In my last column, I wrote of the importance of a shared agenda when you meet with your doctor, and the importance of bringing forth all the items on your agenda - your list - when you book the appointment and clarifying this with your doctor's staff in the examination room before you see the doctor.
Once you meet with your doctor, how do you negotiate the agenda?
In every human encounter - between parent and child, boyfriend and girlfriend, best bud-dies, and strangers, there may be shared and differing priorities.
For your medical visits, however, your well-being is the primary concern of both parties. Your doctor may have some other peripheral priorities - his duty to protect and help others, another sicker patient who requires urgent care, the pressure to stay on time and please many people.
It is unlikely that your doctor's more pressing priorities are a golf date or the hockey score. Most doctors put their patients needs ahead of their own and often ahead of their own families and partners.
In fact, I have often heard colleagues complain that they were so busy in the clinic or attending to hospital patients that they had "no time to pee" or stop for lunch or dinner.
Ironically, the most common conflict in patient-doctor encounters is their different approaches to the patient's health concerns. In every conversation, there are two voices. At your visit with the doctor, there is your voice - the voice of the patient: a human being who has not only one or more medical concerns but also your own ideas, feelings, fears and expectations about those problems, how they affect the rest of your life and how they should be managed.
The other voice of course is that of the physician. We tend to be focused on problem solving.
While you are talking, through the doctor's head runs a background program that is working through that diagnostic process - looking for pat-terns in the presentation of your symptoms and working from many possible diagnoses (the differential diagnosis) to the right diagnosis.
You may have heard your computer revving high, consuming RAM while it is working on some tasks in the background while you answer your emails or surf the net.
A similar process occupies a large part of your doctor's brain while the two of you are conversing. That's why at some point - sometimes it may seem too early in your meeting - your doctor will start interrupting you with focused questioning in our typical clinical style.
These are the diagnostic questions we learned well in medical school and refined through countless patient encounters.
At this moment, the doctor is consumed by the hunt to get to the diagnosis as quickly as possible. We can be thrown off the scent by the interruption of multiple unrelated problems you might bring up. Our hard drives may freeze up like your computer when you open too many windows.
To prevent this brain freeze or to keep your doctor on task - your task, it may be helpful for both patient and doctor to be upfront in setting the agenda and approach to each visit up front, right at the beginning of the appointment.
Next: understanding the structure of every medical visit.
Do you have some suggestions for how patients and doctors communicate? Send your comments and suggestions to me at face book.com/davidicus.wong or leave a comment on my website at davidicuswong. wordpress.com.
Dr. Davidicus Wong is a family physician. His Healthwise column appears regularly in this paper. You can find his Positive Potential Medicine podcasts at wgrnradio.com.
