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Mary Shomon

What Do Doctors Think About Patients Who Come to Medical Appointments With Lists?

By March 21, 2010

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Those of us who are patient advocates are always saying to go into a doctor's office prepared. That means, doing your homework ahead of time, and putting together an agenda, or list of items you would like to discuss with your doctor.

But how do doctors feel about it when a patient walks in with a list? The American Academy on Communication in Healthcare published the results of a study in its journal, Medical Encounters. In the study, e-mail surveys were sent to all members of the University of Wisconsin's Departments of General Internal Medicine and Family Medicine -- plus all family medicine residents -- to find out how these doctors feel about patients bringing in lists to office visits. Among the 217 surveys returned (54% of those contacted ):

  • 60% of the doctors surveyed reported that patients came with a list "very often" or "sometimes."
  • 75% of the doctors surveyed "thought their effectiveness improved when patients were involved in setting the agenda for the visit."
  • 65% believed if patients came with a list, their office visit would take more time.
Respondents were also asked some open-ended questions, and the results were interesting. Generally, while the majority of doctors thought that a patient's list was helpful to the patient's medical care, the doctor were concerned about the prospect of longer appointments. Many of the doctors surveyed felt that patients should only bring one to three concerns on a list to discuss. Overall, the concern about a list adding to the length of the visit dampened the overall enthusiasm doctors have for encouraging patients to bring lists to appointments.

Overall, the survey concluded that more research was needed to explore how patients can be proactive regarding their medical care without increasing the length of appointments.

Learn More About Being an Empowered, Prepared Patient

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Source: Medical Encounter , Vol. 23, No. 3 Fall 2009, journal of the American Academy on Communication in Healthcare

Comments
March 22, 2010 at 2:58 pm
(1) Cindi Straughn says:

I have found that making a list of no more than 3 items I want to cover with my physician is extremely helpful. I actually hand a copy of the list to the nurse who ushers me to the exam room so it is clipped onto my file for the doc to see before she enters the room. I find that having a list keeps me focused on my goals for the visit. And I also think it alerts the doctor to stay focused, as I’ve found that docs can go off on tangents talking about stuff too.

March 22, 2010 at 3:00 pm
(2) cindi says:

oh – and one other thing i put on that list is “Lab Tests Requested” and “RXs needed”…even writing out the complete RX information for the doc so she doesn’t have to go looking through the file for what she has prescribed me in the past i.e. regular thyroid and adrenal hormone RXs

March 25, 2010 at 3:35 am
(3) gina says:

“Many of the doctors surveyed felt that patients should only bring one to three concerns on a list to discuss.”

On what planet is one item considered a “list”?!?!

March 26, 2010 at 3:53 am
(4) MB says:

One of my doctors, an oncologist, gives her email address to patients. I have used it on several occasions to ask her questions that don’t need an office visit or phone call to discuss. She has always responded the same day, or early the next day.

She says that none of her patients abuse the email, and she feels it helps her with their treatments. It’s more efficient for her to type out a quick response to several questions than to play phone tag with her patients.

12 years ago, when I was facing breast cancer treatments, I brought a list of questions to the radiation oncologist, along with my mammogram films. He was happy I did that, because we could discuss all my treatment questions. He told me he wished more of his patients would do that.

March 26, 2010 at 5:22 am
(5) Fran Richardson says:

I am SICK of hearing about a Doc’s PRECIOUS time! Not mentally sick, ACTUALLY sick for they do not take the time to check the interactions of the drugs they hand out just to get you OUT of the office and on to the next patient to dispense another RX within 5 minutes!
I was accused by one Doc for “Reading too much”!
I have had 3 heart attacks and the Cardiologist is concerned about Artrial Fibrillation! Yet, ALL of the drugs he has me on contribute/cause it!
Tired of having to be a Thyroid Expert only to be shut down by an Endo the has no time to discuss why!
Docs have their place but am tired of the Golden Throne upon which they think they have residence!
I have tried the lists, only to have the Doc walk out of the room giving orders for another patient, God forbid he listen to an answer to HIS question of how you feel!!
I have had to save my OWN life 3 times now from Drug reactions! Only to have one Doc tell me “We must look at this objectively, you must take this drug”
The Cardio was appalled and happy I refused to take the drug!
What has happened to HUMAN DECENCY? A doctor is a human being and should treat each patient fully! Triple booking patients every 15 minutes is NOT fair to the price a patient must pay for an Office Visit!
Docs do not like patients that are intelligent and want to be an active participant in their own health! They want to dispense drugs that the pharmaceutical Rep has told them “works”!
I have finally found a DO that LISTENS to his patients, would you believe a FULL hour for the first visit and when you call, HE returns the phone calls? He is interested in the body as a WHOLE not little separate parts!
About time the medical schools start teaching basic anatomy!

