173: How To Talk To Your Doctor, with Dana Sherwin

Doctor visits can feel like a high-stakes performance: you get 15 minutes, you are anxious, and you only remember the perfect question after you leave. 

We sit down with Dana Sherwin, a healthcare management consultant and speaker specializing in patient-physician communication, to make those minutes count and to make the relationship feel like a partnership instead of a power struggle.

We dig into what patient engagement actually looks like in real life and why it links to better health outcomes. Dana shares a simple, repeatable way to prepare for a doctor appointment: write down your top priorities, your symptom timeline, and the questions you cannot afford to forget. We also talk about a surprising idea many people miss: a huge share of diagnoses comes from what you tell the doctor, which makes your story, your context, and your clarity a clinical tool.

If you want more confident conversations and a clearer plan after every appointment, listen now.

Dana Sherwin is a consultant and speaker focused on healthcare management and patient-physician communication. In prior executive and consulting roles, Dana worked in hospitals, managed care plans, and three public accounting/consulting firms. She is also a 6 ½ year survivor of a stem cell transplant for a blood cancer disorder.

• LinkedIn: https://www.linkedin.com/in/desherwin/
• Website: The Thinking Patient

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Transcript

Cold Open On Shared Decisions

Dana Sherwin 0:01

The goal is, and they do teach them in this in medical school now. The goal is to get to the point where the doctor has enough information to understand and perhaps make some recommendations or have some thoughts about what's going on. And then the third step is that there's this sharing of okay, what should we do next? Is that okay with you? It's called the technical term is shared decision making. And that's the doctor and the patient together make the decision about what happens next.

Manya Chylinski 0:37

Hello and welcome to Notes on Resilience. I'm your host, Manya Chylinski. My guest today is Dana Sherwin. She's a consultant and a speaker focused on healthcare management and patient-physician communication. We talked about how to talk to your doctor, how to prepare for appointments, things to think about so that you can make the best decision about your health. Really gonna find this episode interesting. I know I did. Dana, I'm so glad we're having this conversation. Thank you for being here today.

Dana Sherwin 1:11

Oh, thank you, Manya. It's really a pleasure.

Manya Chylinski 1:14

I look forward to our conversation. Before we dive into that topic, question I start with for everyone. What would the title of a book be about you if your worst enemy wrote it?

Dana Sherwin 1:28

Since you told me that question in advance, I've been thinking a lot about it because I've never gotten that question before. But the book would be called Stay Out of Her Way. And the reason I say that is because you use the word worst enemy and not just enemy, a worst enemy, one would think, would be somebody who would want to get revenge on you in some way. And I'm at a part of my life and gone through a lot of experiences where I feel like I'm bulletproof and I can handle anything. So they would not get the revenge that they were seeking. So just stay out of her way. And that's how I came why how I what I came up with.

Becoming A Patient Changes Everything

Manya Chylinski 2:09

Oh, I love it. I love that title. I think, and I like your categorization of what would define someone as your worst enemy. So thank you for thinking about that. I think that would be a fabulous title of book about you, no matter who wrote it, right? I think you could spin it any way that you wanted to. Well, thank you so much for for sharing that. And everyone has had a moment in their life, or more than one moment, that changes how they think about leadership or how they think about taking care of people. What is one of those moments that you'd like to share with us?

Dana Sherwin 2:49

I spent 35 years in the healthcare field as a manager, a leader, as a consultant. And all the time that I was in the field, more on the management side than the clinical side, I really didn't know what it was to like be a patient until I actually was a patient. And this was like a real sort of wake-up call for me. You think you're immersed in an area and you know everything about it. But for me, it was something I ignored my own health. I just ignored things that were mine, I thought they were minor symptoms, but they actually were indications for an underlying genetic disorder, which turned out to be a blood cancer disorder. And when I realized that I had it, my whole thought process changed. And I knew that I had to then redirect my energy and my thinking and in a way relearn how I should really be taking my care of myself as an adult.

Why Patient Engagement Improves Outcomes

Manya Chylinski 3:53

Wow. Well, thank you for sharing that. And what's so interesting is that you were in the healthcare fields and then sort of on one side of the coin, and then were on the other side, and then essentially became, you know, a patient advocate and an advocate for improved communications between doctors and patients. And I love that you turned your experience into helping others. I think that patient physician communication can be very difficult from the patient side. There's a lot of fear about, I'm not sure if the word is challenging what a doctor says, but there's a lot of fear about taking agency and care for our own care in the presence of a doctor.

