Deeper Dialogues

What do you need to say?

Skip to main content
What to say

Hard times

Your own doctor's appointment, and getting what you need from it

You've got something worrying to raise, maybe a question you've been putting off for weeks, and a doctor with fifteen minutes and a waiting room. You want to leave knowing what they think, what the options are and what happens next, not remembering your real question in the car park. This is about the conversation, not about what might be wrong with you.

What they need from you, and why

The doctor has fifteen minutes and a waiting room, and the research on what happens next is unusually precise. In 1999 Kim Marvel, Ronald Epstein, Kristine Flowers and Howard Beckman found that family doctors redirected the patient's opening statement after 23 seconds on average, while patients who were allowed to finish took only about six seconds longer. Twenty years on, Naykky Singh Ospina, Victor Montori and colleagues (2019) analysed 112 recorded consultations: in only 36 per cent did the clinician ask what the patient had come about at all, and when they did, two-thirds of patients were interrupted, after a median of 11 seconds. The finding is not that doctors are rude. It's that the opening of a consultation is where your agenda is most likely to be lost, and it's the part you can prepare for.

What the doctor needs from you is the list in your first sentence, the story in the order a doctor needs (what it is, when it started, what makes it better or worse, what you've tried), the thing you're afraid it is, and what you want from today. Jocelyn White, Wendy Levinson and Debra Roter (1994) found that in 21 per cent of consultations the patient raised a new problem just as the visit was ending, often the one they were most worried about and least able to say. The authors wanted doctors to ask early. You can do it for them.

Two more findings shape the rest. Roy Kessels (2003) reported that 40 to 80 per cent of the medical information given in a consultation is forgotten immediately, that the more that's said the less is retained, and that anxiety makes it worse; written information was remembered better. And when Heather Shepherd, Alexandra Barratt, Lyndal Trevena and colleagues (2011) sent actors posing as patients into Sydney family practices, the ones who asked three questions (what are my options, what are the benefits and harms, how likely are they) were given considerably more information about the evidence, and the doctors did more to involve them in the decision. Jennifer Wolff and Debra Roter (2011) pooled 13 studies and found that bringing someone made visits longer and doctors gave more medical information, and none of the five studies that measured outcomes found it made things worse. Health systems differ across the countries this app serves, in how long an appointment is, what it costs, whether you need a referral and how you get a second opinion, but what you can do inside the consultation is much the same everywhere.

Understand it properly

First

Before you go, write down the three things you want from the appointment, in order, with the one you're most afraid to ask at the top, and decide whether you want someone with you.

You could say

  • I've got three things today. The main one is [the chest pain], and I also want to talk about [my sleep] and get the referral sorted. Can we get to all three, or should I book again?

    Your agenda is most at risk in the first seconds of the consultation, so the first sentence is where it goes.

  • Before we start, there's something I've been putting off asking about, and I'd like to get to it today.

    It is the "oh, by the way" question, moved from the last minute of the visit to the first, where there's time for it.

  • What I'm really afraid of is that this is [my heart].

    Doctors can't address a fear you haven't named, and saying it changes what they look for and what they tell you.

  • What I'd like to leave with today is a plan for what we do if this doesn't settle.

    Doctors are good at answering the question that's asked and poor at guessing the one that isn't.

  • What are my options, including doing nothing for now? What are the possible benefits and harms of each, and how likely are they?

    These are the three questions the Sydney study tested: short, polite, and hard to answer with a script.

  • So, to check I've got this: you think it's probably X, the tablets are for Y, and I come back if Z. Is that right?

    Most of what's said in a consultation is forgotten; saying it back and letting the doctor correct you is the simplest fix.

If it goes badly

Three ways this can turn. Read the one that happens; the others can wait.

You've said something like

I've got three things today. The main one is [the chest pain], and I also want to talk about [my sleep] and get the referral sorted. Can we get to all three, or should I book again?

  • If they cut you off before you've said the part that matters

    Can I just finish the bit about when it happens? I think it matters.

    The research found doctors redirect patients within seconds and that letting them finish costs very little time; a kind "can I finish" is all it needs.

  • If they wave your worry away as probably nothing

    I understand you think it's probably nothing. Can you tell me what would make you want to look further? And I'd like it noted in my record, so if it comes back we've got a starting point.

    You don't have to be rude to refuse to be dismissed; asking what would change their mind, and getting it on the record, keeps the door open for next time. If you're still not heard, "I'd like a second opinion. How does that work here?" is a fair question in every system, even though the answer differs.

  • If they use words you don't follow, or tell you to choose and you can't

    Can you say that in plain words and write the name of it down for me? And I'd find it easier if you told me what you'd recommend and why.

    Written information is remembered better and followed more closely, and sharing a decision includes the right to ask for a recommendation.

Share these words

Send them to yourself, or to someone helping you.

Try not to say

  • Saving the thing you're most worried about for the door

    In about one in five consultations a new problem comes up as the visit ends, and it's often the one the patient most needed to raise. Ask it first.

  • "It's probably nothing, but..."

    It invites the doctor to agree with you. Say what you're afraid it is, so they can look for that and tell you why it does or doesn't fit.

  • Letting the interruption stand

    Patients who finish their opening statement take only seconds longer than those who are cut off. If the part that matters was lost, say so, kindly.

  • Nodding along to words you don't understand

    Anxiety and a lot of information make a consultation a poor place to store anything. Ask for the name written down, or for a leaflet or a site they trust.

  • Walking out without knowing the next step

    When the results will be in, who calls whom, what should bring you back sooner and who to call after hours are questions for before you stand up, not the car park.

Afterwards

Write down what you were told while it's fresh, or ask whoever came with you to read their notes back to you; their job was to hold the list, take notes and ask the one question you forgot. Make sure you know when the results will be in, whether someone calls you or you call them, and what should make you come back sooner. If you left feeling your concern was waved away, you don't have to accept it: ask what would make them look further, ask for it noted, and ask how a second opinion works where you are, because the answer differs by system (a new referral, a different practice, a specialist). If you're regularly not heard, change doctors where you can. In some systems that's a phone call; in others it takes more work, and it's still worth doing.

Understand it properly

The words above come from these. A section is about ten minutes; the whole module is there when you have longer.

Where this comes from
  • Deeper Dialogues, Illness & Health Challenges, "Your Own Appointment": the AGENDA appointment, interruption (Marvel et al., 1999; Singh Ospina et al., 2019), the by-the-way problem (White, Levinson & Roter, 1994), recall (Kessels, 2003), the three questions (Shepherd et al., 2011) and bringing someone (Wolff & Roter, 2011)

We gather and pass on what researchers and support organisations have found. This isn't a replacement for a doctor, counsellor or support service.