The Doctor Script
Three things to write down before, four sentences to say during, one to say before you leave, and when to ask for a second opinion. The appointment card, on one sheet. Part of The Humanual Toolkit. Free to read, print and photocopy.
A medical appointment is an information gap wrapped in a power gap wrapped in a time limit. You have the symptoms; they have the training; neither of you has enough minutes. The fix is structural: go in with three things written down, ask four sentences while you are there, and say one sentence before you leave. Print this and take it with you. Nobody will think it is strange. The good ones will be relieved.
Before: write down three things
- Your symptoms. What it feels like, where, when it started, whether it is constant or comes and goes, what makes it better or worse, how bad it is out of ten, and what you have already tried. “I feel bad” is hard to work with. “A sharp pain low on the right side, three days, worse after eating, seven out of ten” is a case.
- Your questions. The specific things you want to know, in order of how much they matter. If you leave without asking them, the appointment failed, whatever else was discussed.
- Your medications. Everything you take: prescriptions, over-the-counter, supplements, and the bottle with a leaf on it that a colleague recommended. Bring the actual bottles or a photo of the labels; the doctor can read them and you cannot pronounce them, and that is fine.
Also write the one thing you are afraid to say. The embarrassing symptom, the thing you looked up at 2am, the lump you have been not-mentioning. It is the reason you booked. Say it first, not at the door on the way out.
During: four sentences
When you do not follow
“Can you explain that in plain language?”
Before agreeing to any treatment
“What would happen if I did nothing?”
About the treatment itself
“What are the risks and benefits, in actual numbers?”
Before you accept the diagnosis
“Is there anything else it could be?”
The first is quality control, not a confession: if it cannot be explained plainly, either it is complicated and you need more time, or it is being explained badly and they need to know. The second is the most under-asked question in medicine; a surprising number of things get better on their own, more slowly, and the appointment is built to do something rather than say so. The fourth is a courtesy to a tired brain: doctors anchor on the first plausible diagnosis like everyone else, and the question invites the alternatives they may have considered and not had time to say.
The numbers to insist on
If a treatment cuts your risk of something from 2 percent to 1 percent, that is a 50 percent relative risk reduction, which is what the advertising says, and a 1 percent absolute risk reduction, which is what will actually happen to you. Ask for the absolute numbers: “Out of a hundred people like me, how many does this help, and how many does it harm?” If the answer is not known, that is also an answer.
After: say it back before you leave
Twenty seconds, every time
“So, what I am hearing is that I have X, the plan is to try Y, and I should come back if Z. Is that right?”
Clinicians call this teach-back and are trained to ask it of you; doing it yourself catches the misunderstanding that would otherwise run for weeks, and gives them the chance to correct it, which they cannot do if you nod and flee. Then ask the last two: “When should I expect this to improve?” and “What would make this urgent?” Write the answers on this sheet.
When to push back, and how
The second-opinion rule
For any significant diagnosis, any recommended surgery, or any treatment you will be on for years, get a second opinion, and say so plainly: “I would like a second opinion before I decide. Can you send my notes and results to name?” No competent clinician is offended by this; many will suggest it. In one Mayo Clinic study of 286 patients referred for a second opinion, the second doctor confirmed the original diagnosis in 12 percent of cases, refined or better defined it in 66 percent, and reached a distinctly different diagnosis in 21 percent. Those are referred patients, not everyone, so the numbers overstate the risk for a routine visit; they do not overstate it for the visit that changes your life.
Keep your own file
- Diagnoses, with dates, and who made them.
- Test and imaging results: ask for a copy every time, in writing or through the patient portal. You are entitled to them.
- Current medications and doses, and the ones you stopped, and why.
- Allergies and reactions.
- Operations and hospital stays.
- Vaccinations.
- Every call to an insurer or a billing office: date, name of the person, what they said. Read it back to them before you hang up.
Once a year, put every bottle in the house on the table and ask three questions of each: Why am I taking this? Is there evidence it works for that? Would my doctor know I take it? Anything that fails two goes on the list for the next appointment.
Sources. Teach-back: Agency for Healthcare Research and Quality, Health Literacy Universal Precautions Toolkit, Tool 5. Second opinions: Van Such M, Lohr R, Beckman T, Naessens JM, “Extent of diagnostic agreement among medical referrals,” Journal of Evaluation in Clinical Practice, 2017; 286 Mayo Clinic referrals. Relative versus absolute risk: the worked example is illustrative. Your right to your own records: HIPAA (US), UK GDPR and the Data Protection Act 2018 (UK), and equivalents elsewhere. The symptom triage that tells you where to go in the first place is on The Body’s Dashboard.
Other pages, printable
New pages are added as they are finished, and the index is always the current list. The Toolkit indexThe five volumes