White coat silence. That’s what a recent article in the Journal of the American Medical Association called the button-the-lips approach many patients have when they walk into their doctor’s office.
Many people think that if they don’t talk much or ask a lot of questions, they’ll get a better report. That’s simply not true. Then there are others who fear sounding stupid if they ask questions.
Still other patients see the doctor’s white coat as a symbol of authority that should be respected. I’m all for respect, but that includes my respect for the patient – which begins and ends with an open dialogue.
White coat silence is real. But where do those barriers come from?
Literacy is the No. 1 factor. A college-educated person is more likely to ask questions than a skilled-trades worker. If you’ve asked questions in class, you’re more likely to ask questions in the examination room.
Next is financial situation. People who make more money usually ask more questions at work, so they do the same in my office. If you’re told what to do all the time at work and are not asked to participate in the discussion, you often do the same thing when you see that white coat.
Age also plays a role. The younger you are, the more likely you are to question the doctor. Baby boomers ask questions because they often questioned authorities. But go up a notch to the next older generation, and many of them associate asking questions with disrespect.
So what steps can you take to rid yourself of this white coat silence?
• Be prepared. Bring a list of your questions. If it’s a long list, don’t expect everything to be answered, as you might only have 15 minutes. The “hour with a doctor” is a myth. When I first came to my small town and asked my senior partner if he spent an hour with each patient, he said if he did that, he wouldn’t be able to see all the patients who needed his care.
• Educate yourself about your condition. Go to the Web. Read health magazines. Also, discussing things with your friends and relatives may help you sort out what you know and don’t know. Do this before your visit.
• If you have something complex, bring a friend. Someone who is smarter or savvier than you can help sort things out and remember the doctor’s advice.
• Finally, we doctors need to get rid of the paternalistic medical system. Your doctor is your mentor – your advocate but not your parent. They are not the one to decide for you. It’s your body; it’s your decision. Most importantly, you know your body.
My spin: Ask questions. Get answers. Don’t be afraid of that white coat.
Dr. Zorba Paster is a family physician, university professor, author and broadcast journalist. He hosts a radio call-in program at 3 p.m. Saturdays on WBFO-FM 88.7.