What They Say vs. What They Mean: How Doctors and Patients Miscommunicate

What Doctors and Patients Say

Doctor: Tell me about your headaches, Mrs. Jones.

Patient: Well, it all started when I was 3 years old. …

Doctor: Yes, yes, that’s fine. How frequent are your headaches? Do you have an aura?

Doctor: I see you brought your MRI scan. I’ll show it to you. See, this is the brain, and this is the skull. And see these little white spots? They’re high-signal intensity abnormalities on T2- weighted images that can occur with headache.

Patient: Oh. Continue Reading


What You Should Expect From Your Headache Doctor

Any healthcare professional who is going to treat you for chronic headache should also be a person you feel comfortable with. The following are some characteristics that often contribute to a positive doctor-patient relationship. They are essential qualities in a comprehensive headache clinic. You have a right to expect such characteristics in the person to whom you are entrusting so much. Continue Reading


Talking To Your Headache Doctor

Accurate and open communication is the beginning of good medical care. This is especially true for headache patients, because a correct diagnosis depends almost entirely on information the patient gives the doctor. Unfortunately, both doctors and patients can fail to express their thoughts clearly and accurately. Doctors may not clearly explain their diagnosis and treatment recommendations. Patients may not clearly express their fears and concerns about their headaches. Patients may also be so anxious that they don’t hear or understand what their doctor is telling them. Doctors often complain that they simply don’t have enough time to deal with all of the questions many patients ask. Unfortunately, patients may react by thinking that their doctors are ignoring their needs and concerns.

Often, what doctors say is very different from what patients hear. For example, a doctor trying to reassure a patient that her headaches aren’t caused by a serious problem might say, “You don’t have any serious medical problems.” In response, the patient might think, “Oh no! Everybody thinks I’m faking my headaches. I can’t even find a doctor who takes me seriously.” Or, if the doctor explains that migraine is a condition caused by abnormal blood vessels in the brain, the patient might think, “Oh no! My uncle died of a burst blood vessel in the brain.”

There is even a difference between what patients want most from their doctors and what doctors think patients want from them. A study has shown that what patients want most from their doctors is a willingness to answer questions and a willingness to teach them about their treatment. On the other hand, doctors think that what matters most to their patients is headache expertise and understanding and compassion.

Both you and your doctor need to communicate clearly to effectively treat your headaches. Here are some simple steps you can take to improve your communication skills so your concerns are expressed and your needs are met. Continue Reading


Effectively Prepare for Migraine Office Visits

In this article, we interviewed Richard B. Lipton, MD, MPH, Professor and Vice Chair of Neurology at the Albert Einstein College of Medicine, Director of the Montefiore Headache Center, NY, and co-researcher of the American Migraine Communication Study (AMCS), to determine what migraine patients can do to make their visits with healthcare professionals (HCPs) as productive as possible.

Q. At your headache clinic, how do you and your staff prepare for an initial visit with new migraine patients? Continue Reading


What They Say vs. What They Mean: How Healthcare Providers and Patients Can Miscommunicate

What They Say

Healthcare Provider: Tell me about your headaches, Mrs. Jones.

Patient: Well, it all started when I was 3 years old. …

Healthcare Provider: Yes, yes, that’s fine. How frequent are your headaches? Do you have an aura?

Healthcare Provider: I see you brought your MRI scan. I’ll show it to you. See, this is the brain, and this is the skull. And see these little white spots? They’re high-signal intensity abnormalities on T2- weighted images that can occur with headache.

Patient: Oh.

Healthcare Provider: Migraine is caused by abnormal blood vessels in the brain. Serotonin imbalance within the brain causes the blood vessels to react abnormally and cause headache.

Patient: So will I need surgery? Is it serious? Is it fatal?

Healthcare Provider: You don’t have any serious problem and you don’t need surgery. Are you depressed?

Patient [with tears welling up in her eyes]: Not at all!

Healthcare Provider: For people with your particular condition, we often use antidepressants. And we’ll have you meet with the psychologist. They have good treatments for you. Biofeedback and relaxation are also effective migraine therapies.

Patient: How do I take these?

Healthcare Provider: Just take one pill before you go to bed and I’ll see you back in 4 weeks.

Patient: Okay. Before you go, I wanted to ask a few questions. Here’s a list I wrote down for you.

Healthcare Provider: Here’s a couple of pamphlets and we’ll answer any questions you may still have at your next visit.

What They Mean

A new headache patient—and I’m already 20 minutes behind!

I brought 10 years worth of charts for him to review and he never even looked at them!

Doesn’t she realize I’ve already read 10 years worth of records about her? Why did she bring all of these if she’s going to tell me every detail that’s in them anyway!

This is a normal MRI scan. There is no tumor or abnormal blood vessels. Often small white spots are seen in patients with chronic migraine, but they are not a sign of any disease or damage.

Does he think I have a brain tumor? Are those spots an infection?

Migraine is not serious. There is no reason to worry.

Abnormal blood vessels! My uncle died of a brain aneurysm — is that what I’ve got? What’s serotonin, and how did I get it?

She’s not even listening to me! She seems very anxious and high-strung. Could be a mood disorder — not unusual with chronic headache. Maybe that’s why she’s not focusing on what I’m telling her. Luckily some migraine medications treat both.

Not again! My husband doesn’t believe me, my boss thinks I’m a faker. I can’t even find a healthcare provider who’ll take my headaches seriously.

She’s in denial. Maybe this mood problem is more serious than I thought! Antidepressants are great headache preventive medications, so that would be a good choice.

He really does think I’m just crazy. I’ll try these pills and see if they help. I’m so desperate at this point I’d try anything!

She needs to take this every day for several weeks before it will work.

I wonder what the side effects are. I’ll take it a couple of times and see if it works.

She brought 4 pages of questions! I don’t have time to answer 4 pages worth of questions today…

Dawn A. Marcus, M.D.
Associate Professor
University of Pittsburgh School of Medicine
Neurologist, Coordinator of Headache Research
The Pain Evaluation and Treatment Institute
Pittsburgh, PA