Communicating with your Doctor

A beginner’s guide to understanding medical terminology, Jim Sliney Jr, November 2015

I have spent almost 25 years working in medicine as a Medical Assistant. I’ve worked in several different departments, doing both clinical and research work. Thousands of patients and hundreds of healthcare workers later, I have learned some important lessons. Take those lessons and add what I’ve learned as a patient and I come away with what I hope is a bit of wisdom.

The most important element of healthcare is COMMUNICATION.

STEVE: “Doctor Jones I have pain in my stomach, help me”.

DR BOB: “Where is it precisely?”

STEVE: “It’s kind of just below my belly button, but in the back, like over here <waive your hand over your back>”

DR BOB: “What kind of pain is it?”

STEVE: “uh…I don’t know…it hurts!”

DR BOB: “Hurts like what?”

STEVE: “uh…I don’t know…kind of like a bruise. And I have high blood pressure and I think when my pressure is really high its worse”.

DR BOB: “And how long has it been going on?”

STEVE: “Well it first started when I was twelve but by the time I was thirty five it was gone and then when I was thirty eight it came back and now that I’m fifty seven it’s really bad”.

DR BOB: “So, this isn’t a new problem?”

STEVE: “No, it is, because I have blood in my pee now and the way it feels now is worse than….”

DR BOB: “LET’S just get you on the table.”

This is inefficient communication to say the least. Let’s break this down and see what could have been done better.

ONE: Why are you going to the doctor? The CHIEF COMPLAINT

When you go to the doctor the doctor is expecting you to PRESENT with a CHIEF COMPLAINT. You can have ten complaints but your doctor is always going to focus on your chief one.

Some Chief Complaints:

  • I think I have a fever
  • I have a nail stick in my head and it hurts
  • I am nearly out of my prescription, I need a refill please
  • I haven’t been sleeping well

What do these have in common? They are medical problems that require solutions. But problems aren’t always easily understood, so, kind of like a medical detective a doctor must INVESTIGATE the nature of the problem. Dr. Bob asks Steve some questions to try to get more information but Steve’s answers aren’t very precise.

TWO: What do you have to say about your Chief Complaint?

Doctors need specifics. A pain on the right side of your abdomen that is sharp points at a whole different problem than a pain on your left side that is dull.

When asked where it was, Steve could have:

  • Put his hand where the pain was concentrated
  • Used terms of orientation
TERMS OF ORIENTATION (see neighboring graphic)

Article graphic

 

Term Definition
Distal situated farthest from the body part
Lateral towards the sides, away from the middle (or midline)
Medial towards the middle (or midline)
proximal situated nearest to the body part
Anterior the front
posterior the back
superior above a thing
Inferior below a thing
Prone face down on a horizontal plane
Supine face up on a horizontal plane
Deep away from the exterior surface, further into the body
superficial on the surface, or shallow
Vertical up and down
horizontal like the horizon, side to side

So it seemed like when Steve said “in my stomach” and “just below my belly button, but in the back” was confusing things. If he said, “In the posterior hypogastric region and deep” and not make reference to his “stomach” which isn’t where Steve’s pain is.

Article 2

When Dr. Bob asked about Steve’s pain, Steve could have chosen from some better terms:

Aching Heaviness Piercing Sore Throbbing
Burning Icy coldness Pounding Stabbing Tightness
Crawling Intermittent Pressure Tearing Tingling
Crushing Numbing Sharp Tenderness

An intermittent aching in the posterior hypogastric region. We’ve got some good information there. With it Dr. Bob can rule out all kinds of issues and narrow down the source of the problem significantly.

THREE: Duration – “how long has this been going on?”

It has either been

  • CHRONIC – persisting for a long time
  • ACUTE – having severe symptoms and a short course, or
  • INTERMITTENT – marked by alternating periods of activity and inactivity

Steve could say “this is a chronic pain, I’ve had it intermittently since I was twelve years old, but now the pain is acutely different than it has been in the past”. This tells Dr. Bob a lot. It’s not new, it’s been around, but it has changed.

This could be a very good time to share other characteristics like

  • It only bothers me when laying down or
  • It’s worse after dinner or
  • It wakes me up in the middle of the night

Those are also important clues for your detective-doctor!

If you can communicate with your doctor in the language he/she has been trained to think in, you may have more successful communication. Successful communication can save time, frustration, money, and misery. It may require some preparation on your part, but it pays off.  Good luck and be well. – Jim

I intend to write further installments of “Communicating with your doctor” so if you have specific terms you would like to have explained please feel free to email me at slineyj@g-pact.org

References:

Definitions were pulled from the following sources:

https://www.nlm.nih.gov/medlineplus/mplusdictionary.html (uses http://www.merriam-webster.com/)

http://medical-dictionary.thefreedictionary.com/ (make sure you are on the Medical Dictionary tab)

http://apma.gostart.com.au/descriptors

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