(Image Credit: Jared Rodriguez / Truthout )

As a family physician practicing in my own ideal primary care clinic, I can’t tell you how often I’ve heard patients say, “Dr Karen, thanks so much for listening to me. My doctor didn’t take me seriously” or “I feel like my doctor ignored my symptoms.”

While I can’t speak for all doctors, I can say that when I worked in busy big-box style clinics I felt very stressed trying to manage my patients’ health concerns while working on a very tight clock. There are lots of individual factors at play here, but I feel it can be boiled down to two main reasons why people experience the feeling of not being listened to by their doctor: lack of face-to-face time with your doctor and lack of active listening skills on the doctor’s part.  Let’s talk about why this happens and what you can do to get your doctor to listen to you.

Lack of Face-to-Face Time

Everytime you go and see your doctor, or any doctor for that matter, you spend all of your time waiting to be seen.  You wait at the front desk to be checked in. You wait in the waiting room. Then you are led back to an exam room where you maybe have your vitals taken and an assistant or nurse talks to you, and then you wait some more. Finally, 45 minutes after your scheduled appointment time, the doctor walks in, gives you 5-10 minutes of time, and then whisks out the door.  Then another nurse or assistant comes back in and opens the door and leads you down the hall back to the waiting area and you leave. You never know when your actual time appointment was. All you know is that your appointment ran 1 hour longer than it should on your schedule and that you saw your doctor for 5-10 minutes. Yes, I know this system well as a physician and a patient.  I used to joke somewhat sadly that my Toyota Camry got more attention when I took it into the shop than I did as a patient in my doctor’s office. Isn’t it sad when your car gets better care than you do? As a doctor working in this hamster-wheel style of medical care, I became extremely depressed and frustrated because of this reason – lack of time with my patients. People had lots of questions either related to their immediate diagnosis or for some other reason and I wasn’t able to address my patient’s health concerns.  Your doctor may not show it, but chances are he or she is just as frustrated as you that he or she can’t take the time with you that you need.  Doctors are being pressured by employers/administrators to see more people in less time, because insurance companies are paying doctors less and less for providing care. Meanwhile you are paying through the nose for insurance premiums and deductibles! It’s such a dysfunctional system. Frustrated with this whole thing, I created my own small ideal micropractice that runs lean on administration so that I can see less patients and spend more time with them.

Lack of Active Listening Skills

Have you ever had the feeling that your doctor doesn’t “get” what you are trying to tell him or her? No matter how many times you seem to explain it, he or she still isn’t on the same page as you? Or maybe they seem a little distracted and don’t really understand the full implications of what you are telling them? This is such a frustrating experience! Your doctor is supposed to be the one who really cares about what’s going on with your health and then helps you come up with a treatment plan.  While doctors are used to listening to patients all day, we aren’t always using the best kind of listening skills. Often times as doctors we are listening to our patients concerns and at the same time formulating a diagnosis or treatment plan in our mind. We have one “ear” listening to our patient, and the other “ear” is focused on the health puzzle that we are trying to solve in our minds. Another thing we are doing while patients are talking to us is we are either typing on our keyboards or clicking boxes on our computer screens. Between trying to sleuth the diagnosis and tapping away on a keyboard, there isn’t much “hearing space” left to really listen to our patients. While this approach can save time in the exam room, people catch on to this quickly that that they don’t have their doctor’s undivided attention. Active listening means that we don’t have a preconceived idea or conversation/dialogue running through our minds while someone else is talking to us; rather we have no agenda except to truly listen with all of our senses and respond empathetically. Active listening goes a long way towards not only making someone feel heard and understood, but also in truly appreciating the full scope of what’s going with them.  I practice this listening technique with every patient that I see in my practice and it works wonders. At times I will type during my visits or formulate treatment plans in my head, but I make it a point to stop and give my patients undivided attention.  Often I’ll vocalize what I’m thinking so my patients can follow my train of thought and jump in if I’m getting off track. 

Why does my doctor downplay my symptoms?

Many people have this experience; you go to the doctor for a problem that’s really bothering you and affecting your quality of life, and he or she poo-poo’s your symptoms and tells you to go take some Tylenol or Motrin and have a rest for a few days.  Sound familiar? It can be SO frustrating to have extremely bothersome symptoms and be told that “it’s nothing to worry about”. Yeah, doc, thanks. If I didn’t have the problem I wouldn’t be here wasting my time waiting in your exam room! Here’s the real truth: doctors are more like Google Search bots than people. With every word you tell us and every question you answer we are piecing together your story like a puzzle. We are listening for clues of serious illness or looking for patterns. When we evaluate someone we are always trying to rule out the deadly diseases first.  When your doctor says, “It’s nothing to worry about” what he or she REALLY means is that “This problem is unlikely to kill you.” YOU may intuitively know this, but your doctor doesn’t. We catch all sorts of strange and life-threatening diseases that masquerade as vague or innocent problems. This is what we’re trained for.  It’s our job. We MUST rule out the serious things first. Unfortunately, doctors don’t have the time to explain things thoroughly; such as reviewing what they’ve ruled out and what they are thinking are possible causes for your problem. Due to lack of time, doctors come up with brief one-liner statements to “reassure” their patients. But it has the opposite effect! Instead of feeling reassured, people actually feel dismissed. Is it possible that my doctor is an uncaring jerk? Well that’s always a possibility, but it’s more likely that he or she is just trying to reassure you in a very bizarre way that you don’t have a life threatening illness.

