Feeling Unheard at the Doctor’s Office? Here’s What Might Help
Physician and author Neil Farber shares simple ways patients can advocate for themselves, ask better questions, and get more out of increasingly short appointments
A skin check can take months to book with a dermatologist. By the time you see your primary doctor for the fever you had days ago, you’re already feeling better. That lingering headache you have? You’d like a couple of tests, but the 15 minutes are gone before you could mention it, and the visit is already over.
The same squeeze lands on the doctor, who wants the time to listen but doesn’t have it. The pace of a medical day is set well above the exam room, by schedules and charting demands that have grown heavier with each passing decade—little of it chosen by the doctor in the chair across from you. The patient and doctor have to find each other inside limits neither one set, and that matters most in the visits that carry the hardest news.
For decades, Dr. Neil Farber collected the stuff that never makes it into a chart: kids’ names, weekend plans, where patients were going on vacation. He ran on the conviction that knowing his patients was the medicine, that the 10 minutes before he even used his stethoscope did the real work. Then, in March 1997, his wife got sick and he found out how the whole thing feels from the other end of it.
Farber’s wife, Terry, had a brain tumor. The neurosurgeon examined her, put her MRI films up on a light board, pointed at the tumor, and told them that he could biopsy it, but he would rather remove it altogether to give her another year or two of life. (She lived another 25, until January 2022.) What was missing was everything around the news. He handed over the timeline unprompted, and when Terry started to cry, he just stood there. Farber held his wife as he cried as well. No one named what had just happened, that a life had been completely upended in one sentence.
Then he realized it wasn’t the surgeon’s fault. Farber had been through years of lectures on communication and had never once been taught how to hand a person the worst news of their life. So he went looking, and found Spikes, a six-step protocol for delivering bad news, developed by oncologist Robert Buckman. He learned everything about it and spent the rest of his career teaching it to students and residents, all while caring for Terry.
Then Farber became the patient. In the emergency department with acute appendicitis, a real danger at the age of 73, he waited hours in severe pain, becoming more ill as each minute passed. For the first time, he understood how invisible a patient can feel when the system is simply too busy to look.
Those two experiences became a book, Treating a Broken System, out this October. What’s in it is a set of practices, for both physicians and patients, most of them small enough to carry into any appointment. Farber’s also donating all book proceeds to the Academy of Communication in Healthcare and the Patient-Centered Outcomes Research Institute, two nonprofits focused on physician-patient communication.
Curiosity is the word Farber keeps returning to, and the tool he considers the most useful. He says roughly 80 percent of diagnoses can be reached from the patient’s history alone, before a single test is ordered, a figure that traces to a 1975 British Medical Journal study and has held up in replications since. Farber’s point is that a good appointment depends on both people doing their share. Most of us arrive unprepared, then feel unheard when the 15 minutes evaporate. His fixes are unglamorous, and they work.
He’s optimistic, too. Communication is now taught in every American medical school and most residencies, a shift that took hold around 2000 and a departure from the list of standard stock questions he was handed as a student at The University of Pennsylvania in 1972. Stock questions like: Do you have a fever and chills? When was your last menstrual period? How often do you have a bowel movement? Remediation also exists for physicians who never learned. At the Mayo Clinic, a program called Listen-Act-Develop lets physicians name the problems driving their burnout and gives them the authority to fix them. The next generation of physicians is being trained to be curious on purpose. Farber’s wager is that their patients can learn to meet them halfway.
Tips For Your Next Visit
Bring a written list of what you want to address, in order of what worries you most. A physician may not review it all in one visit, but a ranked list tells them where to begin and what to hold for next time. Also, bring a current list of your diagnoses and medications. Say something about who you are: your work, your hobbies, what you value, and what you would and wouldn’t accept in your own care. Lifestyle factors—like if you’d rather stay independent at home—push your doctor toward one treatment over another. The same diagnosis calls for different care depending on what the patient wants. A physician who does not know where you land is always guessing.
Say when you’re feeling rushed in the appointment: “I know your time is limited, but I have a few more important things I’d like to address before our time ends.” Saying this out loud takes nerve, and Farber believes most physicians will be grateful you said something. When a visit feels rushed, he also asks patients to tell the administrators behind those satisfaction surveys the truth: “Not that the doctor didn’t care about me, but they just didn’t have enough time with me.” Said often enough, that distinction is what moves an institution.
Don’t villainize the doctors: The burnout that compresses appointments, he says, is a result of time pressure on your doctor and the loss of control over the work. The stakes show up in the research: Burned-out doctors are more likely to make medical errors. Plus, chronic understaffing pushes burnout, and burned-out physicians are over three times more likely to want to quit.
Ingrid Yang, M.D., J.D. is a hospital-based physician in San Diego, CA, certified yoga therapist, and longevity specialist. She loves *double hearts* San Diego and spends her days helping people fully engage in long, healthy lives through evidence-based lifestyle medicine. Her books include Adaptive Yoga, Zen Mindfulness, and Hatha Yoga Asanas. When she’s not leading international wellness retreats, she is chasing sunsets, handstanding in nature, or geeking out over mitochondria.
