What patients really want to tell their doctors.

1. "Listen to what I'm telling you."

"The hospital housekeeper was the only person who really took the time to talk to me," remembers Anne, a 42-year-old teacher who was recently hospitalized for a hysterectomy. "My doctors and nurses always looked so busy that I hated to bother them." Sound familiar?

Nan, a young mother of three, describes her frustration in undergoing a complex diagnostic workup by many specialists for an autoimmune condition: "I write down all my symptoms in a notebook, then they just toss it aside and muse, |I see you have pain when the weather changes.' I wanted to scream, |You can't be talking about me.'"

As health care becomes more specialized, doctors must work even harder to promote continuity of care. Those who go the extra mile to get to know their patients typically discover that their patients are more satisfied and often have a less eventful recovery. "A patient's sense of health and well being is often a very important factor in his or her recovery from illness," observes surgeon Kenneth Hauswald. "Successful intervention depends as much on the alleviation of mental and emotional suffering as it does on the relief of physical suffering."

2. "Tell me what's going on and

what to expect in words I can understand."

While I need sufficient information including risks, benefits, and alternative treatments to make an informed decision, it's important to limit medical jargon to my level of understanding. A nurse recalls the time a doctor explained a change in blood pressure medication to his patient. "In reviewing the history of your moderate hypertension," he pontificated, "it is apparent that your beta blocker is causing bradycardia. I'm discontinuing your beta blocker and placing you on a calcium antagonist."

"True, we're dealing with a more informed public," the nurse adds, "but the ability to understand is decreased when someone is anxious or afraid. It's important to give information in small increments, repeating it as often as necessary for the patient to understand and to make the most informed choices."

"When my 70-year-old dad found a lump in his neck and had to go on chemotherapy," remembers Bill, "his doctor took a minute to find out he had once been a soldier and compared his body's immune system to an army fighting an enemy. That moment is forever frozen in my memory. I'll never forget the look that transformed Daddy's face."

3. "Give me your full, undivided

attention if only for a few minutes."

Jim Elliott, the missionary martyred by the Auca Indians in 1956, stated this timeless point more eloquently: "Wherever you are, be all there."

"When my mother needed heart surgery," remembers Shawn, a waitress, "the surgeon sat down and talked with us in plain, everyday language. She called her secretary and asked her to hold all calls for the next 15 minutes. We knew we were important to that doctor and that she belonged to us - free of distractions - for a full 15 minutes." Incidentally, the surgeon probably spent less time in the long run with this preventive approach.

4. "If you don't know, say so."

I respect doctors who are up front and human enough to admit their limitations. "Some illnesses are extremely difficult to diagnose and require the input of many specialists over a considerable period of time," observes Joan, a nurse who works in a neurologist's office. "I've learned that patients prefer honesty and that trust is actually easier to deal with over the long haul of an extended illness. We encourage our patients to seek a second or even a third opinion if they have reservations about their care."

5. "Be compassionate and considerate."

John Cassis once aptly said, "Nobody cares what you know until they know how much you care." The best doctors aren't just skilled with the wonderments of technology. Rather, true artists add an intangible part of themselves to every creation effort. When a physician cares for an "ordinary" or routine condition, he or she uses both science and art to make order out of a puzzle of signs and symptoms. And care is always possible, even when cure is not.

6. "Keep your word."

"If you promise to call me back, do it," says Sharon, whose doctor is located two hours away from her. "Or give me a phone number of someone I can reach in an emergency." Truly, the best ability is dependability. An important part of providing quality health care is being accessible to me and keeping commitments. Not only is this considerate, but it also engenders my confidence. Quality is not what I can count, but rather what I can count on.

7. "Respect me as a human being: remember who I am and who I used to be."

The "routine" tasks of medical care aren't at all routine to me and my family. "Get to know me as a person before you put a stethoscope to my chest," stresses Jeannette, a 75-year-old retired mill worker who recently suffered a slight stroke. "It takes only a few minutes and really helps me to relax. And please don't talk over me or to someone else in the room as if I'm not there," she adds, remembering the day a new doctor and medical student conversed about her symptoms without involving her in the discussion. All the while another doctor referred to Jeannette as "the stroke in examining room 5." "I'm sure I looked like an old woman in failing health to those young men," she says, "but I was once young too. I was scared to death."

8. "Have a sense of humor."

Today's health-care consumers - especially America's 77 million baby boomers - prefer a balance of professionalism and friendliness. "Humor puts things into perspective," says Larry, an advertising executive. "It breaks down walls. Don't laugh at me, but please laugh with me."

The long-lived cliche "laughter is the best medicine" is now considered a sound statement. Laughter helps the body to release endorphins and enkephalins, morphine-like chemicals that are the body's natural pain killers. They strengthen the immune system, improve digestion and circulation, and decrease stress.

9. "Keep confidences."

"Don't discuss my case at the golf course," says Sam, a grocery store clerk. Although this is likely an infrequent occurrence, I need to know that what I share with my physician will be kept in the strictest confidence.

10. Ask me what I think."

In this era of quality control, some health-care providers are taking cues from industry and are focusing more on customer (patient) satisfaction. This new approach, complete with patient satisfaction surveys, has shown that patients will tell their providers how the provider can improve, if they are just asked. "Patients really want an active voice in their health care, especially when interacting with their doctor," says Joella, who works as a secretary in a nursing home. "It gives them a sense of being in control, which adds to their overall well-being."

Ever leave your doctor's office feeling a bit dissatisfied? He or she didn't spend the time with you that you had hoped; or maybe your physician seemed distant, preoccupied. One study showed that 75 percent of people have changed physicians because of the doctor's manner. When there is a breakdown in communication between doctor and patient, the finger of blame often points toward the physician. But as with any relationship, success rests with shared responsibility, especially, when it comes to communication. Here are some samples of what patient and doctors really want to tell each other.

As a patient you

have the right to

* Be treated as an individual with dignity, compassion, and respect,

* Have your needs and feelings considered.

* Be included in the decision-making process and receive sufficient information to make reasonable decisions,

* Know who is coordinating your care.

* Know the expected outcomes, risks, and potential side effects of medications and/or treatments.

* Refuse treatment and have an explanation of the medical consequences of any procedure or treatment.

* An atmosphere of mutual acceptance and trust.

* Be treated promptly, courteously, and responsibly.

* Privacy.

* Confidentiality.

* A second or even a third opinion.

Roberta Messner, Ph.D., is a nursing quality improvement coordinator who works in Huntington, West Virginia. Susan Lewis, Ph.D., is a psychiatric clinical nurse specialist in Louisville, Kentucky. They have collaborated extensively on articles and presentations for both professional and consumer audiences.