Talking about quality of life with your physician?

Dr Gary
By Dr GaryCA Latest Reply 2010-11-22 21:26:29 -0600
Started 2010-11-21 13:09:14 -0600

Hi!

My clients often talk about quality of life with me. And I often ask them if they are having this conversation with their physician. Are you?

This discussion needs to go way beyond getting your answers to "How are you doing on the medications?" Quality of life discussions should include topics like emotions and depression, sleep, staying reasonably active doing things you love, personal relationships, loss of sexual desire… and all of the other aspects of life that contribute to life satisfaction.

Sure, chronic conditions result in change. But by asking questions and working closely with your physician, you can get to a new normal that allows you to be the best possible you.

I can't emphasize enough the importance of patients acting as their own advocate, understanding their condition and its treatment, monitoring themselves, reporting how they feel and asking questions.

What aspects of your life make you feel good? What aspects make you not feel so good? What are you missing in life? What have you given up? These might be some topics to think about, maybe to write about in a journal. Does your physician know what's going on in your life? You might want to make a list of concerns and questions and bring them in with you for your next appointment.

Are you having these discussions with your physician? If not, it might be time to get the conversation started. As the saying goes, it can't hurt to ask. I would add that it also can't hurt to tell. And then to have a conversation.


10 replies

CaliKo
CaliKo 2010-11-22 10:50:01 -0600 Report

Hi Dr. Gary,
I think I need to add "thankful for my doctors" to my list of things I'm thankful for. All of my doctors ask me questions like these.
Thanks for always giving us good topics to think about and making sure we are paying attention to all aspects of our lives. We're not just diabetics.
Have a great Thanksgiving!

Dr Gary
Dr GaryCA 2010-11-22 21:26:29 -0600 Report

Hi! And thank you! for your kind words. Having a good doctor is truly someting to be thankful for. Being able to share experiences and ideas on Diabetic Connect is something else to be thankful for. And you have a great Thanksgiving too!

Elrond
Elrond 2010-11-21 23:20:58 -0600 Report

My problem is that I'm a VA patient. I have a good relationship with my diabetes specialist Nurse Practitioner but my primary care Nurse Practitioner, the one I should be asking all the general questions, rushes me into her office, quickly checks to see if any of my prescriptions need refilled, listens to my chest, palpates my prostate, and rushes me out of her office. If I try to ask questions, she tells me there is no time and I must make another appointment. When I ask for another appointment, it's invariably 3 to 4 months away and when it finally arrives, it's the same story.

jayabee52
jayabee52 2010-11-22 00:29:29 -0600 Report

Isn't there any kind of ombudsman you can go to to interviene??

Elrond
Elrond 2010-11-22 00:53:07 -0600 Report

If there is, I haven't found him/her yet. The VA is so compartmentlized that no one will answer a simple question outside his/her specialty. I asked my endocrinologist to sign for a handicapped license plate for my van because the law requires an MD to sign the order. She refused because it wasn't her department. She's the only true MD I see. All the others are Nurse Practitioners. My only recourse is to request a special appointment with an MD but in what clinic? My primary care clinic no doubt has an MD someplace but I've never seen one. And I only manage to get there about 4 times a year. Any urgent requests for care are referred to ER. A trip to ER generally requires 6 to 8 hours and they only address the urgent problem that brought you in. A phone call to my primary clinic is fruitless. The VA operator refuses to connect the call and if I insist enough, will connect me with the 'help' line where I eventually speak to a nurse in Dallas, TX, who knows nothing and has papers to prove it. After a very long list of filling out forms, she just 'might' relay my request for an appointment to my primary clinic. Unless I can give an urgent reason for an appointment, I often must wait 3 to 4 months. *shrug*

Dr Gary
Dr GaryCA 2010-11-22 21:24:16 -0600 Report

Gosh Elrond, this is a grim situation you are in, it really is. It's an example of a totallly bureaucratized system that is about perpetuating itself but not about offering compassionate care to patients. Our veterans deserve better! I would also wonder if there might be some kind of patient advocate or ombudsman available. You have probably tried this already, but I am wondering if it might help to bring a list of questions and attempting to go through them with the doctor. Sometimes seeing a list can help. I suspect you have become Web-savvy out of necessity, so that you can find your own answers. In your place I might be tempted to request more MD visits, hoping to connect with a doctor who cares enough to answer my questions. Sorry to hear that getting healthcare is such a struggle.

Gabby
GabbyPA 2010-11-21 19:16:50 -0600 Report

I think that the reason they talk to you is that you know how to show you care. So often, our doctors don't make time to listen to our medical questions or concerns. So getting into the emotional things is harder to do. I know just getting my doctor to believe me that my feet were bothering me is impossible. I tell him they hurt or burn or what ever they are feeling....he just says they're fine. So that is why we compartmentalize our lives, because no one person (doctor) wants to take care of the whole.

Dr Gary
Dr GaryCA 2010-11-22 21:02:35 -0600 Report

I know what you're saying here. Doctors have only so much time and often don't want to listen to anything that isn't what thy consider to be within their scope of responsibility. Unfortunately, as you pointed out, they also don't always want to listen to complaints that should be their concern. That's the system.

My concern is that patients may second-guess their doctors and assume that they shouldn't talk about certain things, like emotions, activity level, etc., assuming that their doctors don't want to hear about this. They may be right, of course. But then, they may not talk to anyone about quality of life. The physician may be able to address some of the quality of life issues that come up, they may even be treatment related. Or they might make a referrral and encourage the patient to follow up.

I know the level of attentiveness from doctors varies greatly.

RAYT721
RAYT721 2010-11-21 13:52:34 -0600 Report

Greetings! I am happy to report that I have had a few discussions with my doctor about my sleep apnea and general emotional-physical concerns. You are bringing up an awesome point that I think a lot of people (especially men) overlook when having doctor appointments. I read an article that the average woman asks 5-6 questions of their doctors while men have an average of 1. I don't know the guy who asks two questions because I am USUALLY known for zero. I totally agree with you about making a list because I did that for my last appointment. I wanted a follow up sleep apnea request to my sleep study. I asked my doctor for prescriptions for the generic medications that I can get for $4/month instead of going through insurance. Also I asked when HE is going for his colonoscopy (he's 50) after how gung-ho he was on getting me to go. Although I am not a math major, my questions must average out a bunch a guys who have questions that they think about asking but don't. Hopefully we all get on board to start that list of questions and ASK. Gone are the days for me when "how are you doing" inquiries from the doctor are answered with "ok… thanks for asking." Let's all make our doctors work for the copays by asking about our concerns. I have my sleep study set for next weekend. NOTE TO SELF: pack teddy bear.

Dr Gary
Dr GaryCA 2010-11-22 21:12:43 -0600 Report

Hey, thanks a lot for this. You gave some great examples of why it's mportant to bring these issues up. Men, as you said so well, are especially unlikely to talk about what's on their mind, playing the "strong silent type" and all of that. And I would guess that both and women have a tendency to tell themselves that they are fine, that all of those concerns that they have been having are probably nothing, and also forget the questions they had, once they get into the examining room. And as you said, being a good medical consumer also means doing your research, checking into generics, knowing what's available to address your concerns, like sleep studies. The squeeky wheel gets the grease. And most doctors I talk to want their patients to take responsibility for thier care -- doctors are busy and involved patients make them less likely to overlook something. (And the doctors who don't want involved patients, I wouldn't go to anyway.)

Your post is hopefully an inspiration for others who might be holding back on letting their doctors know what's on their mind. I will be interested to know how your sleep study goes! Take care!