What Doctors Don't Tell You (But Should)


Getty ImagesHave you ever wondered what your doctor was thinking as you sat in your paper robe on the exam table? Or worried that you're not taking full advantage of those precious few minutes you have with her? As a doctor myself (I'm a general internist in New York City), I'm fascinated by the relationship between physicians and patients, and I am convinced that a deeper understanding of what's going on beneath the surface can benefit all parties involved. Here's what doctors like me would love you to know so you can get the most out of your time with us—and enjoy the best health possible.

1. Pick two or three top goals for your visit
Patients often come to my office with a list of 30 things they want to talk about, but it's just not realistic to cover everything under the sun in one visit. And I'm guilty, too: I may want to cram in every vaccination, blood test and pearl of dietary advice I can, while my patient has something else entirely on her mind. Making a list in advance is always helpful, but be sure to prioritize. You might even make clear at the beginning of the visit: "There are two things I want to make sure we talk about today."

On the flip side, do allow time for the doctor to address her top concerns. You can even ask her what they are. She might have something surprising to discuss—like a concerning blood test result, or a new medical recommendation for women your age—that's worth listening to.

2. Don't blow off yearly checkups
You might have read about the recent study showing that physicals don't yield head-over-heels benefits—patients who dutifully get them do not seem to be healthier or live longer. (They do, however, come out with more diagnoses and more possibly harmful tests—see No. 3.) Still, I feel that touching base in an annual or biennial visit is probably the most important way that doctors can keep tabs on how you are doing. When your physician takes a complete medical history, this is her chance to pick up subtle clues about impending illness—like changes in your sleep, energy levels or bowel habits—even if you may feel perfectly well.

The relationship you build with your doctor through repeated visits becomes especially helpful if and when illness does arrive. Carmen Martinez (not her real name) has been my patient for more than 15 years. One day, she came to my office saying she felt slower than usual. She answered "no" to the standard questions about chest pain and shortness of breath. Her physical exam wasn't much different from what it normally was. But she was insistent about the slowness.

This wasn't like the Ms. Martinez that I knew. I decided to order a chest X-ray—and it turned out that she was in the early stages of a heart condition that needed immediate attention. Her presentation hadn't fit the textbook, but I think we were able to catch this disease because we knew each other: She knew me well enough to press a symptom that might seem inconsequential, and I knew her well enough to sense that something was clearly off.

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Getty Images6. Don't be afraid to follow up after a visit
Of course, issues can arise after you leave the doctor's office. So ask before leaving the room: "What's the best way to get in touch if I have any further questions?" (My own preference is the telephone, to avoid some of the privacy issues encountered on the Internet.) Just remember, most doctors aren't allotted time in their day to handle phone calls and e-mails; they may work through their lunch hour or stay late to take care of them. So it's helpful to consolidate your questions into one call or e-mail, and to state whether the problem is urgent or not. Understand that it may take a few days for the doctor to get back in touch. If you have a lot of questions, then it's better to schedule another visit dedicated to discussing them. If your doctor isn't the type to answer follow-up queries at all, though, it's time to find a new one. Everyone is busy, but a good doctor should be able to offer an option for continuing the conversation.

7. Remember: You and your doctor are life partners
Whenever a patient shares a story with a doctor, both of you become entwined in a relationship. Relationships may ebb and flow, but a good one is there for the long haul. Your medical needs will likely vary over time, and a good doctor-patient bond can adapt to this. Ms. Martinez and I often joke that we've outlasted most of our friends' marriages, not to mention presidential administrations, health care reforms, hurricanes and fashion trends. The political winds may shift every four years, but luckily for both of us, our relationship does not.

Danielle Ofri, MD, is an associate professor of medicine at New York University School of Medicine; her fourth book, What Doctors Feel: How Emotions Affect the Practice of Medicine, comes out next month.