With the advances of knowledge and technology, the practice of medicine has become more complex. In addition to increasing complexity, there has also been a growing shift in patient care from paternalistic medicine to shared decision making. Paternalistic medicine is when the physician would make a diagnosis based on a patient’s history and test results, and then tell the patient what the plan of action will be. With shared decision making, the physician explains testing and treatment options, and then the patient makes an informed decision based on his or her preferences and health goals as well as physician recommendations.
Time after time
In the practice of modern medicine, there are many challenges which can often hamper a physician’s ability deliver care in a way that would be both efficient and most appreciated by the patient. These challenges include shorter office visits (the choice of administrators rather than physicians in many situations), the need to address multiple health problems in a single visit, and lack of support staff (someone to check your blood pressure, confirm your medication list, etc.). Given this time crunch, physicians often find themselves rushing, particularly at the end of a visit, to keep their clinic running as on time as possible for the next patient. During this rush, physicians must discuss the implications of a diagnosis, testing options, treatment options, drug side effects, the need for referrals to specialists, and appropriate follow-up appointments. Due to this rush, I often preface some of my visits by saying, “We need to fit 80 minutes of material into a 60 minute visit, so I apologize for speaking and typing quickly during your visit.” I recall when one of my patients from the Midwest asked, “Dr. Mathew, where did you learn to talk so fast?” I replied, “In the republic.” He asked, “You mean the Dominican Republic?” and I said, “No, the Republic of New Jersey. In New Jersey, speaking quickly is common, and it has provided me with an advantage over other doctors. In the Garden State, we would say that it is a ‘Uge’ (the ‘H’ is silent) advantage.”
While rushing through material, physicians may use complex medical jargon without taking the time to explain what it means, and may not go into adequate depth for a patient to feel comfortable proceeding with a decision to start a treatment. Lingering questions and doubts after an office visit can at times lead to non-compliance (when a patient doesn’t follow through with recommended care), which can have detrimental effects. I recall one patient who after arriving 15 minutes late for a 30-minute appointment came to her follow-up visit saying, “I did not follow your recommendations, because my neighbor suggested an alternative treatment.” I replied, “This would be like me telling my mechanic how to fix my brakes. It is an option, but it may not be the best one.” With adequate time during her follow-up appointment, we were able to discuss all the details of my treatment plan for her, and she felt confident enough to follow through with it
A foreign affair
For many patients, English is a second language, and adequate interpretation by speakerphone, or, preferably in person, is essential for providing quality care. I have had the pleasure of working with many fantastic interpreters, and one of my fondest experiences involved an elderly Spanish speaking woman and an interpreter. I asked if she had any further questions, and she said, “El Doctor es muy guapo.” The female interpreter blushed, and said, “The patient thinks you are very handsome.” I replied, “Please advise the patient that I will not be examining her visual acuity because her eyesight is perfect.” The interpreter laughed, told the patient what I said, and the her ear-to-ear smile lit up the room.
How you can help your doctor speak your language
- Show up on time, or preferably 15 minutes early for appointments.
- If English is your second language, make sure to let the office know in advance so interpreter services are available at the start of your visit. (You do not want to waste the first 20 minutes of an appointment waiting for an interpreter.)
- Rank your concerns, and discuss them from most to least important. (You may not get to everything in a single visit.)
- Bring any records, including test results, with you to avoid repeat testing, and to avoid treatments that were previously not tolerated or ineffective.
- Ask your doctor to explain things in simple terms, and do not be afraid to ask questions to clarify what you do not understand.
- Ask for patient handouts regarding medications, tests, and procedures. Trustworthy information from the physician’s office is better than misinformation, which is often found online.
- Schedule frequent follow-up appointments if you feel you are not getting enough face time with your doctor.