What brings you in here today?

It's a simple question that's at the heart of many patient-doctor conversations, but it's not a question to take lightly. Discussing your symptoms with a doctor, nurse, nurse practitioner or physician’s assistant can be one of the most important tasks you perform as a patient, putting you on the right road to treatment and recovery or sending you down a blind alley of confusion and misdiagnosis.

What to Say—and How to Say It

As a family doctor, Carol "Vicki" Koenig knows what she wants to hear from her patients. "It is their symptoms —what the patient feels, what makes it better or worse, what’s worked before and what hasn't," said the retired physician from Exmore, Va.

During Patrina Reddick's chemotherapy for breast cancer, her son kept an ongoing, written record of all the side effects she experienced. "I had to find a way to tell them how I was feeling each day," says Reddick, a counselor and mentor from Charlotte, N.C.

Your symptoms are what you know. When you describe them to your clinician, that’s the time when she or he is learning from you. Here are a few tips on what to say when describing your symptoms and sharing your personal health knowledge:

• Give your health care providers a basic description of your problem—one to two sentences should do it
• Tell them when you experience the symptoms and how often they occur
• Let them know if anything makes the symptoms better or worse
• Tell them if you have ever experienced the symptoms before, and under what circumstances
• Tell them if anyone else in your family or workplace is experiencing the same symptoms.

These questions can help the doctor sort out with you whether your symptoms relate to a new condition, an old medical problem, or a side effect of your medications. Although we think of symptoms as "problems," some symptoms can be good news, signaling an improvement in the way you feel or a sign that your current treatment is working.

How you describe your symptoms can be just as important as what you describe. Most physicians—and experienced patients—urge you to be as detailed and descriptive as possible, to help zero in on a diagnosis and track the progress of your care.

• Adjectives are important. Don’t just call it pain, said Shelley Ellis, a Dallas, Texas consultant with endometriosis. "I would use descriptive words like dull, throbbing, intense, or piercing." Sometimes ranking pain on a scale from one to 10 (with 10 the highest for example) can be a good way to track changes and severity of your discomfort.

• Describe how symptoms change your daily life and ability to function. A June 2009 story in the The Washington Post detailed a "medical mystery." For months, doctors could not pinpoint a woman's diagnosis. The story concluded that the medical team should have "thought outside the box," but the patient wondered if she also could have been more clear. Instead of saying she was "tired," talking about changes might have raised red flags: she became too weak to use a blow-dryer and needed two hands to lift a glass of water.
  
  Rather than just telling your doctor that "I can't do things like I used to," be specific. "I'm  sleeping 12 hours a day," or "I can't walk to my mailbox anymore" or "I have trouble standing up more than 10 minutes," give context and explain any measurable differences in how you carry out daily activities.

• Be sure to give a location for your symptoms, and don't be afraid to point if necessary and possible to do so. In some cases, a picture can help you tell the story, as Linda Jitmoud found out. When she wanted to show her swollen glands to her oncologist, the Lexington, Ky., writer snapped a photo to bring in to her next appointment.

• Writing down your symptoms can help you remember everything you're experiencing and make your time with the doctor more efficient. Carol Jay Levy, a North Wales, Pa., resident who suffers from chronic pain, recommends keeping a symptoms diary if you have a chronic illness. "Having a diary so you can be very specific when you visit the doctor always helps," she said. "Then you can tell them, 'I feel worse at night, when I'm tired, when I stand for 15 minutes.'"

"I used a combination of verbally telling my story along with a sheet of paper that summarized what I was experiencing," Ellis said. "In every case that piece of paper made the most difference in my next course of treatment."

Your Symptoms, Your Say

But remember: not everyone describes symptoms the same way, and you may have to try several times to get your story across. Some people describe asthma symptoms as more of an upper-respiratory phenomenon, like a tight or itchy throat, while others described a more lower respiratory response like "hurts to breathe" or "out of air." Doctors expect to hear: "shortness of breath" or "wheezing."

• Doctors want to hear how you feel, not what you think your diagnosis is, said Davis Liu, a family physician in Sacramento, Calif. Although you might come in saying you think you have the flu, "doctors are very specific with terminology and what you mean could be completely different than what a doctor understands the term to mean," he noted. Instead of saying that you have a certain condition, talk about how you've had a fever for three days, or that you have a sharp pain in your stomach.

• Be insistent about your symptoms if it feels like your provider isn't clear on what you're experiencing. Your doctor may have the technical knowledge, but only you can accurately describe the impact your symptoms have on your life. A recent report in the New England Journal of Medicine found numerous studies showing that doctors often downgrade the severity of patients' self-reported symptoms, particularly when it comes to medication side effects. It may help to keep a record of the frequency and severity of your symptoms, so you can talk about them with certainty.

• Finally, you might have difficulty describing your symptoms if they sound embarrassing, if they are about sexual activities or concerns , if they may be as a result of actions that are illegal (like drug use), if  you fear you may be judged or criticized (like using alcohol or smoking), or if they relate to emotional or personal problems. You could start the conversation by saying something like, "This is difficult for me to share with you but I need your help…"
  
  But if you can't trust your doctor with this kind of information, says Koenig, it's time to find another doctor. "If you took the time to make the appointment, at some point you have to screw up your courage and say what's on your mind," she says. "The doctor is not a mind reader. And there is nothing a doctor hasn't heard or dealt with before."

An Urgent Conversation

If all of this hasn't convinced you that the symptoms conversation is an important one, consider this: the average doctor's visit lasts 13 minutes. It pays to be ready to tell your story.

"Knowing the amount of time my doctor can spend with me is important," Levy said. "If it's only a few minutes, I need to be prepared with the most important thing to say. Coming with a list helps so the time is not wasted with thinking of what I may have forgotten."

The symptoms conversation can set the tone for your future care, helping your doctor correctly diagnose your condition and work with you to start the right treatment plan.

Communicating With Your Health Care Team

"Science has provided many wonderful medications and tests, but the doctor's decision to order a test or prescribe a medication most often depends on the information provided by the patient."
--Ohio State University PACE System

From the moment you pick up the phone to schedule an appointment, you’re sharing vital information with your doctors and other providers that can help you get the best possible health care. Registered nurse Mary Jo Kreitzer, Ph.D., director of the Center for Spirituality and Healing at the University of Minnesota, has developed a 20-minute interactive guide to help you better communicate with your health care team.

Kreitzer’s online module, can help you learn what to say, what (and who) to bring, how to ask for what you need, and what information you should have after you leave the doctor’s office.

Published by
Health Behavior News Service
Lisa Esposito, Editor
Written by
Becky Ham, Science Writer

Designed by
Brandon Moore, IT/Comm Manager

The Health Behavior News Service, of The Center for Advancing Health, does not provide medical advice or consultation. The Prepared Patient is a new series intended to help people make informed choices about their health care.

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