My friend's grandmother-in-law, at 94, has refused her son's pleas to make a routine doctor visit. "'Why should I go to the doctor?'" my friend recalled her exclaiming. "'They don't know anything anymore. You used to go to one doctor and he told you what was wrong and what to do about it. Now all the doctor does is draw vials of blood, order tests, and then tell you to go to another doctor.'"
Dear lady, you are so right. Medicine is not what it used to be. No longer do most people see just one doctor for whatever ails them. And no longer do most doctors have the luxury of spending half an hour or more with each patient, getting to know everything about their lives and families, as well as their bodies and minds. To meet rising costs, doctors are having to cram more and more patients into their already busy and demanding schedules, meaning that appointments are rarely more than 15 minutes apart.
Even those doctors who specialize in family or internal medicine usually limit the time they can spend with each patient. And if symptoms or test results suggest a problem, they must often refer patients to medical specialists and other providers for further diagnostic work and follow-up care.
It is easy to see this as a downside. But considering that people in industrialized nations today are living longer and healthier than ever, there must be something good about how medicine is practiced today.
No longer can one doctor "know everything" (not that any doctor ever did). Nor do doctors have the training and expertise to perform the myriad tests and procedures that did not even exist half a century ago and that have helped to extend quality years of life for so many.
The doctor-patient relationship has changed, too. Doctors are less likely to be paternalistic and patronizing. Patients are more likely to be knowledgeable about symptoms and ailments, and the two are more likely to be partners in the patient's care.
Still, insurance problems aside, many people like my friend's grandmother-in-law are dissatisfied with the tenor of modern medical care. They feel rushed, poorly understood and more like a customer in a supermarket line than a well-cared-for patient.
With just the 7 to 15 minutes that doctors give each patient on most visits, the roots of dissatisfaction are easy to understand. The trick is establishing a good working relationship with a doctor and getting what is needed from these necessarily brief medical encounters.
Marisa C. Weiss, a breast cancer specialist at Lankenau Hospital in Wynnewood, Pennsylvania, who has ample experience as doctor and patient, has written 7 Minutes: How to Get the Most From Your Doctor Visit. Some of her advice follows.
PREPARE FOR THE VISIT
You don't want to waste doctors' time on things you could and should have done at home. Arrive with a complete list of all the prescription and over-the-counter medications and supplements you take, including dosages and dosing schedules. Also have the names, mail and e-mail addresses and telephone numbers of the other doctors you see in case your doctor needs to contact them.
Write a list of your symptoms, their nature and frequency, and anything else you may have noticed about them, including what may relieve them.
Make a list of questions and concerns, and put them in order of priority so the most important ones are dealt with. If time is short, ask if you can set up a phone call or e-mail communication for those that remain. Bring paper and pen to write down what the doctor says or ask in advance if you may record the doctor's comments to be sure you heard them correctly.
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