“When I’m at the doctor, I can’t remember all the things that are on my mind and I have no idea where to begin. How can I sort through everything and figure what’s important for the doctor to know?”
Figuring out what’s important (and what’s not) can be very challenging. Medical students spend years learning how to recount patient histories to their supervisors. You have to practice doing this now, before you or your loved one are seriously ill. Focus on the following tips.
Tip #1: Start at the beginning and proceed chronically. It helps the doctor to understand your story if you tell it in a chronological order.
Tip #2: Use concepts such as timing, pace, onset of symptoms, severity, changes over time—these are key to arriving at your diagnosis, and will come through naturally if you tell your story from the beginning. Remember that all diagnoses have a natural history, and the better the chronology of your story, the better the fit can be.
Tip #3: Draw it out. Our book contains worksheets that you can use to help you explain your symptoms. One of the exercises is a graph of severity of pain over time. You can use this graph to plot your symptom and how it has changed over time. Your horizontal axis can be any time interval you choose (hours, days, or months, depending on your symptoms). The vertical axis is your level of pain or discomfort. You can think of it on a scale of 1-10,with 1 being minimal pain and 10 being the worst pain, or just as “not so bad”, “bad”, and “very bad”. If there are two or more symptoms of concern, you can plot them alongside each other.
Tip #4: Provide your doctor with context and tie the chronology to other events. Instead of getting bogged down with exact times and dates, try to relate your symptoms to things that were going on in your daily life. Don’t just say, “my headache started at 10:30AM”; instead, relate the symptom to what you were doing. “I first noticed the headache after a long day at the office,” or “I felt the stomach cramp for the first time after getting home form the church picnic, but it went away after I threw up.” Talking about details like this may seem extraneous, but understanding the context can help you and your doctor put together the temporal relationships of symptoms and identify factors that make your symptoms better or worse.
Tip #5: Describe how your symptoms have impacted your life. Your doctor’s office will often try to get you to quantify your symptoms in an “objective” way. Give them an answer, but expand on it. Telling the doctor “My headache was so bad I had to leave work early for the first time in 5 years” is going to be more helpful than “the pain was a 9 out of 10.” Mentioning whether you have had to miss school or work is another measure of severity. Explaining the impact on your daily life also gives your doctor a window to who you are, and improves the chances of the doctor making the right diagnosis.
Tip #6: If something surprised about your symptoms surprised you, emphasize it. All good stories are driven by the element of surprise. “I thought I was just having a garden-variety headache, like the migraines I always have. Then, all of a sudden, the room started spinning and I couldn’t stand up straight. That’s never happened before!” Relating what surprised you will help make sure the doctor pays attention to this part and address it. And who knows; it might surprise your doctor too, and completely change his thought process.
Tip #7: Share your impressions with your doctor as you go along. We all experience minor ailments from time to time and we do a pretty good job at making our own diagnoses. Accurate or not, these provisional diagnoses are very important for the doctor to understand as he or she hears your story. For example, you might say, “At first I thought it was just a pulled muscle, because I had been working out with a new bench-press machine earlier in the week. But when the pain began shooting down my left arm I started to get worried.” Or, “It started out like just like every other migraine I’ve ever had, it’s just that it hasn’t gotten better, and now my right eye vision is kind of blurry, something that’s never happened before with my migraines.” If your impression changed along the way, or if there are things that you think are NOT the cause of your symptoms, it helps to share these as well.
Tip #8: Use simple language. When you describe your symptoms to the doctor, don’t incorporate medical terms unnecessarily. Patients often think it helps to talk in “medicalese”, but this can lead you into trouble. If you have a fluttering sensation in your chest, explain how it feels; using the term “palpitations” will focus the doctor on your heart, but this may or may not be the issue. If you feel off balance, describe what it’s like for you; saying that you have “vertigo” may lead your doctor down the wrong path. As much as you hear doctors using these terms, try to avoid saying things like “intermittent,”, “radiating” or “associated with.” Don’t be shy to tell your doctor what you think is going on, but focus on telling your story as if you were speaking with a relative or a friend.
Tip #9: If there is a diagnosis that you are particularly concerned about, let your doctor know up front. The doctor may be trying to “rule out” an abscess, but if you’re worried about breast cancer, you may not get the answers you’re looking for. If you are concerned about seeming too presumptuous, you can always say something like, “Look, I’m not a doctor or anything, but I have a cousin who had these same symptoms and she ended up being diagnosed with breast cancer. Should I be worried?” Sharing your fears can help your doctor consider a wider list of possibilities, and also potentially alleviate your concerns.
Tip #10: Write it down. Your story may be long and winding, with twists and turns that aren’t necessarily straightforward. To help make sure the important parts of the story aren’t left out, you can use our worksheets and write down your story. The next time you are going to the doctor, complete the worksheet before you go (or take it with you and complete it in the waiting room). Along these lines, If you are experiencing symptoms over days to weeks, it might help to keep a journal You can also use the journal to keep track of other aspects of your daily life (activities, eating habits, sleep patterns, times you take medications etc) to the extent that you think they may relate to your symptoms. This information can be incredibly helpful in leading you and your doctor to your diagnosis and, later, in tracking your response to treatment.
Table of Contents
Jerry’s Story (excerpt from Chapter 3)
Danielle’s Story (excerpt from Chapter 5)
8 Pillars to Better Diagnosis (excerpt from Chapter 13)
Advice For Patients (excerpts from Chapter 14)
For more advice on avoiding misdiagnosis, please visit our blog, Facebook site, and Twitter. Make sure to preorder your copy of When Doctors Don’t Listen today!