Tips for your conversation with the doctor

How do I begin a conversation with the doctor – and what can I do as a patient to make sure I’m satisfied with how the conversation goes?

A good discussion with the doctor can significantly improve the prospects of treatment. It is therefore worthwhile for patients to prepare themselves

Surveys have shown that one in two patients leaves the consultation without knowing exactly what has just been discussed.

A conversation with a doctor often begins with a question like: "What brings you here today?” As the patient, it is now up to you to steer the dialogue in the desired direction. You shouldn’t wait until now to think about that you actually want to say; rather, you should have considered it in advance.

A patient’s demeanour and opening remarks provide the doctor with very important signals for the upcoming conversation. Does the patient come across as anxious and uncertain, as someone who tends to make light of symptoms, or someone who is unusually worried? Or does the patient seem like someone who has already self-diagnosed on the Internet with the help of “Dr Google”? An attentive and skilled doctor will address these aspects in the consultation. Please also read the text “What type of patient am I?”.

There is no “one size fits all” approach when it comes to conversations between patients and doctors, because communication is always individual and influenced by many factors, such as the individual’s state of mind on a particular day. All patients arrive at the doctor’s practice with their own previous experiences and corresponding expectations.

Here are some example situations and tips that should make it easier for you to start the doctor-patient conversation:

• It’s not just about exchanging information: As a patient, you describe your symptoms and after examining you, the doctor provides a treatment recommendation. Things are (almost) never that simple. The conversation can and should convey a feeling of trust and safety, especially if it’s the first consultation. This will ultimately increase the success of the treatment.
• To make the best possible use of this valuable time (in Germany, patients have an average of just under eight minutes for a doctor’s consultation), you should describe your concerns as straightforwardly as possible, preferably based on notes you’ve written in advance.
• Some patients start by saying “You’re my last hope”. "This is a challenge for any doctor," confirms Prof. Ulrike Bingel, Director of Interdisciplinary Center for Pain Medicine at the University Hospital Essen, "but it is helpful for managing the patient’s expectations, because it tells me, as a doctor, about the hopes - probably after several frustrating experiences - of this person asking for my help. This openness gives me the opportunity to respond, and to incorporate the patient’s expectations into my considerations on the best course of action. This can also mean being truthful as a doctor and telling the patient what you can and can’t offer, and which expectations might be unrealistic”, Prof. Bingel explains.
• Patients sometimes just want a second opinion because they are already undergoing treatment but are unsure whether everything is right. Here too, it’s helpful if you, as the patient, express this clearly from the start.
• If a patient starts by saying “I’m beyond help anyway”, this is pure desperation talking. As a patient, explain why you are so disillusioned and have evidently lost your confidence in a treatment or a doctor. In such cases, there is no longer any trace of positive expectations, so a doctor will first try to find out the reasons for this.
• Patients with a chronic health problem have usually already had many conversations with doctors and have experienced everything from bold promises to helpless shoulder-shrugging over the years. Heike Norda, Chairperson of the Independent Association of Active Pain Patients in Germany SchmerzLOS e.V. , who is herself affected by pain, therefore advises the following when talking to a doctor: "As patients, we need to be really honest. I can't trust a new doctor right away, and I have to be allowed to say that. You should also express your wishes and be open with a new doctor."
• “You’re nervous, not as focused as usual, and all sorts of thoughts and fears are swimming around in your head”, knows Prof. Sven Benson, Professor of Medical Psychology at the University of Duisburg-Essen. "That's why it's good to think carefully in advance about what's important to you, what you definitely want to say." When you’re agitated, you might forget important things and be annoyed with yourself afterwards because you didn’t directly ask about something or other. Please also read the text „What a doctor needs to know about me“.
• Part of being open is also expressing your discomfort if you don’t like the atmosphere of the conversation. Since screens have found their way into every practice and clinic, some doctors may also tend to spend more time looking at their computer than at the patient describing their symptoms sitting opposite them. The patient can deftly bring the doctor’s attention back to him or her with a polite “May I describe the pain to you again, doctor?”. Another option for the patient is to stop talking until the doctor has finished typing notes.
• If the chemistry between doctor and patient is just not right, this can weaken the therapeutic effect. In such cases, it is legitimate to consider whether this is the right doctor for you as a patient (and vice versa). It’s better to tackle concerns, misunderstandings or reservations openly. A relationship of trust either needs to be in place or to be able to develop over time. “Of course, this is especially important for the treatment of chronic diseases, e.g. with the family doctor. If a relationship of trust does not develop here, any patient can consider actually changing doctors”, advises Prof. Bingel. For a one-time appointment with a specialist physician, on the other hand, she believes that the patient can make some concessions …

First impressions are formed very quickly, in just a few short seconds, and are determined not necessarily by the first words that are spoken but rather by the whole approach, facial expressions, gestures, and ambience. There is no such thing as a perfect opening sentence, either for patients or for doctors. Prof. Sven Benson advises his colleagues that “it starts with a question when I first enter the practice or clinic as a patient: How will I be greeted by the staff? Even a simple ‘Good morning, I’ll be right with you’ can generate a positive mood.” And his advice for patients: “As a patient, it shouldn’t even enter my mind that I might do something wrong!” But certainly, it’s helpful to say “I’m glad to have an appointment today and I’d like to tell you briefly why I’ve come to see you …”. You can also read the Interview with Prof. Sven Benson: “What role does communication with my doctor play in my treatment?”

Time is short, there might be lots of questions to clarify, and fears and worries also have to be addressed. Added to this, the patient and doctor aren’t usually speaking the same language, because one side has never seen or heard what for the other side is routine and self-evident. Surveys have shown that one in two patients leaves the consultation without knowing exactly what has just been discussed.

Even when time is tight, you shouldn’t be afraid to ask questions if you haven’t understood something during the conversation. A doctor should explain everything in such a way that laypeople can understand. This is even explicitly stated in the German law on patients' rights, which has been in effect since 2013. To make sure that you, as the patient, have understood everything correctly, you can briefly reiterate what was discussed in your own words. This is the best way to compare your understanding of what was said with your doctor’s understanding, and clear up any misunderstandings. Leaving the consultation with a good feeling increases your confidence in the proposed treatment and increases its effectiveness.