March 26, 2010 at 7:56 am
(6) Alexis says:

What gets me is that a doctor CAN’T fully understand a patient’s health status unless he listens to EVERYTHING that is bothering them! Why should you be limited to one to three items? How about the fact that you could have a number of symptoms that are all part of the same problem? For instance if you are hypothyroid and you just say you are having trouble losing weight they may say wel you need to exercise more and eat less. But what if you have a host of other thyroid symptoms – then they should put two and two together! Many problems in the body have a lot of varied symptoms. If I were a doctor I would want to know everything that is bothering my patient and then try to actually THINK about what could be the problem rather than just write a prescription for a drug to “cure” one of the symptoms. They don’t mind billing our insurance for $150 after spending 5 minutes with us and often not helping us at all!

March 26, 2010 at 8:03 am
(7) Sherry says:

Why should I have to come back for a second visit if I happen to have more than three items on my list? Doctors bill in 15-minutes increments. I get grilled when I call to make the appointment. I resent having to discuss my personal business over the phone with a total stranger whose job it is to schedule the time. If there’s not enough time to cover my four or five concerns, it doesn’t mean I’m demanding. It means not enough time has been allotted for the appointment.

Doctors yap about efficiency all the time. But expecting people to drag themselves back in for a second appointment instead of getting everything done the first time is incredibly inefficient.

Also, what Fran said.

March 26, 2010 at 8:07 am
(8) Sherry says:

Ha, ha, Alexis. I brought my shopping list of what I now know are very specific hypothyroid symptoms to doctors for literally decades. Only one paid attention but, alas, he died before he could really treat me. The rest of them brushed my concerns aside and treated me to 25 years of disability, lost employment, mistreatment and side effects-laden drugs. My doc’s PA *finally* noticed my blood test results one day and I am now working part time and enjoying life for the first time in 30 years.

You bring up a very good point, however. Had any of the docs managed to pull their heads out of their lab-test butts long enough to listen I did have a complete laundry list of symptoms that would have made diagnosis rather easy. Limiting it to the Magic Three would only give a partial picture.

March 26, 2010 at 8:18 am
(9) Vicki says:

I’ve found doctors don’t want to deal with more than one or two issues per visit. They want you to keep coming back, resulting in multiple appointments and copayments.

The problem is that the doctor needs to know all the symptoms for the big picture with a patient’s health.

It’s like the old story of the blind men in the room with an elephant, each man is feeling a part of the elephant, but can’t see the elephant in the room. I’m tired of hearing, “come back in a month” from doctors. No, I want my health problems dealt with at the first office visit, not one at a time.

Instead, the doctor wants one issue at a time, for which they prescribe a “cure” almost always in the form of the latest “pill” marketed by pharmaceutical companies.

Western medicine is woefully lacking in just about all areas. If the health concern can’t be tamed by a pill, or cut out with surgery, doctors don’t want to hear about it.

The cure for that is an antidepressant, which doctors are happy to dole out to everybody who walks through their door.

I should not have to tell a desk clerk my personal business when making an appointment.
Doctors need to remember that WE the patients are hiring them! We are not there to be ignored, treated like ignorant children, or pushed off like we are taking up too much of their time.

My favorite doctor response came when I asked him how I could lose weight. His answer was “stop eating.” Ihad actually gained 30 pounds as a side effect of hypothyroidism, and the horrible generic version of Toprol for high blood pressure. Yeah, I had already tried stopping eating. Of course, there’s no nutrition in that, hehehehe.

March 26, 2010 at 8:52 am
(10) Kalvy says:

I always brought a list to my doctor; however, on my last visit, she complained that my visits always take longer than other visits where she makes more income (I do not have insurance, so she does not bill me as much as people with insurance)! So the results of this study are right on target. I’ve decided that I will no longer bring a list.

March 26, 2010 at 9:05 am
(11) Margaret Sullivan says:

I am blessed to have the doctor that I do… if I don’t have a list in my hand, he asks me where it is!

March 26, 2010 at 9:27 am
(12) Patient B says:

What do you think of a doctor that tells you he doesn’t have time to address an issue. After I’d sat in his office for two hours already!

