MARA GORDON, HOST:
Hey, Mr. Askew?
JOHN ASKEW: Yes.
GORDON: Hey, I'm Dr. Gordon. How you doing today, sir?
GORDON: I'm Dr. Gordon.
ASKEW: Oh, OK.
GORDON: So, John, you and I, we're both doctors. Remember when we had to work with standardized patients when we were medical students?
JOHN SCHUMANN, HOST:
Oh, God. Yes, standardized patients. I remember when I was working with standardized patients, we had to videotape ourselves with the patient interaction. And it was so painful to have to watch yourself on video.
GORDON: Well, recently, I went to see one again.
Nice to meet you, sir.
ASKEW: All right.
GORDON: How are you doing today?
ASKEW: Well, it could be better.
GORDON: Yeah. What's going on?
So standardized patients, they're actors who pretend to be patients. They're given a name, a little bio, a list of symptoms and then they act out a doctor's visit with medical students. I'm actually a practicing family doctor, but I wanted to brush up on my communication skills, so I asked a local patient actor to come in for a visit with me.
ASKEW: I can't sleep at night. It seems that I'm waking up every night for about a month now, and I just can't go back to sleep. I don't know what to do about it.
GORDON: That's John Askew. He helps train medical students at Georgetown, and he's been doing this for about a decade.
Well, what do you think? Do you think that's what's keeping you awake?
ASKEW: I have no idea. That's why I came to see my doctor.
GORDON: So I ask him a few questions.
Tell me about your caffeine intake. Are you a coffee drinker?
ASKEW: I'll have maybe two cups in the morning.
GORDON: Even though it's something I do all the time, it was still a little nerve-wracking.
Your heart sounds great. Deep breath in and out for me, please. You sound great - in and out, in and out. Good.
Of course, you know, this all serves a purpose. It's so that I can better play my role as the doctor. A frequent piece of feedback that John Askew, the patient actor, gives to his medical students - he wants them to calm down.
ASKEW: You're still learning. You're not the expert yet. But when you come in, I'm Dr. Jones and you know, chill out. You know, we'll get there.
GORDON: So when real patients come into the office, you know, even if you're not an actor, you're still playing a role, but you don't exactly get any training for it. At least we doctors, we get training, but patients, they're expected to play their part without any guidebook at all.
SCHUMANN: And that's what we're going to do with this episode of NPR's LIFE KIT - give you a guide to being a more empowered patient.
GORDON: I'm Mara Gordon, and I'm NPR's health and media fellow.
SCHUMANN: And I'm John Schumann, a general internist and host of Medical Mondays for Public Radio Tulsa. We're the hosts of your NPR LIFE KIT to navigating health care.
GORDON: We are here to tell you all of our insider tips about how to find a doctor you like, feel more in control when you're at the doctor's office and make the whole process of going to the doctor a little less painful.
SCHUMANN: And we're not here to be doctors telling you what to do. We're here to help you feel more empowered in the doctor-patient relationship.
GORDON: There's more after the break.
(SOUNDBITE OF MUSIC)
SCHUMANN: So where do you even begin? You're thinking about choosing a doctor or other primary care provider, like a nurse practitioner or physician assistant.
GORDON: So right off the bat, let's acknowledge that this process is a lot easier if you have health insurance.
SCHUMANN: If you have insurance, you can start by looking through the directory that your insurance provider puts out. Usually, they'll list a bunch of names and addresses of doctors who are in network, which means it'll be a lot cheaper for you to see them.
GORDON: If you don't have health insurance, please don't despair. I actually practice in a health center where we see lots of uninsured patients. And I think we give them really good care. There are lots of great clinics like mine all across the country, and most of them will see you for free or for a sliding scale fee. You can search for clinics like mine by typing federally qualified health center into Google.
SCHUMANN: Or F-Q-H-C for short. But after that, how do you know where to go? Well, the first step is our first takeaway. Figure out what type of patient you are and let that guide your choice of doctor.
