How to talk so your doctor listens, with endocrinologist Dr Gillian Goddard

[00:00:00] Hey everybody, this is Overlooked and I'm Golda Arthur. The title of this episode is kind of provocative, How to Talk So Your Doctor Listens. But your doctor is supposed to listen to you, however you talk to them. And you know that, and they know that, and yet you still click that play button to listen to this episode. So let's get into it.

[00:00:23] Okay, I want you to take a second and think about the worst doctor's visit you ever had. For me, it's not hard. One doctor's appointment stands head and shoulders above the rest. In my early 40s, probably as I was starting to get perimenopausal, I went to see a doctor about this weird pain in my chest. It was like a fist tightening everything inside my chest.

[00:00:53] When I told a doctor about this, what happened next was so awful that it ended up being the inspiration for this series. And I wrote about it in my newsletter and you can check out the show notes if you want to read that whole story. And I know you probably have a story of your own. So share it with me. Email hello at overlookedpod.com.

[00:01:17] This is the start of a new series to reflect on the gap between patients and their doctors. It's a gap that can cost you your health and neither doctors nor patients actually want it. But everybody recognizes that it exists. As women really of almost any age, we have long felt dismissed and disrespected in the doctor-patient relationship. Not listened to and not taken seriously.

[00:01:42] But on the other hand, doctors today are facing unprecedented challenges working in healthcare systems that don't make it easy to practice medicine optimally. So in this series, I'm going to explore this topic by talking to doctors and healthcare providers who do listen and who give us some insight on how to advocate for ourselves in the best way possible at our next appointment. All nine minutes of it.

[00:02:09] In this episode, I talk to Dr. Gillian Goddard. Dr. Goddard is an endocrinologist and the author of a new book called The Hormone Loop. We talk about how to set a goal for your appointment, how to push back gently in that conversation, and how to tell your doctor about all the neat things you learned about your health at three o'clock in the morning when you Googled your symptoms on your phone in the dark. All of that is coming up after the break.

[00:02:36] My conversation with Dr. Jillian Goddard. Our health impacts the way we move through the world. The stories you hear on Overlooked illustrate this so well. I hear from listeners all the time who tell me the show helped them understand their own health in a new way or give them language for something they'd been experiencing.

[00:03:02] The idea that this podcast could help someone be bolder in their self-advocacy is important to me. So I'm creating a storytelling workshop called First Person Health. Croft, record, and produce your own powerful health narrative. Take a look at our show notes to learn more about the workshop and to sign up. Jillian, hi. Welcome back to Overlooked. Oh, I'm so glad to be back.

[00:03:30] I'm so happy to have you here, and I want to start by saying congratulations on the new book. Tell me about it. Tell me why it's called The Hormone Loop, and tell me why you wrote it. Yeah, it's called The Hormone Loop because it basically gets into the real how and why of our hormonal system, and not just our reproductive hormones, but all of our hormones.

[00:03:55] And the reason I wrote it is because so often in this conversation about women's health, we both talk about women's health in these discrete stages when, in fact, they really flow in from one to the next. And so I really wanted to give people a more comprehensive picture of what's going on in their bodies throughout their reproductive lives and beyond.

[00:04:22] That's really great. And I also love the idea that, like, oh, it's actually all joined up across the lifespan, which seems sometimes it's a revolutionary idea, but I love that. And today in this episode, I want to talk to you about something that you've written an entire chapter about, really, and that kind of reflects on the relationship between doctors and patients.

[00:04:46] And this podcast episode is going to have a provocative title as well, but I am going to go out on a limb and make a broad, sweeping generalization and say that a lot of women feel dismissed by their doctors. They feel not listened to and not taken seriously. And this episode really starts with that at its center.

[00:05:11] And I want to be clear that you, Jillian, are on the show because you're not one of those doctors. You listen, you take people seriously. And we've talked before about, you know, the extent to which you take your patients seriously. And I loved that. And I'm so happy to have you back on the show to kind of reflect on this topic from a physician's point of view. But we're on the same page, right, with women feeling that way? Oh, 100 percent.

[00:05:37] I would say so many of my patients come to see me and so many of my readers comment on how they tried to talk to a doctor about something and they didn't feel like they were communicating with their doctor. And I think a lot of times that's true. And I think, you know, there's a couple of reasons for that. But unfortunately, the system in which doctors and patients are functioning, particularly in the U.S.,

[00:06:06] but I think outside the U.S. too, sets us up for failure. It sets doctors up for failure. It sets patients up for failure because we really are so limited in the amount of time we get to spend together. And also, I think a lot of times we are not speaking the same language. A lot of times the patient is speaking one language and the doctor is speaking another language. We're using the same words, but we often have different definitions for those words.

