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Health Matters: 'Why don't you doctors just listen?'

Q. I'm frustrated with my doctor. When I go to see him with a concern, I can barely tell him what I'm worried about before he interrupts me. Why don't you doctors just listen?...

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Q. I'm frustrated with my doctor. When I go to see him with a concern, I can barely tell him what I'm worried about before he interrupts me. Why don't you doctors just listen?

A. Oops! I hope you're not talking about me! But you are quite right - one classic study recorded patient-physician clinic encounters and found that the doctor interrupted the patient more often than not as the patient was stating their chief complaint. In that study, doctors waited only 18 seconds on average before interrupting the patient.

So, you are quite right that we physicians need to listen more and talk less - and at the very least - not interrupt you when you are saying something important. Now there are appropriate situations where it is OK to ask questions, such as when the patient is not providing crucial information that is important in forming a diagnosis.

For example, I see lots of patients with chest pain. I need to know where in the chest the pain is located, how long it lasts, what brings it on, and so forth. If the patient isn't giving me the answers to these questions, I need to get the information to form a working diagnosis.

But what should you do so you and your doctor communicate better? First, you need to have a frank discussion with him or her about this problem. Second, try to focus on your main concern or concerns when you see the doctor, and emphasize them right at the start of the visit. Finally, I can assure you that we are working hard with our medical students to make them aware of this communication problem so we hope it will decrease in the future.

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Q. I was just diagnosed with prediabetes. What is it and what can I do about it?

A. Diabetes (the full medical name is diabetes mellitus) is a condition we've discussed here before, and is marked by too much sugar in the blood.

This can result in a variety of vascular complications that can injure the kidneys, heart, eyes, nerves, blood vessels and brain. The sugar gets too high either because the body doesn't make enough insulin (insulin helps the sugar move from the bloodstream into the cells of the body) - we call this type 1 diabetes - or because there is resistance to the effect of the insulin, which is the much more common form and is called Type 2.

Prediabetes often is a precursor to Type 2 diabetes and is marked by elevated sugar levels, but not to the degree where we say diabetes is present. About 1 in 20 to 25 people with prediabetes progresses to full-blown diabetes each year and, eventually, about two-thirds of prediabetics become diabetic.

But this trend isn't inevitable, and the progression to diabetes can be delayed or even prevented by two treatments. The first and more effective approach is what we call lifestyle changes, consisting of diet, weight loss and exercise. This reduces the rate of progression to Type 2 diabetes by more than half. The other approach (used in conjunction with lifestyle changes) is to use a medicine, most commonly metformin (brand name Glucophage and others), which reduces the rate of progression by about a third. So, follow up with your provider and get a prevention program going. It works.

Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training. Submit a question to Health Matters at healthmatters@med.und.edu or Health Matters, 501 North Columbia Road, Stop 9037, Grand Forks, ND 58202-9037. Remember, no personal details, please.
The content of this column is for informational purposes only and does not substitute for professional medical advice or care. The information provided herein should not be used for diagnosing or treating a health problem or disease. If you have or suspect you may have a health problem, you should consult your health care provider. Never disregard professional medical advice or delay in seeking it because of something you have read in this column.

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