1 Question, 5 Answers is a column where we ask different types of healthcare pros to weigh in on the same issue.
There might be no such thing as a stupid question, but there are plenty of embarrassing ones. While issues like butt pain, bladder leakage and mysterious genital spots are the stuff of perfectly valid, important medical inquiries, they’re not usually topics of polite conversation — which might explain why so many of us consult the internet for information on less-than-savory functions of the human body. Americans, for example, look up hemorrhoids online an estimated 120,000 times per week.
Still, it’s better for us to pepper our doctors with cringey questions than hold our tongues. We asked five healthcare providers to tell us which issues make patients blush most often, and what both doctors and patients can do to make awkward exam-room conversations easier to get through.
Dr. Andrea Matho, MD
Clinical assistant professor of pediatrics and internal medicine, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California
Los Angeles
I find that people hold back from asking questions or sharing information with their physicians for a lot of different reasons. They may feel embarrassed about their symptoms, ashamed about a body function, whether physiological or pathological.
Sexual problems, as well as issues related to urinary and bowel habits, are common topics that people tend to be reluctant to discuss out of embarrassment. There is also unfortunately a lot of stigma remaining with regards to certain conditions, including mental health concerns, memory issues, STDs, aging, gaps in health literacy and even financial struggles. People perhaps don’t want to admit that they haven’t been taking a medication they were prescribed, or did things they know are detrimental for their health (smoking or using recreational drugs, for example).
My suggestions: I often tell my patients to write down questions as they come up, so they remember to ask them when we meet in person. People often get anxious or flustered at the doctor’s office, but keeping a written list can help spark the conversation more easily.
Don’t be afraid to ask questions. We spend all these years in school learning the language of medicine so we can help interpret it for our patients, which is as important a part of our job as is our prescription pad or scalpel. I also recommend, if possible, finding a doctor that you feel listens to you, with whom you are at ease and feel your concerns are being heard. It may never feel 100 percent comfortable talking about intimate issues and body functions, but remember that doctors are used to talking about these sensitive subjects. Talking about poop and pee is just part of our daily routine.
Dr. Daniel Summers, MD
Pediatrician at Boston Children’s Hospital and columnist for Slate and Arc Digital
Boston
In pediatrics, the issues parents are most reluctant to bring up are generally ones where they have a sense that their parenting deviates in some way from what doctors recommend. There are all sorts of examples: giving in to picky eating, letting kids crawl into bed with them, not limiting screen time as much as they think they should. I think there’s a lot of shaming that’s inappropriately wrapped up in how medical providers address these issues. I make an effort to discuss them in a manner that’s free of that dynamic and acknowledges how challenging parenting can be, despite our best intentions.
Children may hold back, too. For instance, gender issues are something that people are very reluctant to bring up. For trans or gender nonconforming kids, if they fear parental disapproval, that’s a huge barrier to care. I think medical providers for children need to do a much better job at asking proactively about gender development in a manner that seems routine and nonthreatening to parents and patients alike.
Dr. Setareh Alipourfetrati, MD
Resident physician at Mount Sinai St. Luke’s and Mount Sinai West
New York City
I’ve found that sometimes patients try to tell the doctor who they want to be, not who they are. They tend to keep information that they themselves judge negatively. The routine question about the number of sexual partners is a prime example. If it’s too many, based on the patient’s perception of an appropriate number for sexual partners, they have a hard time answering. And if they don’t have any, then they are embarrassed about not being sexually active and often try to explain why. Similarly, many patients hold back information regarding their use of recreational drugs, shy away from bringing up certain complaints, such as constipation or sexual impotence, and even lie about their adherence to medication. The latter can be a big problem, as the doctor may change their medication thinking the first one is not working, whereas they just haven’t been taking it.
I think doctors should always keep in mind that patients may not volunteer certain information until they are asked in nonjudgmental, open-ended questions. When taking history of drug use, for example, if I ask the patients, “Do you take drugs?” many say no. But if I press further and ask if they have ever, maybe once in their life, tried any drugs just for fun, then some admit they’ve been using IV drugs until yesterday. Instead of asking if a patient is taking their medication, I might ask how they score their medication adherence, from zero to a religious 10. Then I hear answers that more closely reflect the reality. Asking more open questions nudges the patients to give you the data you need.
My advice to patients is to never lie about a medical question. If you don’t want something to go on your medical record, just say you don’t want to answer this question. And don’t hold back anything out of fear of being judged by your doctor. We don’t judge, we only care about giving you the care you need. It’s helpful to be reminded that your doctor works for you. Just like a lawyer does — you don’t go to them just when you are good. You also go to them when you are bad.
Dr. Len Horovitz, MD
Director of Carnegie Medical P.C.
New York City
From my experience as a doctor on Park Avenue in New York City for 30 years, I can say I’ve seen and heard a lot. You can imagine what the walls of my consultation room have heard: everything. Nothing shocks me.
A doctor’s job is to be available and open should patients want to discuss any sensitive issue. To help them out, I just very simply ask a few questions at the end of the medical part of the interview. I start out with asking about things like mood and sleep. Then I ask if there’s anything of medical, or psychological or even spiritual nature that they would like to ask me or tell me. If they don’t take the opportunity then, usually somewhere down the road they will open up. When people first come in, they can be a little intimidated. But there’s a way of telling the patient that the doors are closed and everything here is confidential — is there anything you want to say?
