Danielle Ofri, MD, PhD, reveals how she and other physicians interpret what patients tell them—and how they use that information.
Scenario 1
The Patient says... "I have the worst stomach pain, the worst dizziness, the worst headache—24/7."
The Doctor hears... "I'm under a lot of stress."
The Doctor thinks...
"When a patient tells us that every symptom is the most horrible ever—and the physical exam and labs are normal—we often suspect something psychological is going on. The symptoms aren't fake. They're physical manifestations of anxiety, depression, and stress. So while I'm always on the lookout for a serious underlying disease, I'm also thinking,
Can I get her to see a therapist or enroll in a yoga class or eat a healthier diet and get better sleep?"
Scenario 2
The Patient says... "Everything's fine."
The Doctor hears..."There may be something I'm not telling you."
The Doctor thinks...
"I worry that the patient may be uncomfortable about sharing something. It could be sexual dysfunction, an eating disorder, depression, domestic violence—these are serious topics many people don't want to talk about. I'll try to follow up with questions like: How are things at home? How's work? But we don't always have time to probe. Don't be afraid to bring up the important things going on in your life, even if they don't feel 'medical.' Your doctor would rather know than not know."
Scenario 3
The Patient says... "Oh, just one drink per night."
The Doctor hears... "At least two drinks per night."
The Doctor thinks...
"We're taught in medical school that people ususally underreport their alcohol and drug use, so we genreal double the amount we're told. Don't be insulted if your doctor asks follow-up questions about yout drinking. We're trying to be diligent so we don't miss an alcohol or drug disorfer that could be amenable to treatment."
Scenario 4
The Patient says... "Here are my records from my previous doctor."
The Doctor hears..."I'm about to dump a pile of info on you."
The Doctor thinks...
"Patients sometimes bring in years' worth of medical records, and reviewing them would take valuable time from the visit. It's best to prioritize what you want the doctor to see (like a recent heart test from a cardiologist) and put those documents on top."
Missed connections
In a survey of nearly 240 hospitalized patients, only 32 percent could name even one of their treating doctors. —From
What Patients Say, What Doctors Hear
