A visit to the doctor these days is a sprint, not a marathon.
With luck, you've got about 22 minutes from start to finish. And you begin with a disadvantage -- you're sitting down, half-naked, often sick, sometimes scared. The doctor is vertical, dressed, presumably healthy, definitely the top dog.
This event is winnable -- but winning means finishing together, with a health plan you come up with jointly.
To get the max from a minimal doctor visit, you have to screw up your nerve and ask, front and center, about the two or three things that worry you most, not the 20 things you're vaguely concerned about. Don't blither on about your latest cold if it's heart arrhythmia, depression, alcohol use or sleep troubles that are the real problems.
If you are seeing a new doctor, or even a familiar one whom you haven't seen in a while, take a minute to remind the doctor of important things in your medical history or your life -- how long ago you had your heart attack, for instance, or whether you've just gotten divorced. If your medical history is complicated, bring your medical records with you.
"Don't assume that your doctor knows your whole medical history," said Sherrie Kaplan, a social psychologist and associate dean for clinical policy and health services research at UC Irvine School of Medicine. This is especially true if your clinic has a high turnover or you see different doctors for different conditions.
To help you and your doctor focus on the important things, write down your questions and bring a list of all the medications -- prescription, over-the-counter and herbal -- that you take, said Dr. Donald Berwick, president and chief executive of the Institute for Healthcare Improvement, based in Cambridge, Mass. (You can also put all your medications in a bag and bring them with you.)
Some doctors shudder when a patient walks in with a long list of questions, said Dr. Barbara Korsch, director of patient-doctor communication at Childrens Hospital in Los Angeles. But if you're worried about being too pushy, keep the list in your pocket or purse, then check it midway through the visit to be sure you've mentioned everything important.
If you're really sick or your illness is hard to understand, take notes and bring someone with you to listen and help ask questions, suggested Dr. John Flynn, clinical director of the division of general internal medicine at Johns Hopkins Medicine. "It always helps to have another set of ears," he said.
And another mouth. When a wife goes with her husband for his checkup, Kaplan said, a common scenario is that the husband will answer "no" when the doctor asks if he has chest pain, leaving it to the wife to add something like, "Are you kidding? You sat across from me two days ago, turned gray and started sweating!"
If you're concerned about spousal abuse or your spouse's drinking or another problem, take someone else with you. If your spouse insists on going, try to signal the doctor that you need a private word.
If the doctor's answers to your questions are likely to be complicated, you might consider bringing a tape recorder with you.
The key to successful patient-doctor communication is what Kaplan of UC Irvine called "planned patienthood." Kaplan has been analyzing audiotapes of patient-doctor visits for decades to see what works and what doesn't for good communication.
In general, she has found, women are much better than men at asking questions and being assertive with doctors. "Men, on average, ask zero questions. Women, on average, ask six," said Kaplan, who attributed this to the fact that women get more practice dealing with doctors, both from going earlier in life for reproductive issues and from taking kids to pediatricians.
Kaplan has developed a program of "coached care" to help patients get more from doctor visits. While patients are in the waiting room, her research team goes over their medical records with them and helps them formulate questions for the doctor. Kaplan, in her study of five chronic diseases, has found that the patients who get coached care do better on physiological measures of improvement (such as better control of diabetes) or in daily function (such as being able to move around despite arthritis) than those who don't get help preparing for the visit.
Short of formal "coached care" training, Kaplan said, the best thing for patients to do to get ready for a doctor visit is rehearse. This means practicing, out loud if necessary, or role playing with a friend or family member, what you want to ask.
Whatever you do, don't wait until the "doorknob" moment -- when you're dressed and heading out the door -- to ask the most important question. And before you do head out that door, make sure you've got a follow-up plan in place.
If you have questions you didn't get to, ask the doctor if he or she will accept a few questions by e-mail or phone. If you have too many questions for that, ask to schedule a follow-up appointment in a week or two.