Why Patients Need to Be Storytellers
When we tell stories, we help doctors get it right
When we’re ill or injured, we count on our doctors to figure out exactly what’s wrong and to fix it. We desperately want them to stop those horrible headaches, or help us figure out why we have that weird stomach ache that only comes at the most embarrassing time. We want them to be insightful, kind, brilliant, and healing while reassuring us that what we’re experiencing is perfectly normal and nothing to worry about. When we do have something to worry about, we want them to identify it quickly and treat it painlessly.
I wish all doctors were like the pediatrician I had growing up who could vaccinate me painlessly, would ask me lots of questions about my favorite books, and would draw me silly anthropomorphic sketches of my organs with word balloons so I could tell him what they would say (a great way of asking me about my symptoms).
The world of medicine is no longer like that though. Primary care physicians rarely have time to look at us let alone examine us thoroughly, unless it’s our scheduled annual check-up. The demands of the electronic medical records (EMRs) designed to improve patient safety have become a time hurdle physicians must jump. At least half of their 10 to 11 hour day is spent entering information into the EMR and they spend twice as much time with the EMR as they do with patients. The average clinic visit is now down to 5 minutes and your doctor will interrupt you 8 to 16 seconds after you start talking.
While Congress debates healthcare compensation, a great many doctors, researchers, and organizations are working on solving these issues but the long-term solutions are just that: long-term.
Short of screaming in the hallway, how do we get our doctors to hear what we have to say when we come in with a medical problem?
John Ely, MD, MSPH, a family medicine physician at the University of Iowa, Carver College of Medicine has a solution. A leader in the work to improve accurate and timely diagnosis, he is a great believer in the use of a diagnostic checklist. Like a shopping list helps us remember we need a quart of skim milk and some heavy cream, a diagnostic checklist can be used by a doctor to ensure they don’t fail to consider the correct diagnosis. It forces them to take a moment and think about what else could be causing the patient’s symptoms.
But taking a moment is exactly what primary care physicians can’t do. So, as patients, we need to do it for them. While we wait for the slow moving battalion of medicine to turn their ships around, patients must take responsibility for getting the care we require.
I've adapted Dr. Ely’s checklist, The Eight Characteristics of a Symptom, which was designed as a checklist for physicians, into a patient tool to help us tell our story well. A great story stops the doctor so she listens to us, and considers the right diagnosis and treatment.
The key is to create a story that answers all eight questions briefly, calmly, factually, and with as little unnecessary padding as possible. As Dr. Ely says, give them a short paragraph, not a novel.
To get your copy of The Eight Characteristics of a Symptom, click here or go to my Contact Form and I will email you the PDF version. Print out the forms and answer the questions before you see the doctor (or fill them out in Adobe Reader first by clicking on Fill & Sign in Tools). This works for scheduled check-ups when you can practice in advance. It even works for emergency room visits. Unless you have the previously mentioned gunshot wound or are unconscious, you’ll have plenty of time in the waiting room to prepare.
The Upshot: You get better results when you have ready and concise answers to the physician’s questions. And if the doctor doesn’t ask all eight questions, you can tell him the answers anyway.