March 26, 2010 at 10:01 am
(13) kaytee says:

Re: doctors not having time for lengthy “lists” of concerns….
If the dr is working for an HMO (like Kaiser…), s/he is limited by contract. S/he is supposed to have a clinic patient in & out of the exam room in 10 minutes, with about 5 minutes between patients… from the time they finish rounds (if any) until the end of each work period (4 hour block). If these drs regularly take longer than that, then they will not have a job there very long. Specialists get a bit longer for appointments, and certain types of appointments for primary care clinic visits are given more time, but generally, they are expected to see 12-15 patients in a 4 hour “block”. I had a dr, briefly, who did take time to look and listen to her patients– she usually skipped her lunch break to catch up her morning “block” workload, and work unpaid overtime to catch up her afternoon workload and to chart…. But… she made too many people “wait”, and she was really burned out by the end of her initial contract– she was planning to take 6 months to a year off to recover and spend some time “getting to know her children”. Luckily, she had the option to do that, because her husband (also a dr) was working full time– other doctors may not have that luxury, especially since most have student loans to pay off, as well as a family to support.

March 26, 2010 at 10:57 am
(14) Patient B says:

I just don’t think that is good quality health care!

March 26, 2010 at 11:25 am
(15) Kathleen says:

I noticed a number of comments are exactly what I’ve experienced. The few times I have brought in lists the doctor replies and asked for specific tests because I’ve done my homework they get angry, offensive, don’t deal with the ‘entire’ issue, etc. I was poisoned with endocrine disruptors on more than one occasion and they are in our food and water supply – its no wonder we have such a rise in these conditions and yet when you bring a ‘list’ of symptoms that you’ve experienced for 30+ years and how they’ve impacted your life, they say ‘don’t tell me my job’, ‘quit wasting my time’, and ‘you couldn’t possibly have all this and look this good’. I’ve been in 5 endo’s and everyone of them is just as bad as the next and none of them look at the whole picture of symptoms, their progression, etc. I took out of my precious time as a scientist to give them information to make an informed diagnosis and I what I get back is insulting childish behaviour that reflects nothing short of a spoiled brat that sits on a throne and does nothing but reflect an image. The list was compiled for a reason and it typically takes a lot of time and thought – we should be respected not patronized.

March 26, 2010 at 12:04 pm
(16) Karen Davis says:

Since my primary care physician has repeatedly proven that she has no time for me, I rarely ever go to her office anymore. I always did bring a list of symptoms and questions, but never got very far before she was already halfway out the door to another patient, still talking to me as she backed out the door with her little computer cart. The endocrinologist is little better. Seems like the doctors I see want me to diagnose my own problems, because they somehow think that diagnoses just take too much time. I now have a $30.00 co-pay and pay $1255/mo. for health insurance for me and my daughter, a 16-yr.-old brain cancer survivor. I dream of the day when the quality of health care is commensurate with the cost. I’m tired of shopping around for a decent doctor!

March 26, 2010 at 1:23 pm
(17) Katherine says:

First, I have always prepared a memo of items I want to discuss with my physician. I usually send it by fax ahead of time and ask that it be put in my chart. I began doing this after leaving messages with the nurse and finding the information never got through accurately. I’ve had some screwups and want to have my side in the chart. I usually do this for annual exams with primary care and gyn. I have always been thanked for this, and I cover everything without forgetting at the last minute that I needed a refill. I do want to respect the time and say that if we cannot get to everything, then we can schedule another appt.

Second, my husband is a family physician resident and he hates the 15-minute thing as much as the patients. If your doc works in a group, s/he is probably scheduled every 15 minutes because insurance companies will not reimburse more than that. Of course, no one tells the patients, “you are scheduled for a 15 minute appointment, so come prepared.” They are not compensated for reading your chart ahead of time, researching your case, or writing up the notes from the patient visit. For a complicated case, that can take longer than the visit. Nor are they compensated for a phone call to see how you are doing.

My husband is always running over because, as many here have said, he can only get the best information by talking to the patient, and that often takes time. Part of this is because most patients do not come prepared with a list, and come up with last minute major issues when they are about to get dressed. I tell him he should train his patients to write down their concerns before coming – it would save time, and they would be able to spend some thoughtful time together.

So keep making lists and tell your friends to do the same. If we only get 15 minutes, let’s make it count!

March 26, 2010 at 9:02 pm
(18) Nan says:

Katherine,
Thank you for your thoughtful and insightful reply.

March 27, 2010 at 12:13 am
(19) Beege says:

Katherine,
As a thyroid patient for the last 40 yrs. and coming from a family with 6 doctors so far, your comments were great. I do the list thing too for yrs now, but never thought of the faxing ahead. I’d still want my own copy in my hand though incase the office misplaced the faxed copy, and also because I’ve found the doctors are so busy and their minds juggling so much (they have hundreds of patients, we have only one…ourselves), I’d want to make sure neither one of us overlooks something on the list, as the doctors sometimes do. So we’d each have a copy in our hand. And I do try, and have little trouble, keeping it to 3-4 things on the list being considerate of their time constraints. That includes each prescription refill as one thing too. For a chronic condition like thyroid disease your in their office every 4 months or so anyway.

