Getting the most out of a doctor’s visit, especially for chronic, unexplained illness

Updated January 18, 2017

After a dozen years and scores of doctor’s appointments to investigate various angles of my health annoyances, I have discovered that the majority of doctors will do the same time-wasting things over and over. This is especially maddening when I am dealing with a complementary/alternative medicine (CAM) practitioner not covered by my insurance. Here is a list of suggestions for dealing with this.

I suggest you treat appointments like you’re running a business meeting with the head of another department you know nothing about for a project you’ll both be working on. You have no reason to be embarrassed by the fact that you don’t know a great deal about his subject, and the other person has no reason to be surprised if you do not. You both have certain things you need to impart and learn in a very short time and your time — yours more than his — is very valuable. You won’t be shy about talking about costs, since the usual social inhibitions against discussing money do not apply when it comes to a businessperson protecting her operating budget.

Which isn’t to say that the doctor in question will play along with this approach. I have yet to be disabused of the notion that the majority of doctors become doctors because they want to be right, not because they want to help people. They’ve been taught their entire educational and professional careers that they hold an unusual, coveted body of knowledge, that they are members of one of the most intelligent strata of society, and that patients need to be protected from their ignorance — we’d gnaw off our own fingers if band-aids hadn’t been invented.

None of these are true anymore. So:

1. Don’t worry about being polite, being liked, or being agreeable.

2. Have an “elevator speech” ready (as they say in career advice circles) of what you hope to accomplish in the meeting, and a brief rundown of your history. When he asks what you’re there for, start the speech and do not let him interrupt you. Keep it short, though. Figure out beforehand what the salient points are.

3. Interrupt him if he’s talking too much on a tangent.

4. Don’t take hemming-and-hawing as no. Doctors are often ambivalent about ordering non-standard tests, for example, but if you state simply and repeatedly that that is what you want, they’ll usually cooperate. They have rarely refused me and will usually do what they can to find the appropriate insurance code for coverage, if it is possible. (Ms. West mentions this as well.)

5. Watch out for the following tricks used to stop you from asking questions or to deal with the doctor’s discomfort at what Dr. Marie Savard refers to as the “new paradigm of a partnership with you” that you are forcing on him. Don’t be sidetracked. Yank the conversation back. Ignore him and continue your questions, or repeat that you are there to get information.

  • Over-explaining. A favorite tactic is drawing diagrams of molecular chemical reactions.
  • Sharing his theories about the causes of obesity or autism or another topic unrelated to your health issue
  • Telling a joke
  • Complimenting you on your intelligence, etc.
  • Laughing at your ideas

6. Manage your expectations.

  • Don’t expect him to be interested or impressed by anything you’ve done.
  • Don’t expect him to express sympathy.
  • Don’t be surprised if he expresses disapproval at something else you’re trying on your own or with another practitioner. If you are not there for feedback, ignore him, interrupt him and continue questioning. Remember, doctors are a lot like cats: they don’t like doing things that aren’t their idea.

7. Ask him to prioritize for cost purposes whatever treatment suggestions he offers. I’ve never met anyone who was unsympathetic or uncooperative on this point.

8. If he wants to run tests, ask him if any of them can be avoided. Also ask if any can give false positives based on supplements you take. For example, getting a vitamin B12 test if you’re taking B12 supplements is pointless. If you had a recent physical with your regular, traditional doctor, ask if any of those results can be used.

In all these years I’ve been pleasantly surprised by a compassionate, interested practitioner maybe three times. The healthcare system is flawed and broken and unwieldy and pretending it isn’t is just another way to waste your energy.

The awesome Monica Cassani of the blog Beyond Meds has a post on this subject, emphasizing the dangers of being an obedient patient.

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