When you go to see a doctor, it can be difficult to communicate your health concerns clearly, out of fear, embarrassment or a misunderstanding of medical jargon. How can you make the most of these appointments? From taking notes to bringing along a friend, and when to request a second opinion, doctors share their advice on how to access the best possible care.
Be upfront about why you are there
It is very common for people to go to the GP with a long list of things to talk about, says Dr Fari Ahmad, a general practitioner partner and GP trainer at Wilmslow health centre in Cheshire. If you make this clear at the start of your appointment, you can work out what the priority is together. Say: “There are three things that I want to talk to you about,” for example, and it gives you and the doctor a chance to decide which should be prioritised. “Sometimes all three could be discussed in 10 minutes, but sometimes there is only enough time to look at one in detail,” Ahmad says.
Raise the most significant symptom first
“Our brains have an anchoring bias, where we treat the first piece of information that is presented as the most important,” says Dr Faye Begeti, a neurology specialist at Oxford University hospitals. “So, if someone’s most important symptom is a headache, it is worth leading with that, rather than talking about a different symptom first. Obviously, all doctors are trained to recognise this, and we try to avoid it, but the thing that you mention first is the thing that they will tend to focus heavily on.”
Above all, don’t leave your biggest concern until you are about to leave. The classic, Ahmad continues, “is someone saying as they are leaving: ‘Oh, by the way, I noticed blood in my poo. It’s nothing to worry about, is it?’ And I have to say, ‘Actually, come back,’ and then we go through the whole thing.”
Try not to be embarrassed
As hard as it may be, try to overcome any embarrassment you have in explaining your symptoms. “Most GPs have seen or heard everything,” says Ahmad. “I’ve been doing this job for 30 years, so I don’t find anything awkward. And actually, sometimes those embarrassing symptoms are really important to help me understand what is going on.”
“Talking about sex is difficult but once you break that boundary, working out what your health needs are comes more easily,” says Prof Matt Phillips, a consultant in genitourinary medicine based in Cumbria and president of the British Association for Sexual Health and HIV. There is a range of treatment options for STIs, but clinics “don’t offer everything to everyone, so it is helpful if someone can tell us every detail of their sexual life, because that enables us to think about the full range of treatments”.
Dress appropriately
Make sure you wear suitable clothing to show the relevant body part, says Ahmad: “If you are coming about your knee, dress so that an examination would be easy and we’re not having to go through lots of layers of clothes.”
Use your own language
“I ask patients to use their own language,” says Begeti. “What a neurologist is really good at doing is differentiating. A patient might say they have vertigo, which is medical terminology. And I’ll say, how does that feel to you? Do you feel like you are spinning? Or do you feel lightheaded, as if you are on a boat? Sometimes people can use the same language for quite different sensations.”
Slang is welcomed if it helps to overcome the reluctance to discuss certain body parts. “I don’t know any practitioners who mind people using slang words,” says Phillips. “We are very used to slang, but we are not always the same generation as the people we are looking after, so don’t worry if we look a bit puzzled and need to ask you to explain what it means.” He adds: “Don’t worry about mispronouncing things – it doesn’t matter.”
Be honest
Doctors aren’t here to judge you, says Ahmad. “We just want to give you the best advice. That’s why it is important to be open about things like how much alcohol you drink, whether you smoke, how active you are and what you eat. If you tell us you only drink a couple of glasses a week when it’s actually a bottle a night, or say you don’t smoke when you do, we’re working with the wrong information. The more honest you are, the better we can help you.”
Make a timeline of symptoms
It can be useful to bring along notes about how long you’ve been having the problem, whether anything makes it worse and any treatments you have already tried, says Ahmad. For example: “It started a week ago; or it has been there for six months. This makes it better; this hasn’t worked.” Bring any relevant medical letters from other appointments, as they may not be on your records, Ahmad adds.
Voice your concerns
In the age of Google, most people attend appointments with a certain amount of information about a potential condition. “If that’s you, don’t be afraid to tell us,” says Ahmad. “Your GP understands that the internet can sometimes make things seem scarier than they are. For example, if someone has a headache, they might worry it is a brain tumour. Your doctor can talk you through the typical symptoms for a brain tumour and why your situation is different. They can explain what they think is causing your symptoms and what steps to take next, whether that is trying a treatment, keeping an eye on things or doing more tests, so that you leave your appointment feeling reassured and knowing what to do next.”
Share what you understand about your condition
The most important thing for the patient and doctor to do is build a relationship of trust, says Dr Petra Jankowska, a consultant clinical oncologist working in Taunton, Somerset, and the medical director of professional practice at the Royal College of Radiologists. Her starting point for this is finding out “what the patient has understood from what they’ve been told so far about the scans, biopsies and other tests they have had, in case there are some misunderstandings that I need to clarify”.
Don’t be afraid to interrupt or ask for further explanation
“I always say to my patients, ‘If there is something during our consultation that you don’t understand, feel free to interrupt me,’” says Jankowska. “It is really important that doctors use clear and unambiguous language and avoid jargon, acronyms and euphemisms.” If you don’t understand what is being said, don’t be afraid to say so. “I was always struck by something one of my patients used to say to me at the end of a consultation: ‘Petra, is there anything else I should be asking?’”
