“I just feel off” is true, and it is hard to work with. Clinicians build a picture from a handful of specific details, and they ask about them in roughly the same order every time. If you bring those details with you, your symptom is understood the first time instead of being pieced together from follow-up questions in a short visit.
The same study found that patients who were not interrupted took a median of just 6 seconds to say what they had come in for.[1] A clear opening is short. It just has to be prepared.
Start with one sentence
Put the most important facts into one sentence you can say right away: what it is, how long, and how it is affecting you. For example: “I’ve had pain in my lower back for three weeks. It’s getting worse, and it’s now waking me up at night.” Everything else can follow from questions.
“Explain your symptoms, health history, and any problems with medicines you have taken in the past.”
The details clinicians listen for
When it started
The date, or as close as you can get, and what you were doing. Did it come on suddenly, in seconds or minutes, or gradually over days?
Where it is
Point to it. Is it in one spot or spread out? Does it move or spread anywhere else?
What it feels like
Use your own words, and be specific. For pain: sharp, dull, burning, throbbing, aching, cramping, pressure. For other symptoms, compare with something familiar: “dizzy like the room is spinning” is different from “dizzy like I might faint.”
How bad it is
Give a number from 0 to 10, where 10 is the worst you can imagine — and then say what it stops you doing, which is often more telling than the number. “A 6, and I had to leave work” carries more information than “a 6.”
Timing and pattern
Is it constant, or does it come and go? How long does each episode last, and how often does it happen? Is it worse at a particular time of day?
What makes it better or worse
Movement, rest, eating, position, time of day, stress, medicine you have tried — and whether the medicine helped.
What comes with it
Anything else that happens at the same time, even if it seems unrelated: nausea, a fever, a rash, trouble sleeping, changes in appetite.
What has changed
Is it different from when it started — more often, more severe, in a new place? If you have had something similar before, how is this time different?
Also say
- Every medicine and supplement you take, and anything you have started or stopped recently.
- What you are worried it might be. It is a fair thing to say, and it lets the clinician address the worry directly.
- What you want from the visit: an explanation, a test, relief, reassurance, a plan.
What makes a description harder to use
- Leading with a conclusion. “I think it’s my gallbladder” can narrow the conversation too early. Describe what you notice; then, if you like, say what you are worried about.
- Minimizing. Many people downplay symptoms in the room. If it kept you awake or off work, say so.
- Saving the main point for the end. The concern raised as you are leaving gets the least time. Say it first.
Write it down beforehand
Memory is unreliable under pressure: a review of research found that patients forget 40–80% of medical information immediately.[3] The same is true of what you meant to say. A few lines written before the visit — your opening sentence and the details above — keep you on track. A symptom log answers the timing and pattern questions for you, and the appointment preparation guide covers what to bring and what to ask before you leave.
Sources
- Singh Ospina N, Phillips KA, Rodriguez-Gutierrez R, et al. Journal of General Internal Medicine 2019;34(1):36–40. Eliciting the Patient’s Agenda: Secondary Analysis of Recorded Clinical Encounters.
- Agency for Healthcare Research and Quality (AHRQ). Be More Engaged in Your Healthcare: Tips for Patients.
- Kessels RPC. Journal of the Royal Society of Medicine 2003;96(5):219–222. Patients’ memory for medical information.