7 Things Your Doctor Needs to Know About You

How to breathe life into the patient-doctor relationship

Jun 17, 2024

ICYMI 👉

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I commonly see patients who’ve had terrible experiences with other doctors. They’ve been shamed, dismissed, or left the appointment feeling unheard. Take, for example, my cohort of patients struggling with obesity who’ve been repeatedly lectured by healthcare providers to “eat less and exercise more,” but with no guidance about the why, the how, or the so what of their weight problem.

Or take my patients with substance use or other behavioral health problems who’ve been repeatedly told by doctors to “just quit drinking” or “start taking care of yourself,” only to feel even more ashamed because they aren’t able to execute on a plan they know intellectually would help them feel better.

Or take my patients who worry about every ache and pain and lab test abnormality—or those who, in the spirit of self-advocacy, undertake their own research by scouring the internet or crowd-sourcing their social networks, who repeatedly feel dismissed by their doctor when they raise a health concern or cite an article they’ve read and who fear they’ve been labeled “anxious” or “difficult,” when all they want is to be heard.

Time with your doctor is short. Our healthcare system doesn’t give doctors the time they need to establish a rapport, build trust, and understand the whole patient, even though that is what doctors and patients both want. The economic incentives in healthcare are misaligned. The patient-doctor relationship often suffers. Thus, it’s no surprise people are increasingly distrustful of doctors. It also explains the high burnout rate among healthcare providers.

To patients, there seems to be a one-size-fits-all answer to every problem—often in the form of medication. Got anxiety? Take Prozac. Got high cholesterol? Take a statin. Got obesity? Take Ozempic. Got a hot flash? Take hormone replacement therapy. Big Medicine seems more inclined to treat symptoms rather than assess the patient’s story, life situation, and social determinants of health. Any relationship—especially one between patient and doctor—requires time. But no one has enough of it.

To anyone out there feeling disenfranchised from the U.S. healthcare system: I feel your pain.

I also have some advice. There are some basic conversations that commonly aren’t had in the doctor’s office—the absence of which can explain why some people feel distrustful of healthcare providers. I’m not going to solve this insidious problem in one post. I’m also not suggesting I’m God’s Gift to medicine (Lord knows I have days when I’m hot and bothered and not a good listener.) However, today I’m going to help you fast-track your patient-doctor relationship (to the extent that’s possible).

Here are seven things your doctor wants to—and should—know about you but often doesn’t have time to ask.

Who are you?

Doctors need to know more than your cholesterol and blood type. We need to know who you are and where you are coming from. To solve medical problems, we need your biographical data as much as we need your biometric data.

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What is your story? What were the social and economic circumstances of your childhood and upbringing? Did you grow up with access to medical care? Were you raised by doctors or by Christian Scientists? What were the attitudes in your home around health and healthcare? What beliefs and biases do you hold about medical care and doctors? How have you been treated by our healthcare system?

Were you the middle child who always kept the peace? Were you raised by a mother or father with addiction? Did you experience childhood trauma that presents in adulthood as anxiety or depression? Did you experience childhood illness or environmental exposures? Have past hardships made you more resilient and strong?

These are just some of the questions to start asking yourself—and then bring to the conversation with the person caring for you. Spending a few minutes jotting down the answers to these questions might 1) jog your memory or 2) help enlighten your doctor about who is the owner of these body parts and test results.

What are your main health issues and concerns?

Just because your doctor wants only to review lab data doesn’t mean you can’t raise concerns that aren’t measured in a blood test.

Think broadly about what worries or concerns you the most. Here are some categories to think about before you go to your appointment (which may take more than one appointment!):

Medical data: What medical tests are you concerned about? What tests have you had with another doctor (e.g., a specialist) that you want to review or have more context around? Is there a family history of a disease that has you particularly concerned? What data would you like more access to and/or an explanation of why you don’t need it? What articles have you read that seem to pertain to your own health?
Body mechanics: How is your skeleton (i.e., the vehicle you are driving around in) doing? What hurts? What joints, muscles or limbs are on the fritz? How are you doing with pain control, balance, coordination, fall prevention, muscle tone, muscle mass? What are you doing to stretch, work your muscles, and increase your overall fitness?
Nutrition and “inputs”: What is a day in the life of your eating habits like? What food groups or nutrients do you think you may be missing? Are you getting enough protein, fiber, healthy fats, and complex carbohydrates in your diet? How much alcohol/sugar/soda/sugar/supplements/vitamins do you consume in a day? Do you have time to cook food, or do you rely mostly on prepared food/take out/eating out?
Behavioral health: What is your relationship with food/sugar/alcohol/social media/shopping/sex like? Are you someone who craves a quick hit of Dopamine with any of the above substances/activities, only to feel bad about it later? Where do you think that comes from? Have you tried cutting back on that habit? If so, what happened and why was it hard?
Social-emotional health: What kind of relationships are you in (romantic, social, work-wise)? Where are you on the continuum of anxiety? Mood? How do you regulate your emotions? How do you handle stress? Where does stress present in your mind, body and life? What would your friends and family say about you if they were asked about your emotional health? How honest are you about your mental health? What tools do you have to be more objective?