[00:06:35] And so we're not communicating with one another well. That's so intriguing. And immediately as you say it, I am like, yes, Jillian's right. That makes sense. But give me an example of what you mean of this sort of crosstalk. I think my favorite example of this is I will see a patient. She'll be in her early 40s and she'll be complaining that she's starting to have some symptoms of perimenopause. So she might be having some hot flushes and some night sweats.

[00:07:02] She's noticing some mood changes and irritability, especially around her period. She goes into her gynecologist and says, I think I'm in perimenopause. And her gynecologist asks her one question. Are your periods regular? And she says, yes. And her gynecologist says, you're not in perimenopause. And the conversation is over.

[00:07:25] The problem is she's still having symptoms and she feels like she's just been dismissed. The issue comes when we talk about sort of the definition of perimenopause. Because colloquially, we use perimenopause to cover this broad, you know, 15-year range in a woman's life. Where she's transitioning from her peak reproductive years all the way through menopause.

[00:07:54] But in medicine, perimenopause has a very specific definition that's been published in journals and sat based on this huge group of experts getting together. And that definition is based on period regularity. And so neither person is wrong. They just have different definitions of perimenopause.

[00:08:19] The technical answer in that case is that the patient is probably in the late reproductive stage, which is like a bridge stage between the reproductive years and perimenopause. And women can be symptomatic during that time. And there's things we can do about those symptoms. But we have to get to that conversation first. I think that is a really excellent example. I want to relate it to what you write about in the book, which is going into a doctor's appointment.

[00:08:47] As it is, we will have limited time. Probably as patients, we're like brimming with symptoms, anxiety, stuff in our minds. And we're facing a doctor. And we're like, OK, I got to squeeze this all in. And from a physician's point of view, you know, you're seeing many patients in the day. There's already a lot of pressures on you. The time is limited. So you talk in your book about kind of heading in there with a goal in mind. And I want to quote this line.

[00:09:15] You ask us to think about what realistic result would feel satisfying to you. Like, this is a very interesting line because of this word realistic. Right. As much as I'd like to have my magic wand at work with me every day, it hasn't been issued to me yet. Yeah, no. And I think this for me as a patient, I was like, ah, OK, I think I see the light because I'm pretty sure I go in firstly without a goal. Right.

[00:09:43] With just feelings and symptoms. And secondly, I think we need to talk about this term realistic. So say a bit more about that, Jillian. I think that we are people and human bodies. And those human bodies have processes. And those processes don't always feel great.

[00:10:10] We may have different ideas about what success looks like. And unfortunately, I think if success to you looks like you're going to spring out of bed every day full of energy and with nary, you know, an ache or a pain, you're probably going to leave unsatisfied.

[00:10:34] But if you're having symptoms that are impacting your life and your goal is to get a good night's sleep most nights, that I think is a realistic goal that will set you up to feel better and to function better in your life. I think that a lot of times what people really want is a name for what's going on with them.

[00:11:01] And they feel much better if what they have has a name because it makes them feel like, OK, this is something that people have. It's got a name. Now I know what it is. It's not just these nebulous symptoms. And so a lot of times getting a diagnosis is the goal. And getting a diagnosis doesn't necessarily change the symptoms at all. But it can change our perceptions a lot.

[00:11:29] Psychologically, I think that's a really big deal. So let's talk about Dr. Google, right? Yes. I have lots of feelings about Dr. Google. Tell me all the feelings. Tell me all the feelings. So I think that patients believe that doctors don't want them to do their own research. And nothing could be further from the truth.

[00:11:55] The problem is a lot of times patients don't know what kind of research would be most useful to their conversation with their doctor. So you're on Dr. Google trying to diagnose yourself, right? And I want you to use your research to understand and think about what questions you have for the doctor.

[00:12:20] Because when you use Google to try and diagnose yourself, you very often are wrong. Google often comes up with the most unlikely possibilities, often that come along with dire outcomes. And this could kill you. Yeah. And I think it actually increases people's anxiety a lot. It also narrows your doctor's thinking.

[00:12:50] Oh, yeah. When you come in and say, I think I have this. Your doctor then gets focused on, it becomes this binary question. Does this patient have this or do they not? Instead of thinking about this patient has these symptoms, it could be A, B, C, D. What evidence do we have for that differential diagnosis? So we don't want to narrow our thinking prematurely either.

