For some people, it’s hard to imagine what’s worse: suffering from hemorrhoids, incontinence, sexual dysfunction or depression—or sharing the news with a doctor.

Fortunately, communicating with one’s doctor doesn’t have to be a bitter pill to swallow. Both patients and physicians can take steps to bridge an otherwise uncomfortable dialogue.

"It’s not surprising that people are sometimes reluctant to share," said Dr. Matthew Brown, program director of the Advocate Christ Family Medicine residency in Oak Lawn. "As medical professionals we are permitted so much access to peoples’ personal lives, and yet we do not get to spend a lot of time getting to know patients during a typical 15- to 20-minute visit."

Too often patients reveal what really brought them in when the doctor is almost out the door. Reluctance to share touchy topics is so prevalent it’s been coined the "doorknob phenomenon." The problem is made worse by the need to change physicians for insurance or other purposes. "You can’t build that trust," said Brown.

A patient’s first stated complaint is not always the most important one, said Edward Krupat, director of evaluation in the office of educational development at Harvard Medical School in Boston. Many patients have to "warm up" before they reveal something intensely personal like erectile dysfunction.

But research shows that when doctors ask patients the reason for their visit, patients are most likely interrupted after 15 to 20 seconds, said Krupat. Doctors address a patient’s first concern, so other problems are brought up late in the visit or not at all.

Effective communication begins when you choose your doctor, said Margaret Fitzpatrick, a nurse at Advocate Christ Medical Center in Oak Lawn, who co-authored "What to Ask the Doc." "It’s a personal relationship, more involved than choosing your mechanic or plumber.

"The key is to think of it as a relationship. Am I uncomfortable with this person during a normal visit? Is there good chemistry? Do I leave feeling confused or anxious?" Patients should ask themselves these questions before they need medical treatment.

Arlene Hochwarter, 65, of Arlington Heights, recently saw her internist for a rash in a "private" area. Although they shared a longstanding relationship, she was embarrassed to show him the rash. "I said, `Can’t I just talk to you about it?’ " Hochwarter said. "We both laughed." As it turns out, she had been using baby wipes for cleansing since she kept them in the house for her grandchildren.

The doorknob phenomenon may not be intentional, said Dr. Bridgid Steele, medical director for primary care and women’s health services at Loyola University Medical Center in Maywood. Sometimes patients may not realize what their real issue is, such as depression, because they are focused on physical symptoms.

Doctors are trained to handle sensitive information, Steele continued. "We want to hear all of a patient’s concerns. We want to know what’s bothering them and to address it early in the visit. Doctors enter primary care because we care about patients and the whole spectrum of health and these are the kinds of issues we feel comfortable discussing."

Patients can break the ice by realizing their doctor cares about them and their health. "He or she is not judging you," said Brown. "Chances are, they’ve heard a problem like yours that same day."

Brown recommends that patients bring in a list of questions, prioritized in order of importance. "If you still feel uncomfortable, hand the list to the physician, or send it ahead of time in preparation for the visit."

Another way to make sure all questions are answered is to make follow-up appointments. "Fight your desire for a quick fix or answer," said Brown. "Your health is important and deserves time and consideration."

Patients can also request their doctor’s e-mail address, if he or she will provide it. "Some physicians prefer to communicate that way," said Brown.

Doctors can take the sting out a patient’s visit as well. "In training family medicine residents, we have a few tricks to build open and honest communication between patient and physician," said Brown.

One tool is to normalize a patient’s concern about an embarrassing concern through the phrasing of a question. "We might say, `Many of my patients have concerns about their sexual function. What concerns do you have?’ " said Brown.

Rather than say, "You don’t do drugs, right?" Brown would say, "Tell me some of your habits in terms of drinking, drugs and so forth." Patients learn the physician is open to the idea that people have unhealthy habits and he or she won’t be judged, he said.

Patients are often reluctant to bring up depression. "Depression is epidemic," said Brown. "We can normalize that by telling them that every day a family physician sees several patients with undiagnosed depression."

Steele elicits patients’ real concerns by asking open-ended questions, repeatedly asking `what else?’ and understanding that some symptoms may point to something the patient is not saying, she said.

Many patients bristle when the receptionist asks what the problem is before booking an appointment. Office staff could say, "In order to know how much time to schedule, can you tell me basically what this is about?" said Brown. Some office visits require more time for tests or research, so office staff needs to ask those questions, he said.

Harvard Medical School requires first-year students to take a course in basic interviewing, communication and relationship skills, said Krupat. Students are observed interacting with real patients and get feedback from faculty. At the end of the second year, students interact with actors posing as patients.

Such courses are increasingly common in medical schools since in June 2004 the national licensing exam for medical students began to require that every student be graded on his or her communication skills. "Schools have to adjust their educational curricula to make sure their students make the grade," said Krupat.

By Terri Yablonsky Stat
Special to the Tribune