Survival Guide
Here are some basics taken from the book to get you started.
"Go To Health" is organized so as to have you familiar with what's really going on and then take charge of your own fate in the health care system.
Chapter 1 "Why Dr. Johnny Can't Speak"
There are real reasons doctors may come to communicate the way they do. That doesn't mean it needs to be this way. The basic guideline to use until you gain specific insight from the book is to remind yourself that there are real reasons. The last thing you want to do is take an adversarial stance. Once you get angry or stubborn or place blame and accusations, all you have done is legitimized some of the reasons and reinforced the wall between you and this doctor.
Doctors (and patients) are not always aware of how poorly they may be communicating. Understanding why and how this comes to be is the first step. For a patient dealing with a doctor who may not be so enlightened, the key to getting around this blockage is to get into the doctor's head. Above all I need you to realize that doctors are normal people in a special situation. Most people would behave the same way. How would someone get you to open up if you were resisting for these same reasons?
Chapter 2: "Things That Make You Go Hmmm"
Let us consider the ways of patients. Most normal people do some things that can quiet a doctor, or even have him/her go into a shell. Some of these behaviors are okay in other situations, so we fail to realize how they hurt us in the doctor's office. Others might be on the rude or annoying side anywhere. The problem is, doctors often keep up such a professional facade that they fail to give the normal feedback that keeps things in check.
For example, we all tend to over-talk each other, but our friends let us know when we are interrupting a bit too much. Doctors may not. If a doctor is interrupted once or twice, he/she may give up and turn the floor over. This is often done automatically and even the doctor may not realize that he/she has "tuned you out."
I advise reading this chapter many times, it is harder to stop doing things that backfire than it is to start doing things that help. You must be aware enough to be able to watch yourself if the doctor isn't giving feedback. If you suddenly think the doctor has switched from working with you as a person to mechanically handling you as a case, you will be able to check for what triggered this.
Chapter 3: "My Doctor Came From Mercury"
Once you have read the first chapter you will have some understanding of why doctors develop a style over time. It's time to examine their situation in the here and now. People are astounded by what it's really like to be a doctor, it is far from the idea you probably get from TV. I want you to consider what your exam seems like from the other side in order to where your doctor is coming from.
Be ready for a shock, the big exam that means everything to you because you only have it once a year, if that often, is just one of dozens of similar experiences the doctor will have this day. Even your broken arm may be a routine, dull "break" in the day of a doctor who has to deal with some real, interesting problems.
One important point: Keep your goal in focus.
It is not about who is right, it is a relationship and problems are usually a failure to communicate, not a failure of either side to communicate. Even if something is the other guy's fault, that doesn't matter. Unless your goal is the thrill of a fight, pointing out blame is never the way to your goal.
Understanding what it is like from the other person's perspective helps you to be goal oriented and avoid confrontations. This is also why I advise doctors to avoid mentioning that they are doctors when they go in as patients. Doctors often have a very poor idea of what things are like for a patient, and the best way to find out is to do "undercover work," as a regular patient.
Chapter 4: "Why Do Bad People Happen To Good Things"
Let's face it, your doctor's professional persona has been molded to a great degree by the worst patients, the ones who give doctors nightmares. A very small percentage of patients have a huge affect on the way doctors act, and this gets worse if you do something that might make you seem like one of these people.
This was the chapter that kept me up nights. Would other doctors say they didn't have patients like these, or these things did not affect them? What has happened is that I get feedback from everyone except doctors about how shocking the behavior of these people are. It boggles their minds to hear that some people sacrifice their own health in order to go after other goals in these ways. As it turns out doctors hardly notice this chapter, it's just a ho-hum repetition of what they deal with everyday. Some have told me that they have benefited from becoming more aware of how dealing with these people affects the way they act with all patients.
Chapter 5: "Pandora's Box"
There are more than just the two sides in a relationship, the fact of a relationship brings its own little things into play. Many of them are "vicious cycles," things that make each other worse, like scratching and itching do to each other. Some are some realities of the system, others are simply realities of how all people behave. These can never be the doing of just one person or the other, but one person can take a step back, realize what's happening, and do what it takes to protect the relationship and the goal of good health.
This chapter contains the one part that I came close to cutting due to the difficulty of the explanation. Many things work best in written form, because readers can take it in at their own pace and think about things. However, some things need charts, and blackboards, and question and answer sessions and feedback. This chapter includes a discussion of the dynamic where a patient complains and complains and is not diagnosed, maybe until it's too late.
In the end I felt this was too important a question to ignore. No matter what checks and balances are put in to improve things, this is still going to happen. Why? The simple answer is that complaints must be filtered to keep the health care system from grinding to a halt, and there's no perfect way to do this. You are right to want want a better explanation before accepting it just because you see it here in writing. That better explanation will take some effort by both of us.
Throughout the book I emphasize that technical words are not necessary, and along with that I try to avoid anything complex, especially dreaded numbers. This question is one reason I can't say numbers are never necessary. A little math is required to get across the truth of the situation. Ahh well, if I can't clear it up with the written word there are always the seminars...
Chapter 6: "How To Talk To Doctors"
This is the main event for most people, the nuts and bolts. Actual things to do. And it all starts by remembering that it all starts before you are face to face with the doctor. You need to prepare for your exam instead of just showing up and trying to deal with a situation.
Part of the preparation involves picking the doctor. Remember, it's a relationship, you have to pick who you're having this relationship with... and sometimes you have to "dump" a doctor and find another one. Don't worry, you'll soon understand when this is the right thing to do.
Do not pressure yourself into trying to start doing everything at once. The fact is, trying to do too much will backfire anyway. It's a relationship, you have a long time to build it. The great thing is, once you have the right relationship with the right family doctor, he or she will be there to help with specialists and hospital doctors in an emergency. You may never know the half of it, but this doctor may be working behind the scenes on your behalf when you don't have the time to build a new relationship from scratch.
Chapter 7: "Suggestions for Doctors"
Over the past few years the health fields have begun to concede that there is a problem. Communication courses have been offered, but many doctors who have taken them as continuing education courses have found their value to be limited. The difference between these doctors and med students, who rate these courses a bit higher, seems to be that working doctors are more aware of the differences between their real world and the generic world approached by communication experts. Giving a communication course adapted to doctors by substituting the word "patient" for "client" or "student" or "friend" and words like "symptoms" for "needs" or "requirements" isn't enough. It's great to say a doctor should ask more questions in a certain kind of way, until you understand the real reasons they have come not to do so in the first place. All of the ideas put out for consideration in this chapter "deal with dealing" with the real world of health care.
Chapter 8: "Open Hailing Frequencies"
or "Why Humor"
It's time to allow the best medicine to be used in health care itself. It is the best way to build the relationship, a great aid to communication, it... oh, don't get me started.
Chapter 9: Story Time
A collection of anecdotes that illustrate some of the points covered, or just because we happen to like them