[00:13:20] I think you write about a patient who came in and said, look, I know you hate this. I've Googled this already. Everything I read said I'm going to die. Yeah. Here's my thing. Right? Yeah. How do you roll a patient back from what they have learned on the Internet? And we'll talk about AI next because there is no Internet without it. Now there's no search without it. There's no anything without it. There isn't. How do you roll a patient back from that moment of like, I'm convinced I have this thing because the Internet told me I have it. Where do you begin with that?

[00:13:49] My first step is to say, well, I appreciate that that's really scary. Let's talk about what your symptoms are. And so I really try to get people back to their symptoms, to what they're actually feeling, to physically what's going on that's changed, that's made them think that there's something wrong. And then once I get a sense of what their symptoms are, then I can start to ask them about other

[00:14:15] symptoms that may be associated with the different things that I'm thinking they may have. Yes, people get scary things. It's just it's not nearly as common as I think we are afraid it is. And so I think when we kind of take a step back and say, well, yes, that can happen. That is scary. Validating goes a long way because people feel they know they've been heard. But that's not such a likely diagnosis.

[00:14:44] Let's take a step back. Let's think about what's really going on with you and see what we can do to figure out why that's happening. The validation piece, like incredibly important. Yeah, because a lot of times what people want to know is that you heard what they said, that you are going to try and help them. And then you can kind of move on to sort of more productive pieces of the conversation. Yeah.

[00:15:12] But I think there's sort of two ways research can actually be quite helpful. And that is in helping you figure out what other symptoms you might be thinking about and want to pay attention to while you're waiting for your doctor's visit. And the other is what questions you want to ask your doctor about your symptoms. And you also write about this idea of keeping careful note of what your symptoms are actually about.

[00:15:39] And this is interesting because so what you're saying here is that we as patients should really prep for this in a certain way, right? Go in with a realistic outcome that we have in our mind or goal that we have in our mind. Go in with like a list of symptoms that are specific. Presumably, you know, a doctor will ask when does this come up? You know, are there certain times of day that this is triggered? So to sort of have that knowledge at our fingertips, I think, was was such a good reminder there.

[00:16:07] And it makes us, I think, better advocates of ourselves as patients. Going back to the Internet for a second, you know, nowadays, these searches, they're just all infused with AI and we can take another step and actually go to an AI program and say, here are my symptoms. What do you think, doc? Doc, and go in, you know, having our minds already influenced by that. So thoughts on AI, Jillian?

[00:16:35] Look, there are some things that AI can do well and there are some things that AI can do less well. That's very diplomatic. I would say at this point, AI is not an amazing diagnostician just yet. And I see this all the time. So, you know, I use Gmail like many, many other people do.

[00:17:04] And one of the things that Gmail does now is suggests a response to an incoming email. So somebody sends you an email. And if you look, there's a whole suggested response below it. But people send me questions for my sub stack. And, you know, Gemini loves to suggest my response to these people. And so often it is just wrong. It's the opposite of what I would tell people.

[00:17:34] So first, I would say, know that it is often wrong, partly because it is pulling in information from all over the Internet, not just from reliable sources. And so it can just as easily predict the opposite answer of what an educated caregiver would give

[00:18:00] you. But the other thing is, you know, AI is only as good as the prompts you give it. Yeah. And I do think that if you are going to use AI to think about this, again, where AI may be useful is if you ask it to generate questions for you. Oh, yeah. What questions should I be asking my doctor? Now, it's also going to come up with some junk in there, too. But I think there are ways to use these tools that can be incredibly helpful.

[00:18:30] But we have to realize that because of what AI is drawing from, it's drawing from as much bad information as it's drawing from good information. And so it may not be giving you a really great answer to your question or an accurate one. Yeah. I want to pivot to something that I think a lot of patients find difficult.

[00:18:55] And actually, that is a very human thing, which is how do you have sort of a pushback conversation with your doctor without sounding aggressive? Like for me, for example, I'll do this annoying thing that a doctor will say, here's a thing that I think. And I will say, why do you think this thing? And in their mind, they're making a calculation of like, is this a seven minute conversation or a 17 minute conversation?

[00:19:22] So I'm either doing that or I'm just completely passive and just being like, yes, yes, yeah. I don't know how to do the middle ground. I maybe come across as a little aggressive when actually I just want to know. So let's say your doctor says something and you don't buy it or it doesn't feel right or you don't understand it. What does a pushback look like inside that relationship? Yeah, I think that the best thing you can do is get curious.

[00:19:49] I feel like I'm taking a note from like DBT here, but I think it's really helpful to approach with curiosity as opposed to with animosity, right? So I'm curious what in my case makes you think that. That's great. You know, I'm curious what in my lab tests you're seeing that is, you know, leading you down that path.