Just wanted to say to you, couldn’t have said it better myself….thanks you.

March 28, 2010 at 1:30 pm
(20) roxann says:

My doctor said to schedule a double appointment if I needed extra time. That was nice -but what really bugs me is that a nurse comes to call the doctor out of the room on MY time and I get short changed on appointment time whether it’s a 15 min or 30 min appt. How do you handle interruptons during your time with a doctor?

March 28, 2010 at 4:03 pm
(21) houndrnr says:

I used to do this, now I do and DON’T hand it to the Dr! The last time I gave my ‘list’ to one, he threw it in my lap and stated “He didn’t have time for all of that!” Needless to say, I’m still looking for a good Endocrinologist!

March 28, 2010 at 8:11 pm
(22) juliet says:

If I only have three things I need to be addressed at the Drs appointment, I reckon I can remember that much without getting too distracted. It’s the times when I’ve visited a new doctor,and wanted to have the formation on hand for history and/or symptoms that are complex, or in the early stages of not knowing why I was sick, that I needed a list to show the doc I was going through something that warranted further, in depth investigation.
Some doctors looked at the paper and said ‘just tell me yourself…’, while others were like ‘oh pullese…’ while the good ones were more interested and asked questions. I don’t think the notes of symptoms and information make an appointment longer necessarily, but potentially help to keep things efficient and directed.

March 28, 2010 at 8:14 pm
(23) juliet says:

typo- information , not ‘formation’. Oops.

March 29, 2010 at 5:57 am
(24) Ciara says:

Some consultants seem to apreciate patients bringing a list – especially for a cons prior to surgery and they will spend as much time with the patient as they need. Others are rude, arrogant, condescending and ignorant regardless and probably should not have anything to do with actual patinet interaction. But sometiems it can depend onthe system they work under – if you have health insurance or cash, they’;ll spend as much tiem and aswer as many questions as you need. If you are a public patient – for which they are reimbursed forkm the system, they want you in and out as quick as possible.
For primary care physicians, I have no problem bring a list and taking as much time as I need whether they liek it or not.

April 12, 2010 at 8:59 pm
(25) Denise says:

I generally have not found the list to be received very well by drs. Despite those in the news media telling us over & over that bringing a list is a good idea, I found when the dr just sees the paper they get defensive & turn off. They already feel you willtake up too much time. I too have had hypothyroid symptoms for 30 years & find Mary Shoman & you all so valuable because my experiences are like yours. I know I am not alone. If somene had been willing to look at my list years ago they might have put them together. Instead I too got it thrown back at me before I even started with the words “I don’t have time for all that!” I have been perscribed Zoloft, Paxil,etc Anything but thyroid medication. But I keep trying because you all give me hope. Thanks

June 26, 2010 at 6:56 pm
(26) S says:

you think doctors would be greatful for a list ,so they can ‘get down to business ‘ so to speak. my old doctor was awful – a 10 min max if the surgery is not busy and you came out with the same medicine prescribed no matter what the problem is . my new one is not so good either-they enjoy sending as many patients as possible to psychologists. i am so sick off being fobbed off ‘nothing wrong with you, your all ways ill coz your fat, were you hoping the you were ill so we could fix you? ill see you in six months , i have a tight schedule ‘ hello – arnt they here to help us get better and listen to our concerns over OUR health? i have no faith in doctors any more-if the problem if not obvious they stop investigating.

October 19, 2011 at 1:08 pm
(27) James says:

The confusion and anger originates from the misconception your doctor is billing you for their time. Lawyers do bill in 10 minute intervals. Doctors bill for their education, knowledge, skill and diagnostic capability.
A list is fine if the patient tends to lose focus or distracts easily. Trouble originates on both sides when the patient tries to ‘get their monies worth of the 15 minutes’. Having an antagonistic approach as a patient can cause mirroring… and you receive what you deal out.

Standard Doctor is giving you the benefit of a minimum of 10 year post high school education and several hundred thousand dollars of education investment. Effectively, you have full access to their mental database during your appointment.

A very good friend of mine is an acclaimed potter. Someone asked her, “How long does it take to make one of your bowls?”
“35 years.” was her reply.

Not saying all grievances stated are wrong, but the standard attitude of paying for TIME is wrong.

Finally, your 15 minute appointment has additional Dr. requirements of charting, interacting with other Dr. on your behalf etc which patients are mostly ignorant of.

Doctors don’t waste the appointment explaining this misconception so thought I may have something to offer.

Peace to all.

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