KIMBERLY MANNING: With some trial and error, I started realizing that one size doesn't fit all.
SCHUMANN: That's Kimberly Manning. She's an internist and an associate professor at Emory University School of Medicine where she teaches medical students and doctors in training.
GORDON: That's her official title, but her family, they have a different way of referring to her.
MANNING: They call me a human doctor. My brother is a veterinarian and everybody in my family - because he was a doctor first, they're like, oh, she's a human doctor. I'm like, he is a dog doctor.
GORDON: So Dr. Manning, human doctor, she says that different patients need different things from their primary care providers, and that's OK. You should start by asking yourself questions about what you need from your doctor.
MANNING: So I'll be sitting in my hair salon amongst, you know, five or six African American women. And someone will say, hey, I need me a new doctor. Tell me who I should go see. And so I start to ask a few questions, such as, well, how often do you need to go to the doctor? Are you someone who has a lot of health problems? Are you a person who likes to see the doctor a lot? Are you a person who doesn't like to go the doctor at all? Are you an extraordinarily busy person? Are you willing to drive far away for the right doctor? Or is convenience more important to you?
SCHUMANN: Kimberly's questions are great ones to ask yourself. An older patient with a few chronic medical conditions should think about their doctor pretty differently from a patient in his 20s who only needs to come in for a cold or muscle sprain.
GORDON: Yeah. I mean, it's OK to want convenience if you're pretty healthy. You can look for a doctor who has last-minute appointment slots or is willing to answer your questions via email. Some offices will even offer telemedicine appointments, which is where you can take care of simple problems over video chat. And you can call and ask about these things when you make your first appointment.
SCHUMANN: If you have more medical problems and you see a specialist regularly, like, say, a cardiologist. Say, like, you have an abnormal heart rhythm, well, there are other things that are more important than convenience. And you should prioritize finding a primary care doctor who works in the same health system as a lot of specialists.
MANNING: As a practicing physician, I know how much better it is for us to take care of patients when we can all see the electronic medical record of what's been going on. It just allows for continuity.
GORDON: Of course, you may not actually need a lot of specialists. Your primary care doc can do more than you think. We love sports medicine. We do lots of women's health. We even do some basic dermatology.
SCHUMANN: Yeah. I love a good rash. But if your primary care physician wants you to see a specialist, it's important that they be able to communicate.
MANNING: You don't know when you're going to need an MRI. You don't know for sure that you're going to need some kind of X-ray or emergency services. That's a really good question to ask after - beyond the in-network questions. Where do you admit to? What is your electronic medical record? And if you have been hospitalized in the last year, I think that might be something to consider.
SCHUMANN: It's so hard when my patients come to me after a long hospital stay and say, I felt terrible. I was scared, and I have no idea why I was there. It's much safer when I can see exactly what the hospital doctors were doing.
GORDON: It's still a good place to start by asking around for recommendations because word of mouth can be a really powerful tool. Physician rating websites might be helpful, although we do caution that they're a little bit like Yelp. They tend to attract reviews from people who are either really happy or really not happy.
So John, I looked up reviews of you online. I know. There were only three, which is pretty crazy because you've been in practice for - what? - almost 20 years? And John, I have to tell you - one patient gave you 1 out of 5 stars.
SCHUMANN: Ouch. You know, I don't think three reviews in 20 years is really something I would say is statistically significant.
GORDON: I totally agree. So when you choose a primary care provider, the most important thing is that you get to know yourself a little bit. Be honest with yourself about what you need from your doctor.
OK. So you've done some soul searching about what you need from your doctor, and you're getting to know what kind of patient you are. You've done some shopping, which, by the way, is totally allowed. You can make introductory appointments with different doctors when you're figuring out what you want. This is really common when, you know, expectant parents - they'll go interview pediatricians before their child is born to see that they get somebody that they like. And that is totally OK for grown-ups, too.