It still surprises me how uncomfortable people are when they are trying to communicate. People generally lie about the amount they drink. So I ask how much they drink, and double it in my mind. Sexual health questions, for example about erectile dysfunction or testing for sexually transmitted diseases, are another problematic topic. I don’t take sexual history or orientation. I simply ask, “Are you sexually active? Do you want to be tested for any STDs?” That’s all I need to know — not the stories. I try to cut to the chase and keep it medical.
My advice to patients: Many illnesses can be prevented if they are diagnosed early. It’s better to be transparent with your doctor than to risk dealing with the consequences of a bigger problem down the road. If the doctor recommends a test, go and have it, without having to be chased. That’s what makes my job difficult: chasing people. And lastly, try to find a doctor you are comfortable with. An internist is a little bit an armchair therapist, someone you can trust and open up to. The right patient-doctor relationship is the foundation for all of these things.
Dr. Ali Ezzati, MD
Research scientist and instructor of neurology, Albert Einstein College of Medicine Montefiore Medical Center
New York City
Many patients feel uncomfortable asking about side effects of treatments. This is common both when the medication is first prescribed and during follow-ups. At the initial visit, patients are usually hesitant to ask such questions because they might not have any prior information about treatment options or because they are only focused on treatment of the primary disease and not concerned about the side effects. In addition, some patients might be concerned that asking a question about this from the doctor is equivalent of questioning doctor’s decision-making. During follow-up visits, some patients might not be willing to share side effects that affect psychosocial or private aspects of their lives. For example, a very common side effect of neurologic medications is sexual side effects, which I have found patients are very reluctant to discuss.
I try to follow the guidelines and discuss side effects and what to expect (or not to expect) from treatment with patients upfront at the initial visit. Providing a summary of most common side effects and subsequently asking if patients have any concerns about them is usually effective. If one patient shows concerns about this, I usually provide a printed version of information about that specific treatment to the patient. In follow-up visits, I always try to ask about incidence of new treatment-related side effects, specially the ones that I believe patients might be hesitant to share.
I encourage all patients to be very open with their doctors and ask them about the rationale for any treatment or intervention, and its particular benefits and possible side effects. I have found that this approach can help with managing patient’s expectations and improve overall quality of care.
Responses have been condensed and lightly edited.
For the physician who comments that they assume patients are not revealing the truth-that, he doubles the number of drinks in his head that his patients state. The first step in creating an atmosphere where patients open up is to trust them and believe them when they tell you something. Everyone is capable of reading the body language of a physician who doesn’t believe their answers. I for one would not open up to any physician who doesn’t take me at my word.
Oh, please. I am a nurse, but more importantly. I come from a very “social” friends and family circle, I am related to and have been married/involved/engaged with several gentlemen who have enjoyed their vices. I try not to fall off my chair laughing when they answer the doctors’ questions about drinking and drugs! Better yet, this circle includes some medical people, nurses, PA’s, paramedics, etc
My, what a piss poor article!
You don’t play/write by the basic rules. You’re out. Educate yourself! Sheesh!
You numbered the items in the headline. You SHOULD HAVE numbered them in the article as well!
Why didn’t you? Why don’t you do it the way you should?? Why don’t you care enough to do it right?
Stating physicians don’t judge is absolutely 100 false. I’ve worked with plenty to know they do and now that I’m chronically ill Donto some poor life style choices I know they do even more so based in the treatment and medications they will not will not give me. Never ever put your faith in one doctor alone and if your being judged drop them like a hot potato and search for the rare ones who don’t. If not it can effect you surviving or being diagnosed properly.
I think Dr. Horovitz attitude is appalling: “People generally lie about the amount they drink. So I ask how much they drink, and double it in my mind.” I wonder if he doubles the amount on patient records as well as in his mind. I do not know Dr. Horovitz, but imagine that his willingness to substitute intuition for trust would be a problem, and that problem is probably apparent to many of his patients.
Poppycock. Dr’s are bogged down by insurance companies and business administrators. In the end, medicine is a business and time is money. The days of sitting down and discussing health issues with a Dr at any length is over.
Wow, people are really sensitive about that drinking question. The word “lie” is probably not the best way to phrase it. Maybe a better way to think of it is that most people are bad at estimating how much they drink for a number of reasons – embarrassment, denial, shame, or simple lack of paying attention. It’s wise for a doctor to take that into consideration so that he or she is working with an accurate number instead of a flawed patient self-assessment.
On a separate note, I think one subject that patients avoid talking with their doctors about is: major health issues which may be considered a pre-existing condition and therefore might affect their ability to get or keep insurance. I know many people who don’t bring up concerning health issues because they don’t want it on their health record. It’s a sad state of affairs in the current American healthcare system.
Oh my. It’s 2019 and according to the Institute for Safe Medication Practices, the 3rd most common safety issue for patients is “provider inexperience or lack of comfort with psychiatric disorders”. So, why would anyone admit to depression, bipolar episodes, delusions, hallucinations, or other psychiatric symptoms, especially given a MANHATTAN physician (read: very rich) who never believes his patients?
Reading the “Privacy” policy at my major hospital/provider conglomerate (Mercy); It clearly states they will give any patients PHI to any law enforcement with or WITHOUT a subpoena!? (Furthermore it states you will NOT be informed even If you make a formal request!) Why the secrecy? If law enforcement or “other”* can’t/won’t/didn’t get a subpoena; why presume your patient/paying customer is outside of the law? Trust? Sure. What harm could that do? *Privacy policy actually states…. any law enforcement or other pursuing a suspect.”. Not a criminal. A suspect which I presume to them as ALL are.
…edit last comment….I presume to them, we all are.