Friday, September 19, 2008

How to talk to your Doctor about symptoms.

A few years ago, a 58-year-old social worker slated for elective surgery came to see me for a routine preoperative consultation. He had been having severe neck pain for some time. Two orthopedists had recommended surgery to correct a slipped disk.
I questioned him about his symptoms. He had said that the pain, which radiated from his lower neck to his left shoulder and arm, came and went and wasn’t linked to any sort of neck movement. Even more telling, his symptoms occurred only during the daytime, when he was most active. Since he did not think it was relevant, he hadn’t told the orthopedist. I sent him for treadmill stress test. Sure enough, the test triggered the pain showed that his symptoms were caused by coronary heart disease. He had his operation, all right-but it was angioplasty, not neck surgery.

HELP your Doctor
Most of the time, a complete medical history can lead to an accurate diagnosis-even without a physical exam. But a lot rides on your ability to communicate your complaints to your doctor thoroughly and clearly. Here’s how.
• Make a list and check it twice:
Bringing a list of concerns to each office visit can be especially helpful when it comes to describing symptoms. So start preparing your list a few days in advance, if you can. Don’t make the list too long; you don’t want to put off your doctor with a three-page laundry list. But do be thorough. Omitting potentially important details or even jumbling the order in which your symptoms developed can lead to the wrong diagnosis – which, in turn, could lead to unnecessary testing or inappropriate treatment.
• Speak up:
Since doctors tend to narrow their diagnostic choices very early into the office visit, you need to make your concerns known at the outset, before your doctor jumps conclusions.
• Get Specific:
When describing symptoms, use the most descriptive terms you can. Think of analogies. For instance, don’t just speak of “pain.” Is it dull and aching, as from a toothache; burning, as from heartburn; stinging as from an insect bite; piercing or sharp, as from a knife cut; or pressing, as if someone was sitting on your chest? Does it spread it into nearby area? How often does it occur? How long does it last? Is it affected by position, exercise, sexual activity, emotional upset? What makes it better or worse?

• Don’t minimize your symptoms:
Remarks like “it’s probably just gas” might lead your doctor to the same conclusion. Moreover, minimizing symptom is often a cover-up for the fear that something is seriously wrong. If you worry that your “gas” might signal abdominal cancer, say so. A few reassuring words or an appropriate test could put your mind at ease.
• Seek reassurance:
The week after comedian Gilda Radner died of ovarian cancer, I saw several women with lower abdominal complaints who wanted their ovaries checked. That’s not unusual; symptoms often stem from fear of a disease that case, a celebrity. But even if you suspect that’s the cause of your symptoms, you should still take it over with your doctor, if only for reassurance.
• Tell all to someone:
Sometimes one minor symptom triggers a cascade of others that can obscure the initial problem. I recall one women whose lightheadedness, sweating and diarrhea led myriad tests and ultimately to a psychiatrist. Careful questioning finally revealed that the entire alarming sequence was kicked off by a “skipped” heartbeat or two. Once that irregular beat was determined to be harmless, the women’s symptoms, caused by anxiety, promptly disappeared. Occasionally, several symptoms from a syndrome-a constellation of symptoms that point to single underlying problem –and the forest may be missed for the trees. I remember one woman who had a high blood pressure treated by a cardiologist, her backache by an orthopedist, diabetes by an internist, and thin skin by a dermatologist. It turned out that every problem stemmed from an uncommon disorder called Cushing’s syndrome, caused by a benign adrenal-gland tumor. That potentially fatal disease had gone undiagnosed-and untreated-for nearly five years because she had not discussed all of her symptoms thoroughly with one doctor.

• HELP yourself:
For many people, notion of modern medical diagnosis probably conjures up images of assorted high-tech tools, including sophisticated tests, computer analysis, and scanning equipment. To be sure, all those things can play an important role. But today as always, nothing is more important than the patient’s own report of symptoms-and the doctor’s analysis. When you make the most of your half of the equation, your doctor stands the best chance of solving your problems.

Source: Consumer Reports – The Best of Health.
Author: Marvin M. Lipman, M.D. and the Editors of Consumer
Reports on Health

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