Thursday, September 30, 2010

Help Your Doctor Make the Diagnosis

When patients and doctors communicate effectively, the patient has the best result. Not every doctor asks the critical question that can cinch a diagnosis.  Yet good communication, coupled with good diagnostic skill can be worth more than $10,000 in tests and referrals to consultants.  You can help your doctor figure out what is going on by thinking and communicating like a physician.  Whether you have a new problem or something that has been bothering you for a long time, here are some things that the doctor will want to know.

1.  What are the symptoms?  Be specific.  Don't just say "Sometimes I have a pain in my stomach."  Since more than 80% of health problems can be diagnosed based on information that you provide, make sure you can verbalize what you are feeling.  Is it crampy?  Does the pain come and go?  Where is it located?  Is it sharp or more like an ache?  These specifics are giving information that your doctor can use as she thinks of the anatomy, physiology and causes of pain.

2.  How long has it been going on?  Try to be specific.  "Awhile" doesn't mean anything to a doctor.  That could be 2 days or two years.  Did it come on gradually or suddenly?  There is a different cause for any symptom that is chronic (over several weeks) vs. sudden or acute.  Did anything precede the symptoms?  Travel, trauma, life stress can point to different causes.

3.  What other symptoms have you noticed?  Don't worry if you give too much information.  Everything is important.  Fatigue, weight loss or weight gain, difference in balance or smell or taste? New cough or headache you have never had before? Change in diet or appetite or fever are clues that help the physician narrow down the diagnosis.

4.  Other info that might or might not play a role.  Do you drink alcohol or take drugs?  Are you taking over the counter medication?  Are you worried you have cancer or AIDS?  By communicating these worries, the doctor can alleviate your fears or order the correct test to prove it.

Physicians are trained to think about the most serious, life-threatening conditions and then work backward when making a diagnosis.  A good doctor doesn't just order every test in the book, they tailor the follow-up testing for the most likely "differential diagnosis".  Most conditions will respond with easy treatment (or no treatment) so there is always time to make the tough diagnosis if the doctor and patient have close, tight follow-up.

If you are not completely back to normal after treatment, it is important to return and communicate the continuing symptoms.  I always know if I have good follow-up planned (via email or another office visit) we will get to the bottom of the problem 100% of the time.


(btw:  I can't stand the series "House")

24 comments:

KM said...

I like the 100% of the time.

Health tips said...

Yes I agree with you not every doctor ask critical question to patient. Very informative guidelines to doctor which I never knew it before. http://www.youtube.com/watch?v=eyr_KC2dbao.Expressing your symptoms to doctors is the best way to cure yourself. I thank the author for posting such interesting tips.

tracy said...

Excellent informatiom, Dr. Brayer.

Did you like Hugh Laurie in the "Black Adder" series? Hilarious! :)

Toni Brayer, MD said...

tracy: Never saw it or heard of it. I'll check it out.

Anonymous said...

"Don't worry if you give too much information."

Well... I'm a pretty savvy patient and pretty healthy, so don't require a lot of care... but in my time, I've encountered a number of providers who simply don't want to (or maybe can't take the time to?) listen to all I think needs to be reported. I try to be complete & relevant without being over-long, or a hypochondriac, you know? but more than once I've been dismissed in mid-narrative by a provider who's ready to move on.

Don't get me wrong, I've encountered providers who were great WRT listening, communication, etc.... but even with the patient's best efforts, sometimes the important information just doesn't get communicated.

It gives me pause to wonder how much angst could be saved (how many tests, missed diagnoses, how much psychological stress and discomfort) could be prevented with simple listening. (Actually it scares the socks off me.)

Val

Raymond Bouchayer said...

I have been lucky to have the best Doctor in the world and over the years we developed a trust when I would say that I was in trouble , it was accepted as I always told my symptoms and pains and what I would think was wrong with me ......but most of all having a very good, humble, dedicated , sympathetic and always accurate Doctor is a blessing

Michael Kirsch, M.D. said...

Very fine post. Of course, the patient/family need to be the advocates. If your doctor is sending you to a specialist to evaluate an abnormal CAT scan or blood tests, make sure these records will be transferred. Even better, ask for a copy yourself to assure that the specialist will have the relevant documents in hand. Keep a 2nd copy of these in your home medical file (what do you mean you don't have one?) where you should store your medical history. @anonymous regarding 'too much information', I get your point, but there are some patients who really want to tell us much more than we need to know. We don't want to cut you off, but there are times that we need to guide patients back to relevant.

Toni Brayer, MD said...

Michael Kirsch, MD: Your last sentence is very nicely said!

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Anonymous said...

Raymond Bouchayer; You are so right about the utmost importance of trust. Once I had a doctor I felt like you do about about yours, until my doctor was dishonest with me, and betrayed me in a situation, that changed the trust and respect in our relationship.

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