What gets you out of bed in the morning?

Your doctor needs to know about your personal vision and life priorities. Just because our medical system is geared toward lengthening life doesn’t mean you want a pill for every body part or a doctor for every organ system. If you’re like most people, you also value quality of life. The wellness industry has capitalized on this basic concept as our medical system falls down on the job. So, for your doctor to appropriately care for you, he/she should know why you’re alive in the first place.

What brings you pleasure and joy? What gives meaning and purpose in your life? What is the actual reason for slugging down a handful of medications every morning and night? Why do you care if your cholesterol is lowered (no right answers here): Is it to please the doctor, to make the lab numbers look prettier, or is it because the evidence shows that your particular risk of atherosclerotic heart disease truly outweighs the downsides of the medication itself?

Perhaps you are someone who doesn’t care about preventing every disease or solving every medical problem at all costs. Perhaps you are comfortable declining prescription medications, certain vaccines or treatments because you are comfortable tolerating certain risks over others. Perhaps you are someone who would rather live until you are 105 years old even if it means hemming in your lifestyle or taking added precautions that themselves may do harm.

Take, for example, my patient who is going through menopause and experiencing hot flashes and night sweats. My job is not to instruct her to take hormones simply because the data shows that the benefits of hormone therapy are likely to be greater than the risks, but rather to understand what her tolerance for risk is on either side of the coin. Nothing is risk free; every medical decision we make carries risk.

In other words, the best treatment plan is when we, as medical professionals, treat the patient and their goals more than anything else. In sum, it’s important for you to explain to your doctor what life means to you, why you're alive, why you care about getting your labs checked, and how you envision approaching thorny medical issues as they come up.

Or take a patient who is nearing the end of her life. For me to care for her properly, it’s more important for me to know that her greatest life pleasures include listening to Mozart and watching her grandson play baseball than it is for me to know exactly what kind of end-of-life care she once selected on a menu back in her 50s.

Of course I need access to her living will, however the way I would decide about end-of-life decisions, alongside her family, would be to ask the question: Is this intervention going to allow her to listen to Mozart or watch her grandson play baseball? If not, we would most likely not choose it. In other words, doctors should understand the patient’s North Star—in dying and in living—to help guide every medical decision.

How do you conceptualize health?

Do you define health as living longer or living better or both? What is your tolerance for pain, whether it’s emotional or physical or both? How do you see the patient-doctor relationship and what do you want from that relationship? Are you looking for someone simply to give you test results and then you do your own research, or do you want guidance from them? Do you see him/her as a person to give lifestyle advice? Is your doctor a place for accountability on your own health goals, even those which may or may not match what your doctor recommends?

It’s helpful for your doctor to understand where you’re coming from and what you’re looking for.

What are your goals?

Where do you want to be—in your life and health—next week, next month, next year? Define it. Are you trying to lose twenty pounds? Recover from chemotherapy? Get Sober? Get stronger after injury, illness, or surgery? Give yourself permission to grieve? Work on you sex life? Prevent falls and fractures? Better regulate your emotions? Take care of your health while caring for loved ones? Feel less stressed and anxious? Exercise more? Get more sleep?

Be specific! Let your doctor know what you’re striving for so they aren’t just blindly following someone else’s script. While your doctor isn’t a magician, he/she should be there to help you map out a plan that is rooted in medical evidence and grounded in reality for whatever health goals you have in mind.

What are the barriers to reaching your health goals?

Be honest with yourself. Is it lack of motivation? Lack of time? Is it a lack of financial resources? Or poor access to facts about your health and medical evidence? Is it the lack of a coach or another person to help you execute on your goals? Is it that you have deprioritized yourself as a result of caring for elderly parents or a special-needs child? Is it lack of hope about feeling better?

Being specific about the barriers matters, because doctors can prescribe a whole lot of lifestyle modification tools, but if we don’t understand the realities of your life or the limitations on your time, it’s difficult to help. You’re also more likely to come back with the same problems next year (and feel bad about it).

What do you need to trust your doctor?

This is where you need to have an honest conversation with your doctor. What is it that makes you trust someone? Be specific. You may want to tell your doctor that you had an experience where you called your past doctor on a Friday night, and you were told to wait over the weekend, when in actuality you had some serious problem that took you to the ER, and you felt like you weren’t heard. The doctor sitting in front of you can’t rewrite history and make that better, but be honest about what you’re looking for in a doctor and let them know where you’re coming from from a social-emotional standpoint about your relationship with doctors. Last, let your doctor know that you understand the limitations of their profession and their lives and the American healthcare system. Explain that you don’t expect your doctor to be a miracle-worker, mindreader, hero, or ever-accessible life coach. Just like you want to feel understood, so does your doctor.

Level-setting on your expectations and what your doctor can and cannot deliver can be a hugely transformative conversation for patient and doctor alike. These conversations might happen over years. Insight and self-awareness don’t happen overnight. Stories take time to unfold. Be patient. (That’s what we are in the doctor’s office, after all.)

In sum, my best advice is to know yourself, to understand your doctor and the structural limitations on him/her, and to be clear about your mission, vision, and values—plus the realities of your life—so you can get the most out of your health, whatever your medical issues may be.