[00:20:17] I'm curious why you think that medication will be the best one for me. I think that you can do that. You know, people come to me a lot with what if my doctor doesn't seem to date with the current literature, like the current studies. And I always say, just approach it with a question. I saw a study that said XYZ.

[00:20:46] Are you aware of that study? Because they might have seen that study and have really good reasons for why that study is not affecting their practice. Or they may not have seen it because there's great gobs of medical literature published all the time. And, you know, if my patient asks me about a study that I haven't seen or read yet, I'm honest about it and say that and say, but I will take a look at it and I'll circle back with you with my thoughts.

[00:21:13] And so I think come from a place where you assume that your doctor has your best interest at heart, because I think most doctors do. And then approach it with a question. I like that. And it's a really important mindset to go in with because that really points to trust, doesn't it? It points to trust in the relationship and trust.

[00:21:41] You know, when we talk broadly about trust in science, for example, I think where all of that becomes very real is in that 10 minutes you have with your doctor, right? Where you're trusting the individual, you're trusting their expertise in healing you, you know? So I feel very hopeful that if we get that relationship right, all the other abstract stuff that we talk about, you know, about trust in science and trust in medicine will come.

[00:22:10] So I think that is a great insight. I want to ask again, like from your point of view, I think it's really important for us as patients to understand where your physician is coming from. And you were talking about all this medical literature that's published. I don't know how you guys have the time to keep, you know, I know that's an important part. I mean, we don't and that's the reality, right? Yeah. You started this conversation by talking about the fact that, you know, we're all in this

[00:22:36] system together and the system is about as imperfect as it's possible to get. So what do you wish patients understood about how to talk to you or where physicians are in general that would make your job easier and their care better? I mean, I think the biggest one is trusting that your doctor really does want to help you is huge.

[00:23:04] Most doctors who care for patients who are in patient facing roles, they didn't go into medicine for any other reason than because they really do want to have a relationship with patients and they want to make things better. But we also are human. We don't always have the answer that's going to be the most satisfying.

[00:23:34] That can be disappointing. And I think doctors who are good at communicating know that. I often say to patients, I understand that your labs all coming back normal when you feel crummy is unsatisfying. But the good news is that it means there's not something scary going on. And so I think we have to approach this as though we are, we're on a team and it's, you

[00:24:00] know, the team that's going to help you to feel better. Being in the doctor's office seeing patients, that's our, that's like our every day. I try to remember that for my patients, it's not their every day, right? Like going to the doctor can be anxiety provoking. Most days for me, going to my office is not anxiety provoking. And if it is, it's usually not because of the patients. It's because of something else going on that day, right?

[00:24:29] Their personal lives are also taking place, you know, all around you. They may have just gotten a call from the school nurse that their kid has to be picked up. You know, they may have sick parents. They may have, they have all the same life stuff that we do. And I'm telling you, I try to leave these things outside the exam room as much as I possibly can. But as much as we want our doctors to be human, we just talked about how we really, we really

[00:24:58] do want a thinking, feeling person in the room with us. That comes along with the fact that doctors will have good days and bad days. And so I always tell people, go in, give your doctor the benefit of the doubt. But if the behavior that is not productive from your doctor is happening over and over again, that's different. So if it's a one-off, try and remember that your doctor's human. If it's a pattern of behavior, that's different.

[00:25:30] Well, that is fantastic advice to end with as well. And Jillian, thank you for talking about this stuff with me. You gave so many practical tips for building this relationship with your physician. Well, thank you so much for having me. And I think that you really struck there on a point that is so important, which is if you possibly can build a relationship with your doctors, because it will be much easier to tackle

[00:26:00] challenging problems when you already have a rapport with someone, when they know you, they know your history. There's just so much benefit to that long-term relationship with a practitioner. Yeah, that's fantastic. Jillian, thank you so much for being on the show. Oh, it's my pleasure. Overlooked is here for information and empowerment, but not medical advice. Every person's body is unique.

[00:26:30] So if you have questions, it is best to speak to your doctor or healthcare provider. We're building a community around women's health so that no one is overlooked. If you'd like to be part of it, hit the follow button on this podcast, wherever you're listening to this. Or you can show us some love by writing us a review and sharing this episode with someone. Overlooked is written and created by me, Golda Arthur. Jessica Martinez-DeJos is the show's producer.

[00:26:59] You can stay up to date with the show by signing up for the newsletter. And following us on Instagram and LinkedIn. We read every review and email. So write to us, hello at overlookedpod.com. Thanks for listening.