A Modern Survival Guide Interlude

This is the Modern Survival Guide, a guidebook for interacting with the modern world. And this article is an interlude, an aside that talks about a tip for modern living. This isn’t a philosophical insight or a deep discussion of human impulses, or an explanation of some major phenomenon; it’s just something people might want to know. And a lot of people don’t know how to talk to doctors; let’s see if we can fix that, stat!

Dealing with doctors is one of those things that we all have to do eventually, and it’s almost guaranteed to be unpleasant. With that in mind, it’s a good idea to figure out how to talk to doctors so that you get in and out of their offices in one piece, with the right diagnosis, and with a treatment that will actually make you better.

You’d think this would be their job, and you would be wrong. Doctors, particularly general practitioners, are not really incentivized to do much these days other than collect your insurance information (and copay), prescribe medication, and in some cases shuffle you off to a specialist. Your personal healthcare is, more often than not, in your own hands. And an enormous part of it is in how you interact with your physician.

So — how do you talk to a doctor? Here are 8 tips to make sure you get treatment and stay healthy:

The trouble with talking to another human is that most of us lie as fast as we breathe when we feel threatened, judged, or on the spot. You are, almost by default, going to feel all of those things in a doctor’s office. But good treatment depends on you telling them exactly what’s wrong, without leaving things out or making things up.

Remember — no matter what your issue is, this is a person who has been trained, and is being paid, to deal with it. Whether you have genital warts, a cockroach in your ear, or cancer, you need to tell them exactly what the problem is — without worrying about what they think of you. And for the love of God, just tell them how often you really exercise and how much you really drink; you’re not fooling anyone, and neither are your liver enzymes.

The good news is that no matter what’s wrong with you, it’s probably not new to them. And if it is new to them, well, that’s a data point. That either means you’ve got something weird, or you’ve got a baby doc. Either way that might require some action.

Describe your problem in the closest possible detail. Look up medical terms for things where necessary before you go in. Keep talking even when the doc starts to roll their eyes or yawn — remember that they’re on your time, not the other way around. I can’t count the number of times my treatment changed because of some random detail I mentioned five minutes into the “what’s wrong with you” conversation.

For example, if the question is “Where does your shoulder hurt,” the answer needs to be something like “Right here, on this line, across the joint. It hurts when I do this.” That’s an answer that provides data. And data can mean the difference between being prescribed a Tylenol and told to go rest, versus going to the MRI tech to check out a possible rotator cuff tear.

Never, ever be satisfied with the explanation given. Ask all the questions that occur to you, every time. If nothing else, ask “how does that work?” whenever a doctor is describing a treatment.

If you are given a diagnosis, ask how the doctor came to that conclusion. If they get mad about you questioning their diagnosis, leave and find a new doctor. They have no right to get ticked about you asking questions about your own healthcare. A doctor’s hurt feelings are momentary, but cancer is your ass.

If you are on medication or are being prescribed new medication, ask about any conflicts new medication might create, ask about generic options, and ask about side effects. Ask about non-pill treatments (AKA lifestyle changes) too, particularly if your insurance sucks.

If you are starting down the path of surgery, ask about non-surgical options. Then ask about surgical risks and their likelihood. Ask which local hospitals are better at your surgery. If the doctor doesn’t know, find out. Always ask about physical therapy and post-surgical needs.

In general, make the doctor think. Remember that they’re human too, and subject to failures of boredom and inattention. Their inattention might cost your life. Don’t take anything for granted — malpractice settlements are fun, but the money often goes to the next of kin.

It is a simple fact of psychology that unless someone is acting the way we think they should in an emergency, we’re going to assume there is no emergency. You have to apply this to medical conversations.

If you are having pain, for example, understand that your treatment is going to depend on how you respond to the pain scale. If you’re feeling bad pain, don’t respond that you’re a 2 on the scale. If you say you’re an 8 on the scale, you should be whimpering it through clenched teeth. Forget all your socialization about hiding pain or being tough — those don’t help you here. If you need morphine, you don’t want to act like Tylenol.

Similarly, if you are feeling like you’re about to throw up, it’s no good wandering around like you’re ready to tackle the next course at Arby’s. If you feel green, try to look green. Otherwise people will assume you’re wasting their time, and downgrade your priority as a result.

This goes double in emergency rooms. If you go into an emergency room with chest pains, for example, you need to sell them the fact that you have chest pains. Remember that emergency rooms triage based on obvious symptoms, blood, and screaming people.

