Saturday, December 16, 2006

How to Read Between the Lines During your Next Whitecoat Conversation

By Ron Geraci, Men's Health

The test result is slightly abnormal, and it could be several things.

This could mean:

"It's definitely one of two things, and I hope it's not the first one."

"We may tell the patient initially that there's a 'slight abnormality' because we don't want to worry them," says Leonid Poretsky, M.D,, an endocrinologist at Beth Israel Medical Center, in New York City. For example, there are blood-test irregularities that could mean cancer, pneumonia, or nothing at all--but be assured your doctor is thinking of the most serious possibilities. If you want to hear them, ask the right question, Dr. Poretsky advises: "I know you can't tell definitively what it may be, but what are the diagnoses you're considering?"

I've performed many of these operations.

This could mean:

"I'd choose a more experienced surgeon."

A good measure of a surgeon's skills is how many times he or she has performed the procedure in question--both the Lifetime total and the number per year. "Thousands" is a comforting answer for the first tally, but the annual number is the critical one to know. Replies such as "Quite a few," "Enough," or "I'm comfortable with this" could mean the surgeon is still on his learning curve, says Dr. Oz. You need a specific number,

Dr. Smiddle? He's a great guy.

This could mean:

"I wouldn't let him touch me."

Asking a doctor to rate another doctor can put him in a delicate position. The weasel words? "He's a nice guy," "He's at one of the better centers" (which means not the best center), and the like. What you want to hear are superlatives about the doctor's specific skills.

Our team decided that it was the best course of action.

This could mean:

"There's a 0.5 percent chance we can sew it back on."

Most patients ask vague questions, such as "How serious is this?" and "Is everything going to be all right?" These elicit vague answers. "Make your question as specific as possible, and ask for facts, not his judgment,' says James W. Pennebaker, Ph.D., chairman of the psychology department at the University of Texas at Austin.

You need an ESR test.

This could mean:

"I have no clue what's wrong with you."

The ESR (erythrocyte sedimentation rate) test measures inflammation, says Mehmet Oz, M.D., coauthor of You: The Smart Patient. It can be a shot in the dark ordered for patients with fatigue, weird fevers, or symptoms that might be all in their head. A full-body CAT scan may also signal a doctor's befuddlement.

Our team decided that it was the best course of action.

This could mean:

"I don't know what happened during the shift change."

People are more likely to avoid first-person pronouns-"I," "me," and "my"--when lying, according to research by Pennebaker. "One hypothesis is that [deceivers] are psychologically trying to distance themselves from the situation," he says. Reply by asking what he or she specifically did (or failed to do) at the time.

That growth may be nothing, but I want you to see a specialist.

This could mean:

"I'm about 99 percent certain that it's cancer, but I'd rather let another doctor tell you that."

A lump. A mass. A shadow on the x-ray. These can be code words for the C-word and signal that the doctor wants you to hear the news from a specialist who has the "you have cancer" talk 20 times a week. If you want the full story ASAP, say so. "If a patient asks if I think it's cancer, I'll tell them," says Tan Blumer, M.D., author of What Your Doctor Really Thinks.


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