by Tayla Holman

Many patients struggle with speaking up when they go to the doctor. Although learning how to advocate for yourself with your physician can be uncomfortable at first, it's necessary for getting the best possible care.

Why are patients afraid to speak up?

There are many reasons patients may be afraid to speak up when they go to the doctor. They may have had a negative experience with a previous doctor or they may feel like there isn't enough time to discuss everything. Some patients worry they will sound like they are challenging their doctor's authority by raising concerns.

The doctor's office can also be an intimidating environment, especially a first visit with a new doctor or a specialist.

"As patients, it is not always clear to us that things like communicating who we are and what we need are important things to share with our doctor," says Rachel Peavyhouse, director of Equity of Care at HCA Healthcare. "Sometimes patients aren't aware that who they are, their living circumstances, their backgrounds, their cultural norms, really do impact care, health outcomes and the physician's relationship with the patient."

By telling your physician more about yourself, you can ensure they are aware of all of your needs.

What support should you expect from your doctor?

Healthcare facilities need to make sure they are providing the space and time for patients to feel welcome to share more about themselves, according to Peavyhouse. Using digital interfaces to collect as much information as possible before the visit can help with that. Getting the paperwork out of the way beforehand reduces the amount of housekeeping that needs to be done during the visit and can allow more time for discussion with the patient and doctor.

Prior to the consultation, physicians should make it a priority to review information about how to address and identify the patient including their preferred name and personal pronouns, as well as cultural norms that are important to the patient and that inform the patient's care needs.

"The bottom line is, it's really about the relationship and the rapport between the physician and the patient, and we have to allow the space and time to cultivate and nurture that relationship," Peavyhouse says.

Tell your doctor about yourself and your needs

Physicians need to recognize each patient as a unique individual. This includes getting to know who they are, learning about their needs, beliefs and cultural experiences, as well as understanding a patient's healthcare goals. "It is important that patients think about what their cultural norms and assumptions of care are before they walk in that door," Peavyhouse says. By understanding your own specific needs, you're better able to discuss those needs upfront with your physician and receive more personalized care.

It's also important to disclose who else you want to include when making lifestyle and health decisions, such as a family member, companion or spiritual advisor. Cultural, religious and spiritual norms can affect everything from diet and activity levels to decisions around surgery, blood transfusions or palliative care.

For physicians, learning more about a patient's social determinants of health — such as their education, employment, socioeconomic status and living circumstances — is important because these factors can affect healthcare access, quality and outcomes. For example, many physicians recommend that patients modify their diets. This can be difficult for patients who have food insecurity and are unable to access high-quality or nutritious foods or whose cultural norms make those modifications difficult. If you're upfront with your physician about your circumstances, your physician will be better able to help you find solutions or resources that work for you.

Recognize and resolve language barriers

There can also be language or health literacy barriers that affect how patients are able to communicate with their physician. If there are language barriers, it's important to ask your healthcare facility for a qualified language interpreter to help you. Although you may feel more comfortable using a friend or family member, there are serious medical interpretation errors that can happen, Peavyhouse says.

Additionally, physicians tend to use a lot of medical terminology that patients may not understand. You should feel like you can stop your physician and ask for an explanation in plain language until you have clarity about your diagnosis and treatment plan. Another technique physicians sometimes use to ensure proper communication is the teach-back method. Asking the patient to explain the information they have received in their own words enables physicians to identify any gaps or misunderstandings. Studies have found that half of patients leave their visit without understanding what their physician told them, so make sure you have a full understanding before you leave.

What can you do if you feel like you're not being heard?

As a patient, remember that you have options if you feel like your physician is not listening to or addressing your concerns. According to Peavyhouse, it's not a bad thing to ask someone else to join the interaction between you and your physician, especially if you feel like you're not being respected. Nurses can help fill gaps in understanding, but there are also staff members within the healthcare facility who are there to ensure a positive patient experience.

"If you have a concern and you feel like you just can't get through to the doctor, or the nurse is not helping you, you can ask to speak to the patient advocate or the practice manager or the equity compliance coordinator or the person who's responsible for patient experience," Peavyhouse says. You can also ask for the Patient Rights document if you haven't already been given access to it. The document usually includes information about whom to reach out to if you have a concern. You deserve the best of care, so don't be afraid to advocate for yourself if there are aspects of your care that are not working.

"As patients, we need to be aware that we are engaging in an interaction with another person and sometimes, like in all human interactions, there can be miscommunications and misunderstanding. If we have concerns, and we feel things are at risk, it's imperative that we self-advocate by asking for clarification to ensure total understanding and respect," Peavyhouse says.

You know yourself better than your doctor does. Sharing as much information as possible, even if it doesn't seem relevant, opens the lines of communication and gives your doctor a holistic view of your health and circumstances. Don't feel embarrassed or ashamed to advocate for yourself so you can get the care you need and deserve.