SCHUMANN: But listen. No matter how pleasant the waiting room is or how close the clinic is to your house, our next takeaway is to seek out a doctor who makes you feel comfortable and to trust your gut on this one. Most of us doctors join the profession because we want to help people. But sometimes, your doctor just might need a little help communicating.
GORDON: Maybe it's something small that drives you crazy, like a doctor who's running late or somebody who looks more at the computer than at you.
SCHUMANN: I've been accused of that on occasion. Or maybe you just feel like you're on totally separate wavelengths with the doctor. Don't ignore those feelings 'cause it's worth it to find somebody that you click with.
GORDON: So there's actually research that shows if you have a good relationship with your doctor, it's actually more likely to help you be physically healthy. So there was a big 2014 paper that came out that showed when you have a good relationship with your primary care doctor, not only are you more likely to be physically healthy - so that's on objective things like blood pressure - but you're even less likely to be in pain.
SCHUMANN: And that's not to say that a good doctor is going to give you exactly what you want. Medicine's complicated. And even if you think a medicine or a diagnostic test is necessary, there could be good reasons why that isn't the best choice for you. So a smart doctor will explain her thinking and take you seriously even if you sometimes disagree.
GORDON: We will talk about that more in the next LIFE KIT episode of this guide.
So when you're looking for a doctor who makes you feel comfortable, what should you actually be on the lookout for? We talked to the person who literally wrote the manual on this stuff. Her name is Sana Goldberg, and she's a nurse and the author of the book "How To Be A Patient."
SANA GOLDBERG: Find somebody who is curious, who asks questions that let you know that you're being heard.
GORDON: First impressions can be powerful. Take note of whether or not your doctor makes eye contact, listens without interrupting, calls you by the name that you prefer. You should not go back to a doctor who doesn't make you feel comfortable right from the get-go.
SCHUMANN: And your doctor should never make you feel self-conscious about your sexual orientation or gender identity.
GOLDBERG: The medical system still is very hetero-centric. When you have a primary care provider who feels, let's say, uncomfortable asking about anatomy and that conversation doesn't - you know, isn't navigated effectively, that can lead to pretty serious health outcomes.
SCHUMANN: A doctor who makes you feel comfortable might mean finding a doctor from a shared background, whether it's speaking the same language, coming from the same neighborhood or even liking the same dad jokes.
GORDON: And if English isn't your first language, you should definitely feel free to call around to different clinics and see if you can find a doctor who's fluent in your native language.
Here's Kimberly again.
MANNING: If I'm bilingual but my first language is Spanish, how cool would it be for me to have a doctor whose first language is Spanish, too?
GORDON: If you're a person of color, there's actually some research that shows that having a doctor who's from the same background is good for your health. One study showed that when black patients have black doctors, for example, they're more likely to be up to date on recommended preventative services.
SCHUMANN: It may be hard to find a physician who looks like you, but it's always worth asking because having a doctor who makes you feel relaxed is about more than just pleasantries. It can actually help you stay healthy.
GORDON: And that's our second takeaway. Seek out a doctor who makes you feel comfortable and to trust your gut about what puts you at ease.
SCHUMANN: You found a primary care doctor you like, so now it's time to think about how to optimize your time together. So we took this to Jennifer Brown, one of the standardized patients at Georgetown, to see what she'd learned from being a patient actor.
JENNIFER BROWN: I don't know what it is about walking into the doctor's office, but it's incredibly easy to forget half of what you wanted to tell the doctor. So I am really, really big on bringing in that agenda list with you if you're a patient, and then it's a lot easier to make sure that you get to all of it.
SCHUMANN: Jennifer's not alone in getting overwhelmed when it comes time to finally tell your doctor what's on your mind. Even the most self-assured people with the nicest doctors can feel a little tongue-tied when the doctor says, hi, what brings you in today?