Take your time
“Patients think we are really rushed because they know that the NHS is overwhelmed, and they are almost apologetic for the time that they have with us,” says Stella Vig, a consultant vascular and general surgeon at Croydon University hospital and the national medical director for secondary care in the NHS. “But the time is yours. If that means my clinic overruns slightly, it doesn’t matter. If we can’t cover everything in the time that we have, we can make another appointment. But patients shouldn’t leave feeling that they’ve not been able to talk to us.”
Don’t be afraid to bring someone with you
Having a companion can help you understand what has been said, but make sure they are primarily there to listen, says Jankowska. “If the relative or friend is intending to ask a sensitive question, like, ‘What does this mean in terms of prognosis?’ and the patient hasn’t asked that, it can be very uncomfortable. If somebody is coming with the patient to act as their support, they should chat with that person in advance and say: ‘This is what I was thinking of asking. Is it all right if I do that?’”
For some concerns, such as memory loss, bringing someone who can offer an objective opinion is crucial, says Begeti. “Relatives may notice symptoms that the patient hasn’t recognised themselves. If somebody has had memory loss, or a ‘funny turn’, or loss of consciousness that they didn’t know about, we ask them to bring a witness or a relative to the consultation that we can speak to.”
Make notes
“There is so much information that even if patients bring somebody with them, they still probably won’t remember absolutely everything,” says Jankowska. “Some patients ask to take notes, which is absolutely fine. Some patients take a recording during their consultation, which is also perfectly permissible, although it is advisable to check first and to do this openly.”
Know that you don’t need to commit to a treatment there and then
“There are patients who, perhaps from their own experience or that of a family member, are apprehensive about some of the treatments I might be recommending. It is absolutely fine for them to go away and weigh things up,” says Jankowska.
It is crucial to find out about all the medication options and side-effects, explains Begeti. “First, do people want to go on medication? Sometimes they may not want to. How bad are their symptoms? When it comes to different types of medications, I talk through side-effects and which would be acceptable to the person. For example, some medications make people feel sleepy.” If you are thinking of getting pregnant, it is important to say so. Begeti says the aim is for it to be a “collaborative process” between the doctor and patient in working out the best treatment plan. “I also recommend taking along a list of all your medications, because sometimes people will say they take a blue or orange pill, rather than the name and dose, and that can be quite difficult to interpret.”
Be realistic about lifestyle changes
“If we can do something with no intervention, we do that first,” says Vig. “A patient may have had pain in the back of their calf for around six months. They’ve gone to see their GP and they are sent to me. I examine them, and I realise that they’ve got a problem with the blood supply in their legs. We don’t need to do anything drastic, but they will need to change their lifestyle, stop smoking, exercise more and start at least three medications that will prolong their life.”
Where lifestyle changes are involved, it is important to be realistic about your circumstances, she says. “I might tell myself that I need to lose weight and exercise, but I’m doing a full-time job. I come home, I cook for the family after a really busy day, and I might eat all the snacks in the house. Then, when I’ve cooked, I might not want to eat because I’m so tired. We’ve got to consider what life is like for the patient and how we can work with them to put realistic plans in place.”
Speak up if you feel uncomfortable
“If there is anything in the room making you feel uncomfortable, then say so,” says Phillips. Ask for a chaperone to be present or to be examined by someone of a particular gender if you think that will help. “But say so early on, so that it doesn’t feel stressful.”
Don’t hesitate to ask for a second opinion
You are well within your rights to ask for a second opinion, says Phillips: “If you’re not happy, you should always be able to ask for that.”
“Some of the patients that come to our clinic have rarer cancers that we don’t see very often,” says Jankowska. “Often I will say: ‘If you are uncomfortable, or if you feel that you need more information, or if you want to have what we’ve discussed confirmed so you feel more confident about your treatment, feel free to ask for a second opinion.’”
“But,” Begeti adds, “it is important to come to appointments with an open mind. Sometimes, people come to me with a condition that they’ve heard of, but the same symptom can be caused by dozens of different conditions.”
Follow up afterwards for any clarifications
If you go home and realise you have forgotten to ask something – which is very common – you are encouraged to get in touch with further questions, says Jankowska. In her department, “there are several lines of communication, through the oncology secretaries, the clinical nurse specialist or the acute oncology service if it is a side-effect-related issue”.
Ask about what procedures will involve and any potential complications
“Eight years ago, I had a brain tumour,” says Vig. “When I had surgery, I was less anxious about the procedure and more anxious about the complications afterwards – I knew I would lose the hearing in my right ear.” Vig was told there was a 40% chance of a secondary complication of facial paralysis, and she sought a second opinion from another surgeon. They came up with an alternative procedure to avoid it, which worked. “The doctor-patient relationship is like magic,” says Vig. “Trusting the person looking after you definitely improves the outcome.”
Remember that it is OK to cry
“Sometimes, patients find themselves feeling teary during a consultation, with emotions bubbling up unexpectedly – and that is absolutely OK,” says Ahmad. “Your doctor won’t be surprised; in fact, it can help them better understand the impact of your concerns. Crying can be a real relief; sometimes a few tears do more good than you’d expect, and the release can feel therapeutic.”
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