It Takes Two to Tango: Become an Active Partner in Your Health Care

(from the National Women's Health Resource Center's e-newsletter, HealthyWomen Take 10)

You're sitting on the cold table in the medical examining room. You've been staring at the walls for what seems like eons. Finally, your health care professional enters, flips open your chart, asks some "yes or no" questions, examines you quickly, writes a few notes and is gone again. You get dressed and leave.

You and your medical professional (doctor, nurse-practitioner or nurse) have just missed an important opportunity to safeguard and improve your health. Because the two of you are partners in your care, or should be, you both need to participate actively in that relationship.

That means talking - and listening - back and forth, sharing information and decision-making. Good communications between patients and professionals have been shown to result in better health outcomes, greater trust and more commitment to treatment that works.

"What we have is a conversation, an activity that requires cooperation and coordination, like touch dancing," says Richard L. Street, Jr., PhD, professor and head, Department of Communication, Texas A&M University. "Because this is a conversation, the patient is a person who can exert a great deal of control over what happens."

Smoothing the way

Some medical encounters don't feel like coordinated partnerships. Communication may be blocked by barriers such as cultural differences, medical jargon that's difficult to understand or personality conflicts.

Scheduling pressures also work against efforts to connect. "Sometimes time is our mutual enemy," says Judith Chamberlain, MD, FAAFP, board member of the American Academy of Family Physicians, who practices in Brunswick, ME. "We often do not have the luxury to spend a long time getting to know each other before having to deal with sensitive issues."

When you have a choice, the right health care professional can boost your chances of success. That means shopping for one with at least the same amount of effort you put into buying a major appliance.

"Find a provider that you're comfortable with, that's the first thing. You shouldn't be afraid to tell your provider anything," says Mary Ellen Roberts, RN, APNC, MSN, FAANP, president of the American Academy of Nurse Practitioners, who practices in Belleville, NJ. Ms. Roberts suggests talking with neighbors, co-workers and friends for recommendations. Be sure to ask how supportive those professionals are with their patients.

Becoming a more active patient

Okay, so you didn't go to medical or nursing school, but you have an equally legitimate role in the health care partnership. "As the patient, you are the expert in what you think and what your body feels. You are the owner of that information," says Paul Haidet, MD, MPH, a physician at the Michael DeBakey Medical Center and director of the "How to Talk to Your Doctor" program at Baylor College of Medicine in Houston.

That means you should, can and must speak up and have your views heard. Dr. Chamberlain suggests writing a letter if you're uncomfortable saying something face-to-face.

Why is it up to you? "In terms of changing communication behaviors, it's probably easier to target the patient's side than the doctor's side," Dr. Haidet says. "Doctors have been acculturated into a process that makes them hear only their voice. They have trouble hearing other voices. That's not to say that they won't - if the other voice shows up."

Of course, there are patient-centered health care professionals who want patients to participate fully in the relationship and communicate freely. If you feel you're being ignored, be assertive and take an active role in order to be heard. You may need to speak up more than once.

Speaking up also helps avoid health care mistakes, such as medication errors, surgery to the wrong area and problems in follow-up treatment.

Tips for better communication

- Prepare in advance. Think about the purpose of the office visit, what you want to gain from it, and what you want to say. Make a list of your specific symptoms and all medications you're taking, including over-the-counter drugs, herbal and vitamin supplements. Learn a bit about the condition you want to discuss. "The Internet is a great resource," says Dr. Street, noting that research shows health care professionals believe it's creating better-informed patients. "It helps the communication," he adds.

Ask questions. Bring a written list of questions with you. Take notes during the visit and ask additional questions that may occur to you. Don't worry that you're bothering or insulting the health care professional. In addition to the questions you may have, the Partnership for Clear Health Communication suggests that you include these:

o What is my main problem?
o What do I need to do?
o Why is it important for me to do this?

Ms. Roberts recommends personalizing your questions as a way of strengthening the relationship and gathering information for decision-making. She says to ask, "If this were your sister, what would you do in a situation like this?"

- Express your concerns. Talk about your beliefs and fears. "It helps if a patient tells me what they are afraid might be wrong with them," says Dr. Chamberlain. "I may approach someone's back pain as the usual pulled muscle and be totally oblivious to the fact that she knew someone who had bone cancer that presented as back pain and is therefore scared and also annoyed that I'm not doing x-rays or taking it more seriously."

Tell your story. Relating the story of your illness - how it began, how it has affected your life - helps give meaningful context to your medical condition and promotes a supportive, partnering response. "A patient who tells her story to the doctor becomes Mrs. Smith, rather than 'the pancreatitis,'" says Dr. Haidet.

Request more time. If you know in advance that you have many questions, call to schedule a longer appointment slot. Ms. Roberts says the last appointment of the day may allow for extra time to talk. If you run out of time during an office visit, schedule another appointment to continue the conversation.

Bring listening help. It may be hard to hear, absorb and respond to medical information, especially if you're talking with a specialist or discussing a chronic condition or serious illness. Ask to tape the session, so you can play it later and think about other questions you may have. Bringing a friend or relative along with you also helps in recalling and processing the information you've heard.

Keep communication on-going. Nurture your partnership by staying in touch with your health care professional. Call to ask questions or update information (some offices have special call-in hours). These interactions may be recorded in your file, to be discussed at your next visit. An increasing number of professionals now communicate with patients by e-mail for certain matters, but it's no substitute for regular face-to-face medical encounters. "E-mail may be a good way to ask for a refill or about test results or to determine if you should be seen. But we learn a lot about people from how they look, the tone of their voice. None of that comes across in e-mail," says Dr. Chamberlain. "That said, if I have to choose between playing phone tag with a patient for three days or sending an e-mail, I'll take the e-mail every time!"

References

Kaplan SH, Greenfield S, Ware JE, Jr. "Assessing the effects of physician-patient interactions on the outcomes of chronic disease." Medical Care, 27(3 Suppl): S110-127, 1989.

"How to Talk to Your Doctor (and get your doctor to talk to you!)." Agency for Healthcare Research and Quality (AHRQ), Excellence Centers to Eliminate Ethnic/Racial Disparities (EXCEED). http://www.bcm.edu Accessed 3/14/06. [link not working]

Trummer UF, Mueller UO, Nowak P, et al. "Does physician-patient communication that aims at empowering patients improve clinical outcome? A case study." Patient Education and Counseling, epub, 2005.

Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al. "Race, gender, and partnership in the physician-patient relationship." Journal of the American Medical Association, 282(6): 583-589, 1999.

"Speak Up: Help Prevent Errors in Your Care." (pdf) Joint Commission on the Accreditation of Healthcare Organizations. http://www.jcaho.org Accessed 3/1/06. [link not working]

"Tips For the Savvy Supplement User: Making Informed Decisions and Evaluating Information." U.S. Food & Drug Administration, Center for Food Safety & Applied Nutrition. http://www.cfsan.fda.gov Issued January 2002. Accessed 3/1/06.

"Ask Me 3: Good Questions for Your Good Health." Partnership for Clear Health Communication. http://www.askme3.org Accessed 3/9/06. [link not working]

"From the Director: Developing an Alliance with your Doctor and Medical Team." Ted Mann Family Resource Center, UCLA Medical Center. http://cancerresources.mednet.ucla.edu Accessed 3/1/06. [link not working]

Link: http://www.healthywomen.org/articles/tango_nwhrc.html