to make mistakes.
A couple of years ago I had to switch doctors. I was late getting to the new building, parking was horrible, and frankly, so was my mood. This didn’t improve with my further thirty-minute wait. The doctor breezed in, looked at me and said there doesn’t seem much wrong with you (before even introducing herself) took a phone call. Checked my blood pressure and wrote me a prescription. I have never had high-blood pressure. I still don’t. I bought one of those home test kits. I play badminton three times a week and I’m lucky enough to be in good shape.
If I had taken the drugs, I would still be on them. And I learned recently that there is some organization that reports to insurance companies on drugs patients take. Taking blood-pressure medicine would be an indicator of a prior condition, rather than a one-time irritation. I changed doctors and threw the prescription away. Now this was probably an isolated incident. I do know that in the year 2000 there were 98,000 deaths due to medical errors. I interviewed a medical director on video and that is what he said. It’s easier to talk about slowing down than achieving it.
On anther note, I *think* I sent you an LinkedIn invite.
Great post!
This is excellent advice and should be posted on the front page of every newspaper for all to read. This would help people so much!
One of the biggest things for me is to fully understand what the doctor is saying to me and to feel satisfied with everything before I leave the doctor’s office. Too many people simply nod their heads and then leave with more worries simply because they did not let the doctor know that they were confused or not satisfied with the answers that were given.
lol great Dr. Bob! I wrote a post on the same thing a while back. I talked mostly about communication and asking questions. Alot of people don’t write down before hand what the issues are, how long they have been experiencing them etc. They also minimize symptoms or don’t tell the right stuff. Let the doctor decide what is important or not.
Im glad you are like the rest of us and hate to go….
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