The typical medical visit appears to be carefully formatted; it begins with the patient’s “chief complaint,” and usually ends with a prescription or other treatment plan. But in between the start and finish is where the art of medicine often takes place.
I encourage my patients to share their secrets, and I do my best to present myself as a trustworthy and kind recipient of those secrets. Rapport and sincerity go a long way for a doctor during a patient’s visit. Though I am an internist, many of the complaints I receive may be linked more to depression or anxiety than to strictly physical diagnoses. It is important that I am receptive - that I am carefully listening for these complaints. A 2001 study published in The Journal of Family Practice found that a diagnosis of depression is 65 percent more likely to be made by a family practitioner rather than an internist such as myself.
On the other hand, it is also important for me to realize that some of the secrets that patients may be hiding may lead me to a deeper and more comprehensive understanding of their physical problems. The more I know, the more I can offer them. A patient with a significant alcohol history is someone who may be damaging his or her liver, brain and heart. A smoker is putting practically every organ of the body on the line, especially their lungs and heart. These are not habits to downplay or underestimate if a patient wants me to really help.
I also must dig for problems with their job and their relationships. An affair or recent job loss may be the reason that a patient isn’t sleeping well or is feeling anxious. I need to know about these events because they directly impact a patient’s health. A Consumer Union survey discovered that 28 percent of people who were having job trouble were having trouble remembering to take their medications or to have them filled.
I also need to ask about sex drive and sexual function. The answers I get may be connected to the medications a patient is taking, or underlying common conditions such as diabetes, hormonal problems or depression.
All over-the-counter medications and supplements are fair game for a visit with your internist. Drug interactions or side effects of non-prescription supplements may greatly affect a patient’s health. I need to know about everything a patient is taking, not just the prescription drugs I, and other doctors, prescribe.
If a patient is becoming forgetful, it is important that I know about that as well. It isn’t always dementia I’m on the lookout for; it may be stress, thyroid disease, medications, or even small brain strokes.
Finally, I need to know if a patient is seeing another doctor for a second opinion. I promise not to take it personally, but it will impact the treatment I give. Too much duplication will interfere with good health care.
So don’t be afraid to let it all out. The more secrets you share with me, the more I can help you.
Marc Siegel MD is an associate professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is a member of the Fox News Medical A Team and author of The Inner Pulse: Unlocking the Secret Code of Sickness and Health.