Going to the doctor can be a difficult, frightening experience, and too often we avoid telling our doctors the things they need to know for a proper diagnosis or care. Maybe we're too afraid, or we've rationalized away our symptoms as unimportant. Regardless, being an active participant in your health care has never been more important, and I asked a doctor what he wished more of his patients were up-front about when they came to see him. Here's what he said.
Garbage In, Garbage Out: Make Sure You Get It All Off Your Chest
Dr. Dan Weiswasser is a primary care physician who's been in outpatient practice for seven years. I asked him what patients can do to put their minds at ease, and he responded with an acronym that many of you are familiar with, but applies here: GIGO (Garbage In, Garbage Out). "In other words, if, as a patient, you deliberately provide inaccurate information to or withhold information from your doctor, you may be handicapping the very person who is trying to help you," he said. "If you are anxious about divulging a certain piece of information, be upfront and share that concern with your health care provider. A good provider should be able to address your anxiety. And chances are good that he or she has seen others who are having the same struggles."
In essence, being afraid, even if you think it might mean bad news, is something we all just have to push through. If you're deliberately trying to mislead your doctor, that's bad enough, but if you're rationalizing away real symptoms that you should discuss with your primary care physician or any doctor you see, you have to get through the fog of fear and anxiety and be up-front with what's going on. Here are some tips to remember:
- Tell your doctor you're nervous . Most doctors will try to put you at ease and remind you that they're there to help, even if it means they have to tell you some bad news in the process. They'll also likely let you know that they've seen this—or worse—before, and even if they don't say it, keep it in mind. You're likely not the first person to have your symptoms, and you're likely not the first person the doctor's seen with them.
- Bad news now is better than worse news later . Personally, I've had friends and family who avoid disclosing symptoms to doctors until their illness was so far along that doctors had difficulty treating it. Rationale aside, it's important to remember that if you don't talk about it now, you will talk about it later, and later may be a more solemn conversation.
- Don't be embarrassed . "Many patients are specifically reluctant to talk about psychiatric issues, sexual practice and/or drug use, but, depending on the issues at hand, these behaviors may influence what is in the "differential diagnosis", the list of diagnoses that an provider considers when you come to him or her with symptoms and concerns," Dr. Weiswasser explained. Don't be embarrassed. Your doctor isn't there to pass judgement. They may be human, but their primary obligation is to help you get well, and they need all the information you can provide.
- Find a provider you trust . If the reason you have difficulty talking to your doctor is because you "don't trust doctors," or "they're all in it for the money," or "blah blah medical-industrial-big-pharma-complex," then you need to do some digging and find a doctor or health care provider that you trust and who aligns with your values towards health care. We've even mentioned tools that can helpyou find one .
- Don't be afraid to ask questions . A good patient is an educated patient, and you should be an active participant in your health care. Ask questions, get engaged, read up on illnesses and treatments, and how they may impact you. Let your doctor know when you're unsettled. Share your own opinions and the things you've read, but at the end of the day, remember they're the expert. Allow yourself to be educated—not to the point of passivity, but if you have a doctor you trust, you should be able to be open with them about your doubts as well as learn from what they can teach you.
Tests Don't Reveal Everything
Many people hold back, hoping that a battery of tests will reveal their true condition without them having to say anything at all. That's not true. When talking to your doctor, don't assume that "oh, it'll come up on my bloodwork if it's a problem," or "they'll see it when they look at my x-rays." Tests don't reveal everything, and tests don't give your physician the first-hand account they need to empathize with you and try to understand what you're going through.
This "procedural medical drama" thinking may work on television, but it doesn't always work in real doctor's offices and hospitals. What's worse, tests that could be avoided if you and your doctor were on the same page about your symptoms can at times be costly, unnecessary, and delay needed treatment. You may need some tests anyway, but it's better to clear the air first.
What You Say Is Private
Another important thing to keep in mind is the fact that what you say to your doctor can become part of your medical record. If that makes you worry, don't—it's actually a good thing. There are very strict privacy laws around your medical history, and tight controls over who can see it and under what circumstances. "It is true that whatever you say could become a part of your medical record, so it's not right to ask your HCP to omit it once you've mentioned it," Dr. Weiswasser explained. "There are, however, strict regulations, found within the federal HIPAA law (Health Insurance Portability and Accountability Act), which dictate that protected health information must be kept private. Each HIPAA violation can cost a doctor up to $50,000 ."
Make no mistake, there have been instances where somemone's medical records were mistakenly made available to someone who shouldn't have seen them, but it's a rare exception. For most people, what you say to your doctor is private and between you and them, and only used in delivering you the best possible care. Again, if you feel like you can't trust your doctor, it's time to get a copy of your medical records—available to you at any time, usually for a small fee—and find a doctor you trust with your privacy. Whatever you do, it's more important to be able to tell all comfortably than try to eke quality care out of half-truths.
In the end, it's most important to remember that your health and well-being are paramount, and you shouldn't let anything—even your anxiety and worry—stand between you and better health. Dr. Weiswasser sums it up, "by withholding the whole story from your health care provider, you are running the risk of prolonging your suffering and increasing your possible complications. Be forthright. A good provider is there to help and not to judge."
Do you get along well with your doctor? How did you find a doctor you trusted? Share your thoughts and your tips in the comments below.
Dr. Dan Weiswasser is a primary care physician who's been in outpatient practice in Western Massachusetts for seven years. He spends half his time seeing patients of all ages and half his time doing administrative work, focusing on quality issues and an Epic electronic medical record system. He offered his assistance with this story, and we thank him.