GORDON: But there are some things that you can do to feel like you have a little more control. In primary care visits, Sana says that you should perfect what she calls the opening statement.
GOLDBERG: When you think about what you're going to say, think of it in terms of almost like a little elevator pitch - you know, a couple minutes of explaining your symptoms.
GORDON: Sana encourages you to talk to your doctor about whatever it is that's bothering you, you know, if it's your acne or your joint pain. How it's affected your quality of life - that's a red flag to doctors, something that makes us sit up and listen a little bit more closely.
GOLDBERG: As part of that opening statement, convey how what's going on has impacted your quality of life. So that may be prior to this, I was hiking every weekend, and now, I haven't gone on a hike in five weeks.
GORDON: I actually really love it when my patients come in with a written list of their concerns. It helps me budget our time together, and it helps make sure that you don't forget anything important.
SCHUMANN: I totally agree. To me, a list is a signal that someone is taking their health seriously. I also love it when patients bring in their medication bottles. That way, if a different doctor has added something new, you and your doctor can make a plan together if he has concerns about medications interacting in unsafe ways.
GORDON: Another really good idea is to bring in records from any other docs you see or if you've been to the emergency room so that your doctor can piece together exactly what's been going on. It's because each health care system uses its own electronic medical record, and we usually have no idea if our patients have been hospitalized or seen another doctor. And records from those visits can be really critical to your health.
SCHUMANN: When you visit your primary care doctor's office, always think about what you want to accomplish. It's a good idea to bring an opening statement and a list of two or three things you want to get done during the visit.
GORDON: Bonus points if you bring in all of your meds and a copy of records from other visits.
SCHUMANN: This is our third takeaway - when you come to the doctor, come prepared.
GORDON: The unfortunate reality is that doctors are working under extreme time pressures. I have 15 minutes with each patient. It drives me crazy. And it can be hard for you to get your most important questions addressed in that short window, especially if there's a sensitive topic that you're reluctant to talk about. And as a doctor, the ultimate thing that I am trying to avoid is the doorknob moment.
MANNING: Oh, yeah. The doorknob moment is where we've gone through the entire visit, we're done, and I get up to leave, and I say, you know, Mr. Willis (ph), it's been so good seeing you today, and, you know, we're going to see you back in three weeks. Tell Mrs. Willis that I said hello. And I have my hand on the doorknob, and Mr. Willis says, oh, I forgot to tell you. I'm having some trouble with my nature.
GORDON: Kimberly, I have to say, I've never heard that term, problem with my nature.
MANNING: Oh, see, I live in Atlanta, Ga.
GORDON: I think it's a South - it's a Southern thing.
MANNING: Oh, yeah. Oh, yeah.
GORDON: People always ask about erectile dysfunction when I'm leaving the room. It's classic - classic.
SCHUMANN: Ah, yes, the proverbial doorknob moment - happens all the time. Just like you have a list of things you want to accomplish in the visit, we doctors also have a list of what we're hoping to get done. I always worry about whether or not you're up to date on vaccines or recommended screening tests, things like pap smears, colon cancer tests, mammograms.
GORDON: You know, I always need to make sure that I have an accurate list of the medicines that you're taking because interactions between meds can be really dangerous.
SCHUMANN: We try to focus on your best interests, but it may not always feel that way.
MANNING: If somebody has health problems that can be life-threatening if not well managed, immediately that jumps to the top of an agenda for the doctor, right? You thought, maybe I'm just walking a lot, and it's hot, and this is Georgia, and my ankles swell in the summer in Georgia, and I just didn't think much of it. But as your doctor, I'm trying to make sure you're not about to leave my office and have a heart attack.
SCHUMANN: So we're not telling you all this just to give you the doctor's side of the story. It's just part of the reality of medicine. So what to do? Bring up your main concerns at the beginning of the visit. If something is going to require a physical exam, like a joint problem where I need to examine your knee or shoulder, you've got to bring that up early.
