What Doctors Wish They Could Tell You
Ever wonder what your doctor is really thinking as he or she listens to your story?

BY CLAUDIA CORNWALL

A doctor’s time has always been a precious resource, so we need to make every minute count. But do we? To find out, we interviewed doctors and compiled a list of their concerns. We then commissioned MD Analytics, a market-research company, to conduct a nationwide survey for Reader’s Digest, asking Canada’s doctors to give vent to their feelings and tell us what they’d really like to say to patients. Here are the results:

96% of GPs wish they could say: “Be honest. If you’re not taking your medication as prescribed, tell me.”

Patients not taking their prescriptions? “It happens all the time,” says Dr. Armstrong Mettle of Saskatoon. Studies show that in Canada, 20 percent of prescriptions are never filled, and half of those that are filled are taken incorrectly. This frustrates Dr. Vivian Chow, a Toronto physician who treats a lot of people with depression.

“It takes about four to six weeks for antidepressants to work,” she says. “Sometimes patients don’t give them a chance.”

Dr. Steve Chambers, a family physician and past president of the Alberta Medical Association, says: “Patients are sometimes afraid to tell doctors they have decided to follow another course of treatment or aren’t taking a prescription. They might have had a side effect and decided to go off it and don’t want to hurt my feelings by telling me so.”

Best practice: Tell your doctor what you’re doing. “To make sound decisions,” says Chambers, “the doctor needs as much information as you can provide.”

94% of GPs wish they could say, “If you’re going to be late or miss an appointment, let my office staff know.” GPs told us they hate waiting for patients as much as patients hate waiting for them. “If you come in late, I’ll have less time for you, and chances are everybody after you will also have less time,” says Dr. Sue Harris, head of family practice at the Children and Women’s Health Centre of British Columbia, in Vancouver. It’s even more difficult when patients miss an appointment altogether. One exasperated GP says: “After three no-shows, why shouldn’t I send you a bill? The dentist or the lawyer likely would have after the first time.” Best practice: Patients who can’t come in should cancel as early as possible.

94% of GPs wish they could say, “If you’re taking herbal supplements or over-the-counter drugs, or using alternative therapies, let me know.”

An Angus Reid poll in 2000 found that more than two thirds of Canadians take some form of nutritional supplement, including herbal products. “There is a public mind-set that if you’re taking a herbal preparation, it’s not an active pharmacological preparation,” says Dr. Mohamed Ravalia of Twillingate, Nfld. “So if you take a drug history and you don’t specifically allude to over-the-counter or herbal preparations, oftentimes the patient won’t volunteer it.”

A major concern has been with patients with hypertension who have taken ephe-dra-derived products, which, according to Health Canada, have caused more than 60 adverse events nationally, including strokes, heart attacks and even deaths. These products claim to help you lose weight, feel stronger and more energized.

Recently, several communities had outbreaks of uncontrolled high blood pressure. Doctors discovered that a large number of patients were taking ephedra-derived supplements. They concluded that this must have been interfering with their medical condition.

Best practice: “If you’re taking alternative or complementary therapies, it’s important for your doctor to know that,” advises Chambers.

88% of GPs wish they could say, “Tell me what you’re worried about right away, not when you’re leaving.”

“You spend time with a patient on an ingrown toenail when the real problem is chest pain,” says Dr. Sharon Salloum, a family doctor and the director of clinical skills for first-year medicine at the University of British Columbia. She understands why people often leave the worst for last: They’re nervous, apprehensive. “But if you’ve got something that’s really bugging you, get it out there [first] because it deserves the time.”

Doctors in our survey were divided about what to do when patients have several complaints. Salloum likes to hear the whole list and then prioritize: “We decide what we’re going to deal with today—typically the life-threatening one or the complicated one.” But another GP says, “One problem at a time!”

Best practice: Ask your doctor how he likes to work. If you bring in a list of problems, don’t expect your GP to deal with all of them in one visit.

80% of GPs wish they could say, “When you come to see me, be clear in your mind about your symptoms: when they started, how bad they are, how often they occur.”

“I’m not a mind reader,” says one doctor. “Playing ‘stump the doctor’ is a waste of everyone’s time and is bad medicine for you.” Salloum suggests patients try to sort out the chronology of an illness before they come in. “When do you think it started? Is it getting better or worse? What makes it better? What makes it worse? Where is the pain? Does it radiate?”

Best practice: Be direct, concise, accurate—and prepared.

80% of GPs wish they could say: “Don’t expect me to renew a prescription over the phone. There may be a reason why I need to see you again.”

One doctor was blunt, saying, “I don’t get paid to provide telephone service.” Other GPs stressed the importance of a follow-up appointment to make sure a medication is working correctly. “A lot of patients say, ‘I feel fine, I don’t see why I should spend the time and effort to see the doctor just to get a prescription,’” says Dr. Jay Danforth of Edmonton. “But it’s not just to renew the prescription. It may just be five minutes to say, ‘Are you feeling okay?’ Or we’ll check your blood pressure if that’s what the problem is. We have to look at patients, how they walk in, the state they’re in and so on. There’s a lot more to an office interview than asking questions and receiving answers. You assess how they’re dressed, how they’re behaving. You do that instinctively. Patients don’t see that.”

Best practice: Make sure you understand how many times you can repeat the medication, and be understanding when your doctor won’t fill a prescription over the phone.

66% of GPs wish they could say, “Don’t expect me to read dozens of articles you’ve downloaded from the Internet.”

A 2002 study led by Joshua Fogel at the Queen Elizabeth II Health Sciences Centre in Halifax found that almost 42 percent of breast-cancer patients used the Internet as a source of medical information. But many doctors advise caution. “The Internet has more disinformation than information,” warns Danforth. “We had a pilot who argued with us over the fact that we wouldn’t let him fly and who proceeded to bombard us with 1,500 pages of information he had downloaded from the Internet. Not one of the pages had solid scientific information based on peer-reviewed studies—but it did support his position.”

Best practice: Ask your physician to recommend some reliable sites. “If you want to know about diabetes, go to the Canadian Diabetes Association web site,” says Danforth. “The Heart and Stroke Foundation of Canada will tell you all about heart disease. Those kinds of web sites are useful.”

What would you like doctors to know? What would you like to say to them?

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