Does my doctor really care about me as a person or am I just a number?

Unless your doctor has a some kind of personality disorder, the answer to this question is absolutely YES! Your doctor DOES care about you, even though he or she may not show it.  Doctors today are inundated with all sorts of other demands for their attention and time, but rest assured we DO care.  We stay up late at night finishing work that was left undone for our patients. We spend hours on the phone arguing with insurance companies to get better care for our patients. We lie awake at night researching treatments and second-guessing ourselves. We worry about our patients even when they don’t care enough to worry about themselves. Despite the fact that the media loves to portray us as arrogant, narcissistic, golf-loving millionaires who drive fancy cars and wear designer clothes (remember Nip Tuck?), most of us primary care doctors are in this field because we LOVE it, not because we make good money at it. We love seeing families. We love seeing patients young and old. We love it when we know our patients so well that even though we only see them every 6 months it’s like a running conversation with an old, trusted friend – you just pick up exactly where you left off. We honor being chosen as YOUR trusted doctor and we take that responsibility seriously and with great care.

So how do I get my doctor to LISTEN to me?

• Make a list of concerns and bring it. Unless your doctor has a practice like mine you aren’t likely to get much face time with your doctor, so make the most of what you get. Be organized and bring a written list of concerns to address so you don’t forget anything. Here’s the part that’s really important: don’t wait until the end of the visit to tell your doctor that you have multiple concerns! As soon as your doc walks in and asks you what you here for, make sure to tell them that you have a list of concerns so he or she knows right away that you aren’t here to talk about just one thing.
• Prioritize your list ahead of time. Due to lack of time, be prepared that not everything on your list will get addressed and prioritize accordingly. I know many patients that make lists, but they don’t actually sit down and decide which concerns are the most important to talk about. They assume that the doctor will go through everything on the list in full, but in reality often only one issue gets addressed due to lack of time. Showing your doctor that you have proactively prioritized your list will get your doctor’s attention and be a great time-saver.  This will help your doctor zero in and focus on the most pressing issue for you. A caveat to this: your doctor may look at your list and change the order around. If he or she does this – just roll with it.  We do this for safety reasons. An ankle problem that’s been bothering you for 2 years is going to take a backseat to the chest pain you’ve been having for the past 3 weeks.
• Stay on topic. A little chit chat is good and helps break the ice, but too much off topic discussion can eat up precious time with your doctor. Many times people will get off track when describing their health problems, because they usually occur in conjunction with some other activity.  It’s hard to remember your symptoms in isolation, so talking about some backstory is important. Try to stay on task of describing your health concerns and not going too much into other things that don’t relate to your health. A caveat to this: Don’t feel like you need to decide what’s important and what’s not. That’s not your job, that’s your doctor’s job. Just don’t waste time talking about Aunt Nellie’s terrible cooking at Thanksgiving dinner when you really came in to talk about your stomach problems that started that evening.
• Repeat what’s important to you. Throughout the course of your doctor’s visit you are going to tell your story and then answer some questions about it. It might not seem like it, but you and your doctor are going to cover a lot of ground together in a short time. Remember that your doctor is like a Google Search Bot – continuously looking for clues and patterns in your story. In order to make sure that your doctor really “gets” your situation, don’t be afraid to repeat important things. An example: maybe your knee doesn’t always hurt and the pain isn’t too bad most of the time, but if your knee problems keep you from training for that marathon or stop you from doing your favorite yoga class, it’s definitely worth repeating in the visit if your doctor seems to be downplaying your symptoms.  When my patients repeat things several times in a visit, I definitely take notice that this is VERY important to them and it gets my attention.
• Go back once more. Go back to the non-listening doctor who dismisses me? Are you CRAZY Dr Karen? Yes and no. Yes – I really do mean to go back and no I’m not crazy (well, at least I don’t think I am).  I really feel this is the most important tip of all. If you do NONE of the above 4 strategies, I highly recommend following this one. The reasons are simple: Coming back for a second visit for a problem we’ve already seen you for tells us two things: 1. We didn’t solve your problem, and 2. We need to look deeper and pay more attention to what you are saying. On the first visit for a new problem we have to run through a huge diagnostic tree in our minds. We might seem distant or distracted. We might get the diagnosis correct or not. On the second visit, however, it’s very different. We’ve already gone through our initial checklists and have a lot of information, so we can do a “deep dive” into your health concerns. Less of the visit is spend information-gathering and more of it is spent connecting with you. Doctors typically have much more time to do active listening on the second visit, because we’ve already got all the background from the first one.  I can’t tell you how many times I’ve actually made significant headway into helping solve patients’ health problems on the SECOND visit instead of the first. Give your doctor a second chance by going BACK once more to discuss your health concerns.  If after the second visit you still feel dismissed and not listened to, then I’d recommend searching for a new doctor that you trust.

I hope this article helps you. Navigating today’s overly complex healthcare system is not easy for any of us. I was tired and frustrated of fighting forces beyond my control just to provide decent care to my patients. I’m determined to be part of the solution and not the problem. I’ve done this by creating my own ideal clinic where I can practice medicine how I feel it should be practiced: with trust, honor, and respect. My patients deserve it and so do you.

Dr. Karen Weese Bell MD is a family physician who owns and manages a small primary care practice: Dr Karen MD & Associates in Fort Collins, Colorado.  She actively works to restore and nurture the age-old, sacred relationship between patient and doctor.

Medical Disclaimer: All content including text, images, audio, or other formats were created for informational purposes only. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.