GORDON: And if you have more than two or three items on your list, please know that your doctor's probably going to ask you to wait until the next visit to tackle all of them. But it's not because we don't want to talk about everything that's on your mind. The last thing we want is to feel like your most pressing problem is not addressed.
SCHUMANN: So this is takeaway No. 4 - be clear about your agenda from the beginning because your doctor's agenda may be different from yours. So even though we're always racing against the clock, I like to talk to patients about their personal lives - photos of grandkids or hobbies - and this is actually why I became a primary care doctor.
GORDON: I know. Me, too. I love it. I like to see dog photos, videos of your kids doing funny things. I have this one patient who always shows me YouTube videos of his jazz band, and I love it. It feels like he's giving me a little gift.
SCHUMANN: Sounds like we're on to something. You know, Sana Goldberg agrees, too. She says it's really worth it for patients to open up and let their doctor get to know them personally.
GOLDBERG: Especially in this day and age when things are rushed, it becomes kind of important to be seen as a human, to be memorable, to not just be one in a number of people being rushed through the day.
SCHUMANN: Now, occasionally, patients sometimes get a little bit freaked out and say, you know, why are you asking me so many personal questions? I'm just here because I have a cold.
GORDON: And, of course, we're not saying that you ever have to do anything that you feel uncomfortable with.
SCHUMANN: But there is research showing that the stronger the connection to your doctor, the better your care. Statistically, you're more likely to show up for appointments, get recommended tests, and you're more likely to take the medicines your doctor prescribes.
GORDON: One study - and I love this, I thought it was so interesting - it showed that when patients with the common cold went to see doctors that they perceived as empathetic, they got over their symptoms a full day sooner than patients who went to doctors who they didn't think were as caring.
SCHUMANN: It's more than just about chitchat. If a patient tells me she has back pain and I know she has a job where she's standing all the time, my treatment plan is going to be different than if she has a desk job.
GORDON: We also really want to hear about the difficult stuff, too. If a relative recently died and you're grieving, it's going to change the way that I talk to you about your blood pressure or regular exercise.
SCHUMANN: We want to get to know you. That's why we do what we do. Bring on the family photos.
GORDON: And that's our next takeaway - be yourself with your doctor. It's your time, after all.
SCHUMANN: So what if things aren't working so well? You're trying to show your doctor pictures of your grandkids, and you still feel like the connection isn't there. This might be an opportunity to give your doctor some feedback.
ASKEW: But you speak rather rapidly, OK. And as an older gentleman, I think - and well, as hearing some hearing problems, I think you need to slow that down a little bit, OK?
GORDON: That totally makes sense.
GORDON: Yeah. I've been accused of that before.
That's John Askew again, the standardized patient that we met at the beginning of the episode. He came to see me for his insomnia. He told me that I talk too fast. And the way that he gave me feedback - he gave me clear, specific instructions - that's exactly how you should talk to your own doctor.
SCHUMANN: Kimberly Manning had a similar experience. A patient gave her great advice, and this is the kind of language you can use yourself.
MANNING: You know, I usually kind of burst into the room - hey, how are you? Good to see you. Hey - you know, very kind of animated and happy and kind of jump right on the computer. And everything's kind of going at a fast pace, but it's light, and it's happy. A patient told me that, when I'm feeling heavy, sometimes I don't want to be met, you know, with all that sunshine. You should just come in the room regular, get a feel for where the patient's at, and then, you know, go from there.
GORDON: So that's such a great example. And it might seem scary to tell your doctor what he could be doing better, but trust me - if it can help us take better care of you, we really, really want to hear it.
SCHUMANN: Mara, it's funny because I also get told that I talk too fast. And even though I try to be conscious to avoid it, I often will lapse into medical jargon, you know, maybe trying to sound very scientific or something. But I love it when patients are honest enough to ask me to explain things more clearly to them.
