But doctors are not lawyers, and being human, they sometimes are reluctant to bring up certain questions that may embarrass the patient or worse, the doctor. Thus, vital medical information that could affect the diagnosis and its potential treatment is often unstated, resulting in a needless delay in arriving at a solution.
Why aren’t the questions asked? Sometimes the question is too intimate because it relates to sexual habits or drug history. The doctor may suspect something but isn’t quite sure how to broach the subject. It’s also, at times, a human communication problem – the patient doesn’t want to admit something like non-compliance with taking medicine, and the doctor doesn’t force the issue.
It’s an issue that needs more public attention. Most information on this topic centers on what patients won’t ask doctors. What doctors don’t ask patients is left for the medical journals.
Sometimes the lack of candor on the part of doctors and patients is a matter of trust. A Gallup survey from 2010 on health care reported that 70 percent of Americans are confident in their doctor’s advice. That was an increase from 2002, when 64 percent of Americans felt that way. The report also noted that the older you are, the more trust you have in your doctor. Eighty-five percent of those 65 and older felt confident enough in what the doctor told them that they would not seek a second opinion.
However high that percentage appears, it still indicates a gap between doctors and at least some of their patients. In fact, the same survey showed that Americans trust nurses more than doctors.
New Tool Measures Risk Factors
Fortunately, the reluctance to ask about certain conditions is a problem that at least some doctors realize exists. To combat it, a new tool was developed to assess the risk factors for major health issues that a patient may have, including diabetes, depression, heart disease, addiction, and several others. The ACE test is not perfect, but it does provide hints to doctors as to what might be causing your physical problems.
The ACE test is fairly simple and requires answers to 10 yes-or-no questions about childhood experiences. By answering honestly, doctors will determine the impact of childhood trauma on long-term health conditions.
However, the test hasn’t caught on with every physician. The reason? They believe the questions are too invasive and believe that asking them will lead to an emotional breakdown, something that will delay the precious time a doctor has to spend with any one individual.
The ACE test asks about the following:
1) Childhood sexual trauma
2) Suicides in the family
3) Family history of drugs or alcohol
4) Physical abuse
5) Murder or other criminal trauma
These are about half the questions, but the answers may reveal a surprising burden on the patient. Many studies have shown emotional trauma can lead to ill health, and certainly an affirmative answer for one of the five issues above would qualify as trauma.
Non-Compliance Issues
Doctors are working harder on getting patients to admit one particular sin – adhering to prescribed medicine and their schedules for ingestion. That’s because, despite extensive patient interviews about what prescription medicines they have and tests to determine ailments, studies have shown that doctors never ask the crucial question – are you taking your medicine?
Studies have determined that patients may be reluctant to take medicine because of fears of side effects or the cost of the medication. But because the subject isn’t brought up, doctors may be scratching their heads because the medications they prescribe don’t seem to work for their patients.
Even when doctors do ask, they sometimes get evasive answers. Which means they need to ask the questions again in a way that will eliminate patients' fears of admitting they did not take medication. How a doctor asks the question, surveys indicate, is often an important factor in getting to the truth.
Asking a question in the affirmative is considered the best practice in doctor/patient relations. A physician who asks someone, “You do take these pills every day, correct?” is setting up the answer he or she wants to receive and makes it hard for the patient to admit fault.
A better method is to frame the question in a way that acknowledges the behavior as typical. For example, “I understand that taking your medicine every day can be difficult. Are there times where you feel that you can’t stick to the treatment?”
This allows emotional wiggle room for patients to admit that, yes, they don’t take the medication as often as prescribed and avoids the dreaded scolding for bad behavior that everyone learns as a child to avoid. The key is to avoid shaming patients, particularly by warning them of the dire consequences of not taking their medication.
Sexual Orientation
While society is moving more toward a free and open acceptance of various sexual orientations and behaviors, it’s still not quite all the way there. Thus, some patients whose conditions may be the product of certain behaviors may be misdiagnosed because doctors – particularly older doctors – may not ask them.
As reported in the Journal of Women’s Health, it was discovered that doctors, gynecologists and urologists are rarely aware of patients' sexual orientation. In fact, if patients identify as LGBTQ+ and not “out” about their preferences, it can create extreme anxiety and fears in them of adverse reactions if they admit their orientation.
Just in the past 20 years, researchers found that some 65 percent of lesbians had never been asked about their sexual orientation. The danger is that some care providers may assume that the person is heterosexual and make treatment recommendations based on that belief, such as prescribing birth control pills for contraception instead of offering more accurate sexual health advice.
At a 2002 Women’s Sexual Health Conference in Santa Monica, Calif., an audience of medical professionals discussed the issue. The audience of urologists, primary care physicians and OB/GYNs wanted to know how to approach questions on sexual issues without offending patients. They also were worried about not knowing the culture or terms. Now there are numerous resources for health care providers through the American Medical Association and other governing bodies, which have adopted LGBT-friendly policies and procedures that physicians and others must follow. The Gay and Lesbian Medical Association's provider directory can help those of any sexual orientation find a local health care provider.
Does Your Doc Address Stress?
Another issue that doctors almost never ask about is stress. In a report published in the Archives of Internal Medicine that covered 1,200 primary care physicians and 34,000 medical appointments, it was discovered that only 3 percent of the doctors offered any counseling on stress. That’s even though research has proven that stress can contribute to such conditions as heart disease, irritable bowel syndrome and migraines, among many other medical problems.
Whatever the issue, doctor and patient communication is a primary link to achieving better health. If your doctor won’t bring up an issue, it’s up to the patient to raise the question. If that needs to be done through a third party or even via email, it’s better than never addressing an issue at all. Keep in mind that not every question can be conceived by a busy doctor who may have other issues taking up space. By raising the question, patients can help doctors help them get better.