PCOS Messages for December, 2001: Re: Advice please! How to be assertive with doctor? (Long, sorry!)

Re: Advice please! How to be assertive with doctor? (Long, sorry!)

From: Renee (anonymous@obgyn.net)
Thu, 29 Nov 2001 08:36:57 -0800

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Chris,

It can be tough to be assertive if a doctor has an authority complex or thinks s/he knows it all. If the doctor is open, like mine, then I can just suggest things. For example, I wanted to try changing to Actos from met. He agreed and gave me the Rx. But,when I got the bottle, and read the lit, I saw that it can decrease the contraceptive effect of BCPs, which is a desired effect, and decided I'd stay with met. I just called my doc, spoke with the nurse, and told her that I wanted to change back. She called it into the pharmacy for me. I am lucky that with my doctor, when I suggest something, he just reads about it to make sure it's compatible and won't hurt me if he's not familiar with it (eg: when I asked for Vaniqa the month it was released), and prescribes it.

I have to deal with the less agreeable type of doctor all the time at work. Here are some tips: 1) Speak his language. Use the jargon. Learn some medical terminology. Use the medical, not common names, of body parts. It gives you more credibility, and he's more likely to listen to you. It shows that you know something (even though you know the same thing if you use regular language). 2) Give reasons for your request. Don't just say, "I want to try medication X." Try "I've been doing some research on hormone medications. Premarin contains no 17-beta estradiol, which is our natural estrogen, and therefore many women do better with actual 17-beta estradiol given transdermally. I'd like to try that." 3)Defer to their "superior knowledge". Some docs will resist anything you demand, just to show that they are ultimately the one with the power. In that case, you can frame a request as a question. In the above example, the last sentence could be changed to, "What do you think?" or "What has been your experience with that?" Even better for the tough ones would be, "Premarin contains no 17-beta estradiol, which is our natural estrogen. Do you think that giving it transdermally would be effective?" Professionally, with one particular doctor, if I said, "Mr. X is walking independently and knows his exercise program. When do you think he'll be ready for home?" he'll say that day. If I say, "Mr. X is walking independently and knows his exercise program. He can go home now," he'll keep him an extra day or two. 4) Bargain. Suggest a trial, not a firm committment. "Can I try this for a month, then call/visit you, and we can see how it's working?" That way it gives an opportunity to change it, and not be locked into it. I usually use this tactic after their plan isn't working for a patient; I ask for 1 week to try my plan, then discuss the results. 5) Support your request. You said you have read articles. Bring them with you. When you say you've learned about 17-beta estradiol, give him the articles. Doctors only like articles from doctors. I can have research from an excellent nurse, but if it's not written by a physician in a medical journal, it has less credibility just from the titles. Ugh! 6) Give him lead time. One thing I do is fax my doctor a letter before I see him, stating my concerns and what I want to talk about. I'll include articles or bibliographies or prescribing info or whatever I think he'll need. That way he has time to consider it, and not get caught off-guard. When someone is surprised by an unexpected request, the comfort position is to go to the familar. If they can think about it for a day or 2 first, then they might be more open. Plus, it gives them time to read the info so you can get the answer right away. If I bring new information to my doc at the appt., then he will want to read it before doing something very different. 7) If all else fails, change docs.

I hope these help. They work for me, personally and professionally.

Renee

>
> At Wed, 28 Nov 2001, Chris wrote:
> >when you know what drugs may help you,
> >*how* do you ask the doctor for them without seeming pushy? I have
> >really made great strides in the last few months with getting more
> >assertive, but I still have a problem with requesting drugs. For
> >example, when I left the lst appointment, she gave me a sample of
> >Estrostep bcp. I asked, "Wouldn't a monophasic pill be better?" And she
> >said no, she's had good luck with this pill. So what could I say? Well,
> >I got home and went into one of my research frenzies (!) and found that
> >Estrostep has one of the highest androgen contents of all the bcps.
> >(Acne is my main complaint of PCOS.) So I didn't take it. What I think
> >I need is a higher estrogen, lower progestin and androgen monophasic
> >pill for birth control (like Ovcon or Orthocyclen) and possibly a little
> >extra estrogen, (like Alora or Vivelle but NOT Premarin) to help my
> >fatigue and memory loss. I have read several articles that indicate
> >that Premarin is the most widely prescribed estrogen, but contains no
> >17-beta estradiol, which is our natural estrogen, and therefore many
> >women do better with actual 17-beta estradiol given transdermally. But
> >I can just see it now, she'll say, "Let's get you on a low dose of
> >Premarin and keep taking the Estrostep." So, do I lie and say I spotted
> >on the Estrostep (which I never took) and I'd like to try Ovcon? Do I
> >say my mom had bad results with Premarin (another lie, my mom never took
> >it) and I'd like to try a 17-beta estradiol? I hate to lie, but I also
> >hate to be pushy and act like I know more than she does. How do I
> >assert myself without sounding like a know-it-all? Help!!!!
> >

-- Renee Cordrey, MSPT, MPH, CWS

---

Don't follow in the footsteps of the masters. Seek what they sought. --Zen saying

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