And for the record — DON’T LIE. This isn’t about lying to get treatment. This is expressing on the outside what you feel on the inside. It’s deconstructing the stoic front that we’re all trained to project, because in this situation it doesn’t help you.

Addicts exist, and maybe you are one. If you are, I advise you to seek treatment, and good luck to you. If you’re not, you really do not want to come across as an addict in a doctor’s office. That’s an easy way to get ignored, sidelined, or under-medicated — medical personnel sometimes do not react well to addicts. Remember that your doctor is human, with human prejudices.

So — particularly with painkillers, it is best to act correctly to your pain level, and then play the game the system demands. If your doctor wants to start you on Tylenol, you’re probably stuck with Tylenol, at least for a day. And if Tylenol works, problem solved. But if it doesn’t, you are better served if you try the Tylenol, and then go back and say it’s not enough.

Also, unless you have had a bad experience with particular painkillers in the past, it’s usually not a good idea to request particular drugs — especially narcotics. Doctors think it’s suspicious if patients know too much about things that can get you high. This may mean that you have to go back a couple of times to get something that works, but the point is that you’re playing the game.

A word to the wise — the goal of painkillers, from the doctor’s perspective, is usually to manage your pain. Not necessarily to kill it. They want you to be able to function and sleep. That’s it. If your goal is different, you’re going to have a rough time dealing with doctors and pain meds.

When I was fourteen or fifteen, a family friend died because she trusted her doctor’s office to schedule a prompt follow-up appointment for her melanoma diagnosis. They decided to schedule her for a follow up… six months later. She didn’t question this decision. Her cancer metastasized, and she died shortly after her follow-up appointment. It was a formative experience, and it taught me a lot about how the medical profession views you, the patient.

Ok, so here’s the deal… doctors are only responsible for you while you’re on their property. And even then, if you die, most times they can just say “Oh well, will of God and whatnot,” and walk away. It’s the only profession on Earth where this is possible, other than being a soldier. And even though there are many good, conscientious doctors out there, there are just as many quacks, dummies, and people who just joined up for the prescription pad and a BMW.

So you can’t, ever, assume that they have your best health in mind. You can’t, ever, assume they have thought of everything. You can’t, ever, assume they are responsible for following up with you, or taking an interest, or giving your condition due thought. In these times of overworked and underpaid medical professionals, you must assume that you are (at best) a number and some info on a chart.

You have to be proactive. You have to make your healthcare your problem. You have to track and schedule follow-ups, yearly appointments, specialist visits, and whatever else. You cannot and should not rely on doctors to do this for you.

So whenever you talk to doctors, you need to take the initiative. You need to ask about follow-ups, or specialists, or the prognosis of your illness. And if you aren’t getting the service you need, you need to be prepared to switch doctors.

What all of this means is basically that, although we live in an age of medical miracles, the person who is most likely to save your life is… you. But that’s a pretty serious burden. So a big component of talking to doctors is to stoke up your own personal bravery.

You have to get away from the awe in which we are taught to hold medical professionals. Set aside for a moment the fact that they have a medical degree. If it helps, try thinking of your body as just a very complex vehicle, and your doctor as just a very expensive mechanic. And always remember that you are paying them.

Bear in mind that the more specialized the doctor is, the more likely they are to have a God complex, and the more damage they can do to you if they screw up. Do not let them brush you off. Do not let them do the minimum. Do not let them get away without treating you. And above all else, do not let them intimidate you.

If you need to get the serious skinny on what’s going on, find the nearest nurse and ask them. Nurses usually know almost as much as the doctors after a few years’ experience, they tend to have a lot of front line experience dealing with patients, and they can usually point you in the right direction.

This goes double, or possibly triple, for hospital nurses. Remember that hospital doctors operate on shifts, and their decisions are based on metrics and patient charts. You do not want to be one of their bad statistics, but you have to recognize that’s pretty much all you are to them — a statistic. Nurses, on the other hand, deal with the same patients all day long. They tend to be a bit more involved. So if you have questions in a hospital, ask a nurse.

It may sound like I’m being overly harsh on doctors, and I probably am. But look at it this way: there are only a few people in your life who can screw up so badly that you die. Guess who is at the top of that list?

The bottom line is that getting diagnosed, treated, or cured of most medical problems is all about communication, followed immediately by action. So talk to your doctor. And make sure they talk to you.

Searching for truth in a world focused on belief.

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