21st Century Aging

Living longer and better.

The New Rules of Modern Medicine

How to Talk With Your Doctor and Get What You Need

We all know that going to see a physician is not what it used to be; doctors are more pressured and hurried than in previous generations and we can often feel disregarded as human beings with emotional, as well as physical needs. If we are physically well, the attention (or lack thereof) that we get from our doctors can be mildly annoying. When people are acutely or chronically ill, however, they understandably have more intense reactions when doctors seem preoccupied.

Unfortunately, we need our doctors more than they need us; this puts us in a vulnerable position.

If I could name the most common complaint I hear from all of the people I see who encounter medical professionals, it is that doctors don’t listen. My response to this complaint, after acknowledging how frustrating it can be to talk with physicians, is to say, “Doctors do listen; it is just that they listen in a particular way, and since these conversations don’t seem normal, it is hard for us to adjust.” I don’t say this to defend physicians or downplay realistic concerns. It is just that most physicians I know care deeply about their patients and want to help. However, many of the normal rules of social convention don’t exist in the world of medicine. Doctors think fast and move fast, so they want us to reach our conversational conclusions rapidly as well.

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Many people imagine that physicians are curious and eager to listen to us. Though this is an understandable wish, it is often not true. Doctors do tend to be curious people, but they are also busy and focused on results. And in today’s world of medical advances, much of our medical care is relegated to technology. Think your general practitioner knows what is wrong with you? Let’s wait to see what your blood tests say. Think your cardiologist knows if you have heart disease? Wait until she or he does a cardiac catheterization, just to be sure. Technology has changed the landscape of modern medicine and the relationships we all have with our doctors. Doctors often need to be more distant in order to do their jobs well. 

Although technology is not the only change impacting today’s medical encounter, relative relational detachment is the "new normal" when we spend time with our medical clinicians. We need to adapt in order to get what we need.

Today’s Rules of Modern Medicine:

1. Time is in short supply

2. Discussions should be concise

3. Emotions are generally discouraged

4. Patients are supposed to be compliant

5. Questions are tolerated but not overtly encouraged

6. Though some physicians try to incorporate a collaborative model, most still expect to be the authority

7. Responsibility for health lies within the patient

8. Aggression tends to be expressed more directly

9. Uncertainty is generally not tolerated

As these rules suggest, it is easier to adapt to the culture of medicine when we keep our emotions in check. There is one caveat, however. Though vulnerable emotions are generally not encouraged, there is a surprising tolerance for assertiveness. In fact, some research has suggested that being assertive is crucial to getting needs met from a doctor!

So speak your mind when talking with physicians. Just do so concisely. Treat appointments with doctors like you would a business meeting. Have a brief agenda. Present your questions at the beginning of the meeting. Be clear, concise, and limit TMI (too much information) regarding emotions. Physicians have a job to do, and in this modern age, they are often focused on the body. Psychologists and other therapists are often better suited to have long-term emotional discussions.

In reality, it may be a relief to our doctors and ourselves if we don’t expect them to do it all. 

Some excerpts of this blog are adapted from my new book, When Someone You Love Has a Chronic Illness.

 

Tamara McClintock Greenberg, Psy.D., M.S., is an Associate Clinical Professor of Psychiatry at the University of California, San Francisco.

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