It is very understandable that a medical interview engenders anxiety. Underlying this anxiety is the fear of what the consultation has in store…. the fear of ill-health, disability and indeed death. Such worries can make people behave very differently from their normal selves. When facing the possibility of personal danger, it is often difficult to order one’s thoughts and describe your experience and concerns about this.
In particular MEN are much more hesitant to consult a doctor when they become aware of symptoms. This might be due to embarrassment, shame, or fear, or simply reluctance to puncture their self-image as an alpha male. Unfortunately, many men have a tendency to ‘bury their head in the sand’. Wives, friends, and daughters can play a critical role with gentle persuasion. The sooner symptoms are reported the smaller the consequences are likely to be. Some conditions however have no symptoms early on, e.g., prostate cancer, and this is where SCREENING can be vital especially with advancing age. (For example, nearly 60% of all prostate cancers are diagnosed in men over the age of 65.)
It is often difficult to concentrate on any consultation and to take in what is being said.
Almost without exception older people are intimidated, even frightened by their doctors. The doctors may not be all that much respected as people but in their professional role they very often inspire great anxiety. Older people seem to feel a need to please the doctor and a reluctance to question what they say. Most people seem to be afraid to do anything which might be seen to ‘cross’ their doctor. Most people are well aware that the label “Difficult Patient” is not to be recommended!
The medical profession is assumed to wield a great deal of power and indeed in theory a doctor may be in a position to with-hold treatment, delay referral or obstruct support services. It is very rare indeed for any of these fears to be justified.
Mistakes and delays do happen, but these are not intentional. Rather they are due to overwork and being too busy.
Why not help the doctor out by being ‘on the ball’ and managing your own case well?
Elderly patients in particular can be almost obsequious to their doctor or indeed a senior nurse. There seems to be a fear that in some indefinable and probably undetectable way the patient will suffer as a result of causing some real or imagined slight, or discourtesy.
Try and develop some techniques of questioning which can be perceived as self-deprecating but nonetheless assertive without being aggressive…..a way of asking rather than telling the doctor what to do.
If for example you really feel that you need an x-ray or a scan to clarify a problem (and have good grounds for thinking this) you could say:
“My wife would really like me to have an x-ray.” It’s hard to argue against a caring relative!
Or when appropriate you could say, “my brother thinks I have rheumatoid arthritis and he wanted me to ask you about it.”
This approach shifts the focus onto a third party, which helps doctors lower their defences. It effectively puts you on the same side as the doctor ‘against’ a third party. This approach also means that the doctor knows you are likely to tell a third party what transpired during the consultation which means the doctor will be held to a higher level of accountability.
Alternatively you could use a few seemingly hesitant phrases like “I may be being a bit neurotic but …..“
Or “Oh silly me I may be wrong but…..“
Or “a friend of mine had just these symptoms and he turned out to have a brain tumour.“
From the doctor’s point of view how much better it would be to give the patient an x-ray request form and tell the patient to cancel the appointment and tear up the form in a week’s time if the problem has disappeared.
As a patient you do need to be clear-headed and rational.
As a first gambit if you disagree with the doctor’s approach it may be sensible to accept the doctor’s suggestion e.g. for a simple remedy. But if this does not work in a reasonable period of time be prepared to go back to the doctor and say so and press for something else.
This hesitancy apart, what other issues may complicate the consultation from a patient’s perspective?
Some people are too shy or embarrassed to discuss personal matters with a doctor. Remember however that doctors have seen it all before. They are only interested in you professionally and will not be spreading tales about you. Try talking things through first with a sympathetic nurse. It may be easier to find the right phrases together.
A minority of patients just don’t speak English and this is difficult both for the patient and the doctor. Interpreters are better than no translation but communication through a third party is not ideal! (see topic later on using an interpreter).
Problems which hamper the patient
- Too shy
- Too embarrassed/ashamed
- Not thought through/no list
- Too inarticulate
- Does not speak English
- Patient is deaf or partially sighted/blind.
Counter measures:
Remember consultation is private/confidential
Remember doctor has seen or heard it all before from other patients
Remember doctor is interested in you only as a patient and in a professional way.