GORDON: Right, totally. So when you give your doctor feedback, start with a statement about how you feel. You can say something like, you know, Dr. Schumann, it would help me feel more comfortable if you spend a few minutes looking at me, not at the computer.
SCHUMANN: Touche. Or, I'm having a hard time understanding the plan. Can you use fewer medical terms? The doctor should be receptive, and if she isn't, Sana Goldberg says maybe it's time to think about finding somebody new.
GOLDBERG: If you feel like you're condescended to, especially if you feel like you've made an effort and you're not heard, you're not listened to, it's always OK to find somebody else. And knowing that that takes some upfront investment, but that it's worth it.
GORDON: Sana says that if you've made an effort to let your primary care doctor get to know you and you really still feel like things just aren't clicking, you are totally entitled to find somebody new.
SCHUMANN: Yeah, trust your instincts on this one. If you aren't connecting with your doctor, move on.
GORDON: This is our last takeaway - you have a right to give your doctor feedback, but if things aren't working, don't be afraid to break up.
(SOUNDBITE OF MUSIC)
GORDON: So John, much like a very, very short doctor's visit, we are done, and our time is up. But I try to actually do this with my patients - I try to recap what we discussed so they know what the plan is.
SCHUMANN: So let's do it. Takeaway No. 1 - figure out what type of patient you are, and let that guide your choice of doctor.
MANNING: Each individual - their needs are just so tremendously different.
GORDON: Takeaway No. 2 - find a doctor who makes you feel comfortable, and trust your gut on this one.
GOLDBERG: You want it to be somebody that you're comfortable talking about your sex life with, talking about your mental health with.
SCHUMANN: Takeaway No. 3 - when you come to the doctor, come prepared.
GOLDBERG: Gathering your thoughts beforehand, that can be helpful.
GORDON: Takeaway No. 4 - be clear about your agenda from the beginning because your doctor's agenda may be different from yours.
MANNING: One of the reasons I think that some visits fall flat for people is because their agenda isn't met.
GORDON: Takeaway No. 5 - be yourself at the doctor's office.
MANNING: More is more (laughter) with your primary doctor.
GORDON: And our final takeaway, takeaway No. 6 - you have a right to give your doctor feedback. But if things aren't working, don't be afraid to break up.
MANNING: We are no longer the people sitting on high with all the information. Our patients are savvy, and they can access a lot of really good information.
(SOUNDBITE OF MUSIC)
GORDON: For more LIFE KIT, check out our other episodes. The next in our guide is about how to navigate health care when you get seriously sick.
SCHUMANN: If you like what you hear, make sure to check out our other LIFE KIT guides at npr.org/lifekit. And while you're there, subscribe to our newsletter so you don't miss anything. We've got more guides coming every month on all sorts of topics.
GORDON: And as always, here is a completely random tip, this time from LIFE KIT listener Heather Stevens.
HEATHER STEVENS: For a lot of people, what puts them off to camping is the idea that there's no showers. Kind of a pro tip is that you find the local swimming pool, like a public swimming pool or even if it's like at a resort or a hotel, pay to use the pool, and the showers are always included. So the kids love to swim, and everybody gets clean.
SCHUMANN: If you've got a good tip or want to suggest a topic for a future LIFE KIT, email us at firstname.lastname@example.org.
GORDON: LIFE KIT is produced by Sylvie Douglis, Alissa Escarce, Chloee Weiner and Katie Monteleone.
SCHUMANN: Meghan Keane is the managing producer. This episode was edited by Carmel Wroth, with help from Maria Godoy. Beth Donovan is the senior editor.
GORDON: Our digital editor is Carol Ritchie, and our project coordinator is Clare Schneider.
SCHUMANN: Music by Nick Deprey and Bryan Gerhart (ph). Neal Carruth is our general manager of podcasts, and the senior vice president of programming is Anya Grundmann.
GORDON: I'm Mara Gordon.
SCHUMANN: And I'm John Schumann. Thanks for listening.
NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.