AAARGGH! My OB/GYN Did Not Listen To Me!

 Last year, I had the opportunity to speak at the Minority Health Coalition Women’s Conference.  This is a conference held in Elkhart, Indiana annually focused on women of color and their health issues.  In addition to speaking about breast and cervical cancer, I also discussed how to communicate with your OB/GYN efficiently and effectively.  I thought I would share this with you.

Have you ever left your OB/GYN’s office thinking any of the following questions: “What just happened?”  or “Why was he or she asking me questions about ‘A’ and I really came to discuss ‘B’," or “I didn’t even get to discuss what I really wanted to talk about!”  Well, this is a sign of a frustrated patient and a busy doctor.

You see, most people immediately think about delivering babies when you think about an OB/GYN.  This is correct.  Obstetrics is a very rewarding aspect of our specialty.  However, one should also understand that OB/GYN is a surgical specialty.  When a patient presents to the office with a problem, we are immediately trying to quickly determine at least 5 things:

1. What is the problem?
2. Is surgery needed to clarify the problem?
3. Is the problem urgent or emergent?
4. Can the problem be managed medically?
5. Should the problem be managed surgically?

A patient may have approximately 15-20 minutes to explain the reason for the visit, obtain an exam and discuss the plan with the OB/GYN.  Women often have a certain way of explaining a problem.  In my experience, I have found that this usually involves a storytelling approach with vivid details in order to paint a picture for the physician.  Although effective in conveying the message, this approach can be time consuming.

In order to make the most of your time with your OB/GYN and reduce the potential for frustration, I would like to suggest that you consider the following approach:

1. Be on time. 

Okay, you may think “LOL” with this suggestion (text abbreviation for “laugh out loud”).  It is very possible that you may have to wait 20 minutes or even an hour for your OB/GYN.  Depending on the structure of your OB/GYN’s practice, he or she may have to interrupt office hours to deliver a baby.  We all know that babies do not wait on anyone.  The other possibility is that a routine appointment for an earlier patient became an emergent appointment; thus, putting your doctor behind in her schedule.

Let’s assume that your doctor is rarely running behind schedule.  If you are on time, it ensures that you will receive as much time as possible to explain your concern.  Your doctor will not be rushed and can take the time to listen.

2. Organize your thoughts prior to your visit and make a list of your concerns in order of priority that you would like them addressed. 

I wish I had an hour with each patient.  There is something about performing a gynecologic exam that makes many patients embarrassed.  It is important for patients to feel comfortable with their doctor and to have a certain rapport.  Unfortunately, like most OB/GYNs, I do not have an hour.  The patient that gets the most accomplished is the one that comes to the appointment organized.  The patient must have a clear understanding of what she wants to discuss in order of importance with the understanding that your OB/GYN may need to modify the priority of the concerns based on the severity or impending harm if not addressed sooner than later.  The patient also should understand that not all issues may be addressed on that day.  Also, if there is a background to the problem, such as many years of going to different doctors, this information should be organized in a concise format.

3. When asked a question try to limit extraneous information, try to answer the question directly and concisely. 

As previously stated, OB/GYNs are trying to determine if a patient’s concern is urgent or emergent and whether it can be managed medically or surgically.  Sometimes this calls for very specific, directed questions.  We are often looking for key words or phrases that will help us to determine our next step in management.  Extraneous information can muddle the picture and also make it difficult to determine the issue that may need to be addressed. 

4. Bring a notebook to your appointment. 

Sometimes, when I am explaining a plan to a patient, I see her head nodding and I am certain that she understands but then later I discover that she has forgotten all of the wonderful details I discussed.  Bringing a notebook and taking notes will transform you from a passive listener to an active listener.  It also will serve to keep a record of the visit in terms that you can understand because you wrote them.  You can also use your notes to read back to your physician to be more certain that you understood the plan.

5. Bring a current list of medications, most recent procedures, surgeries and vaccinations with dates. 

One of the most frustrating responses a physician can hear is: Isn’t that in my chart? or It should be in my chart?  It’s true that the current information should be in your chart, but it is the physician’s responsibility to be certain that the information that she is using that day to make decisions is the most up-to-date information.  The beauty of the electronic health record is that it allows a physician to have a host of information at his or her fingertips, quickly and in an organized format.  Paper charts are not so easily navigated.  Also, how many times have you been to the doctor’s office and you provided a list of your surgeries? Then, on your way home, you remembered two other surgeries.  It is prudent to reconfirm information at each visit and/or give a patient an opportunity to add new information.  This will only serve to help the OB/GYN make an efficient but appropriate decision.

6. Bring a current list of other physicians that you see including their full names, addresses, work phone numbers and fax numbers. 

As patients get older, they tend to have more doctors.  As patients develop more medical problems, they tend to have more doctors.  For example, the 55 year old patient with diabetes, HTN, epilepsy (seizure disorder) and depression may have a primary care physician, endocrinologist, neurologist and psychiatrist.  It is critical that your OB/GYN is aware of your other health care providers and which aspects of your care they are managing.  It is also helpful to have their contact information so that phone calls can easily be made or faxes sent.

7. If you are requested to make an appointment to discuss results of a biopsy or a surgery, bring someone with you.  This person should be someone you trust and that knows you well.  They can help you remember what was said and ask questions that you may not be thinking about.

I hope these tips are helpful to you.  Feel free to give me some feedback as to how you communicate with your doctor.   What does your doctor do well?  What do wish your doctor would do?  Ultimately, be assured that we both have the same goal of solving the medical mystery and improving your quality of life.