Straight Talk in the Exam Room
Surveying the patient's medical record, it was clear what I was about to confront. I opened the door to the exam room, and the patient glanced up and instantly read the concern on my face. Before I even said a word, her eyes began to fill with tears, and she buried her head in her hands. I waited, standing in silence for a few minutes until her composure signified that she was capable of talking.

For the next 15 minutes, I spoke about what the tests had shown, answered her questions about treatment and prognosis, and wrote notes for her to take with her in case she forgot the details. I leaned forward as I listened to her fears, and I assured her we would get through this together.
I did everything perfectly -- or so said the professor who reviewed the encounter between the actress and me. Many medical schools build these staged meetings into the curriculum. They hire startlingly convincing actors so that doctors-in-training can experience the difficult scenarios they'll face as physicians.

Although studying the mechanics of body language, intonation, and nonverbal cues may seem like a sterile approach, it helps develop communication skills. Physician educators, of which I am one, are doing their best to teach medical students how to relate to patients. That said, communication is a two-way effort. Patients with a combative approach are less likely to obtain information they want. They, too, need to know how to talk with doctors.

Looking Past the White Coat
Becoming a doctor is not easy. The job itself, although rewarding on many levels, is also difficult. A doctor will not argue if you want to put her on a pedestal, but don't let this respect for the profession prevent you from communicating effectively about your concerns.

It's virtually impossible to embarrass or shock a doctor. We've seen or heard it all. But if you feel uncomfortable bringing up certain issues, go into the appointment with a typed (not handwritten) list of questions and give it to the doctor. As your doctor goes over the list, she'll be the one bringing up the issues, which will save you from having to initiate the conversation.

Patients also worry about raising issues because they don't want to waste the doctor's time. Although time is indeed precious, your health is more so. Your doctor needs to hear your concerns. If she says the problem is nothing to worry about, then the visit will have alleviated your stress. More seriously, the symptom or complaint could signal a larger problem, and taking care of it as soon as possible will save you and the physician much more than time in the long run.

And how do doctors really feel about second opinions? If the consulted physician concurs, your doctor will be thrilled to have her diagnosis validated. If not, she might actually relish the opportunity to learn a new approach. Because the field of medicine is so broad, doctors are encouraged to learn from one another. By seeking out an additional opinion, you're merely facilitating that process. This is not to say that your physician won't feel bad if you choose an alternative approach. Pride is a powerful thing, and doctors don't like to make mistakes. Tell your doctor you admire her efforts to put your interests before her own.

Lastly, what do doctors think when you don't ask questions? They assume you don't have any. The onus is on you to raise questions you want answered.

Learn the Language
If you've ever traveled to a country where a different language is spoken, you know that learning a few key words and phrases can greatly enhance your experience. Visiting the doctor is no different. If you have a complaint or a concern, do some research first. Reading up on rashes, for example, will enable you to provide a more accurate description than "red and itchy."

On the Internet, start with WebMD or a search engine. For more in-depth information, consider the websites of the National Institutes of Health or the Centers for Disease Control and Prevention. Sometimes even I refer to these. If you have more time, consult a reference book, such as the Merck Manual or Harrison's Principles of Internal Medicine, in the library. Developing a knowledge base will help you form smart questions and make it easier to understand what your doctor tells you.

It may also be helpful to think the way physicians are trained to think. Doctors generally organize the story you tell them in the form of a SOAP note; SOAP stands for subjective, objective, assessment, and plan, which I outline below. The format facilitates efficient communication with your doctor. It works for office visits but is perhaps more useful when you're communicating via telephone or email.

Subjective
This is the what, when, where, how, and how long part of your preliminary discussion. Answering these questions up front will give you and your doctor a detailed history of what's going on.

Objective
This is the point after the examination when your doctor records her findings. If you are talking with your doctor on the phone or writing her an email, be as descriptive as possible about physical changes you've noticed that pertain to the problem that has been worrying you.

Assessment and Plan
For these, the doctor formulates a list of potential diagnoses and comes up with a plan for further testing or treatment. But don't think you can't contribute here as well. It is not an overstatement to say that my patients can diagnose themselves 60 percent of the time. With a little homework, so can you.

If you'd like to delve deeper into how doctors approach their jobs, read Jerome Groopman's book "How Doctors Think" (Houghton Mifflin; 2007).

Timing is Everything
To help you make the most of your visit, here are some doctor-patient communication strategies that, in my experience, tend to work well. I find email to be the most efficient, as I can read and respond more quickly than listening to a phone message and returning a call. A recent study found that email improves access to doctors and facilitates patients' understanding while using 57 percent less of doctors' time than called-in questions. (However, if there is a true emergency, email correspondence can be flawed.) I also spend extra time when first getting to know a patient to educate her on the scenarios in which I would prefer to be paged -- but if your doctor doesn't bring this up, by all means ask.

It's important to keep in mind that every doctor is different. If you are seeing someone for the first time, ask her how she prefers to receive questions. You may also wish to ask nurses or office assistants, the people who know the doctor best, if they have any advice on communicating with the doctor. While you're at it, make friends with everyone who works in your doctor's office. The medical and administrative assistants are often the first people you interact with when trying to see your doctor. Take the time to get to know the staff and be considerate to them, and your message is more likely to move to the top of the pile.

You may also wish to divide your questions into two groups: those only your doctor can answer and those a staff member may be able to address. For the latter, call ahead and find out if you'll have the chance to speak with a nurse or an administrator before your scheduled time with the doctor.
If more than five questions remain for your doctor, email or fax them to the office at least one day before your visit, and ask that the list be clipped to the front of your medical chart. Your doctor will see it as soon as she picks up your folder and will enter the room prepared for the session and able to budget the time to address your concerns during the visit.

This may seem like a lot of work. Consider it an investment in your health, one that will reap many rewards. You and your physician must collaborate when it comes to creating the best wellness plan for you. Finding the clearest, most efficient way to communicate with each other is essential to making this happen.

If you'd like to learn more about communicating with your doctor (or would like to get some practice), go to marthastewart.com/healthqa and post your question on the message board before January 30. I'll answer and comment on as many as I can on January 31.

Text by Brent Ridge, M.D.