Dana Sherwin 4:42

Yeah, I think that it's um it sort of seems simple on the outset, but it's just it's so complicated to put a patient, a person. So I I, you know, I quibble with that word patient because it's such a negative connotation, mean good, meaning you're sick. And that's the Latin derivation of that word. Patient is from like a sick person. But I always say we're all patients because you need to take care of your health, whether you're sick or well. So people come into the relationship usually very scared, nervous, anxious. They're not their usual self. They don't have their usual like resilience or courage or confidence. And they nobody trains anybody how to be a good patient, how to be a better patient. And so it's it just becomes a very complicated and layered kind of communication that is not a communication that happens really anywhere else. It's not a friendship, it's and it's not like a relationship with your lawyer, it's not with your accountant. It's it's about your health and somebody who was really very technically trained to be able to help you deal with your health. And most people just go into this relationship not having really any skills. So, what I wanted to try to, what I spent a long time thinking about, because maybe I went into my process as a better than average kind of communicator as a patient, because of my background, one, because of my own, you know, personality traits, because of, you know, because of just like some of the other things I've gone through my life being a little bit stronger, and also, you know, having young children and wanting to like live and you know, had a serious condition. And nobody really teaches you the skills. So when one of my doctors, my hematologist, oncologist, said to me, Oh, you're such a good patient, and I said, Oh, my health is doing well now, I'm doing better. And she goes, Oh, no, I didn't mean that. I meant that you always come to appointments very prepared. You ask good questions, you keep us on our toes, you follow up, you know, you're just very thoughtful of how you communicate. And I said to her, Well, doesn't everybody do that? And she said, No. So I was very inspired by that comment to say, what do I know already? And what extra things maybe I should know if I'm going to share this information with other people. And I spent about a year and a half doing research. And there has been a lot of research on this topic. However, it's not somebody, something that anybody talks about. Your doctor's not going to tell you. I mean, I was in the healthcare field, and it's not something we talked about. And the biggest thing that I found in the research, and I use this like all the time, I think it's so compelling. People who are engaged in their care have better health outcomes. Yeah, I mean, maybe intuitively, but who thinks about that? And your doctor doesn't say to you, look, I we're meeting for the first time. It's so nice to meet you and know you. I just want to give you like a heads up. If you participate more and you want to really partner in your care, you will have better health outcomes. Nobody says that. Now, maybe it's oh, doctors can't say that because it puts them at risk for saying you'll do better if you participate. I don't know. Right. But this is not like commonly known, but the research has shown this. People who are engaged in their care have better health outcomes. And that was the light bulb that went off for me. That I put together really a framework and a pathway, and I speak about it and I write about it and I consult on this topic because maybe you don't teach kids in elementary school or high school, they have other health, although I think in high school they're capable of learning these communication skills. But certainly in college and going forward, there were so many things I wish I knew when I was in my 20s and 30s that I didn't learn until my 40s. And for me, thank God, it wasn't, it wasn't too late, but I had a catch-up because I had a very complex health condition. So I had to do that catch-up. But the message and this sort of structure does really resonate with people because it gives people tools and practices for people to use to yes, the anxiety and the frustration and the being scared about seeing doctors, or there's something wrong with me, or I have this symptom, or I have this mark on my body, I'm like scared what it could be. You can have all that, but what lessens that dread and internal pain is having a process to be able to communicate who you are, what you're interested in doing, what it could possibly be. And they say, uh, I also saw the statistic that 85% of diagnoses are made by what the patient tells the doctor. So the doctor doesn't even touch the patient. Doctor's not looking at any tests, but 85%, I'm feeling this, this, and this. This is my history. So it's so important for patients to know their own story, to have that story in a concise way, their history, what their medical experience has been, their psychological experience has been, and all the things about their life that help inform the doctor to make the right diagnosis.

Manya Chylinski 10:04

Wow. Thank you for that. I never realized such a high percentage is uh, you know, of what's going on is based on what I as the patient tell the doctor. You know, as you were talking about this, I was thinking of some of my own experiences, both successfully communicating and not so successfully communicating. And for most of us, there's that power differential and definitely a knowledge differential between me and the doctor. And the doctor is the one, as I walk in, feels like they have all the power because they have all the knowledge. And then that puts me in a position of then being vulnerable to share things that I might not share with anybody else because they're personal about my body and about my health. And I imagine that part of what we as patients bring to the relationship, that fear and that vulnerability and that differential of power.

Dana Sherwin 11:05

Absolutely. Very well put. I mean, I think the core is the patient has a very important role to play in this process. And generally, I would say I don't think that sort of paternalistic doctor patient relationship is as strong as it used to be, maybe even 10 years ago. Doctors are taught in medical school to how to communicate better with patients and what like a medical interview they call it, what that includes and how that works and how you speak to patients. But what's interesting is that these are new courses, new in the last 10 to 15 years. They didn't used to teach these courses. This is like a new advancement in medical school training. So if you have a doctor who's over, like say 45 years old, they might not have gotten that training. Because I have when I um found this out. I went to each one of my like eight or 10 doctors, and I said, Oh, did you happen to have any training in medical school? Because it's hard, medical schools won't talk to me directly, but I will ask these doctors and they say, No. And the doctors were like in their mid-40s, early 50s. No, we didn't, you know, you learn on the job. You know, if you have a good role model, or you're that kind of personality, or you really want to figure out how to do things better, or you just like people, you know, you can say people are naturally good communicators, but really the best communicators are ones that practice, that care, that learn maybe from mistakes that they make earlier in their life. I mean, it's the same as life. You're in your 20s, what do you really know? You're in your 30s, you know a little bit more. When you get to your 40s and 50s, maybe you realize, you start to realize all the things that you didn't know, so you do them better. So, sort of the age, but age really equals practice. The more practice and the more positive uh interactions doctors have with patients, it reinforces those skills. But same for patients. You go in to meet a doctor for the first time, you come prepared to that appointment, you say to the doctor, this is how I really would like to work with you. I want to work in partnership with you. I've brought this information with you. I want to be able to answer your questions and be honest about it. Um, I'm gonna share myself with you. And I if I don't understand something, I'm gonna ask you and I'm just gonna want to know more. I want to participate. And the doctor, I all of my interactions on that level, the doctors have enthusiastically responded to me. No, because if you think about maybe you don't do this, but a lot of people they come in very defensive to a doctor's appointment. No other doctor has been able to help me. I really hope you can help me. And people are, because people are they're angry, maybe they haven't gotten the care that they have in the past, or maybe one of their family members have has had a very bad experience. And that like infiltrates their brain that they think it's more of an adversarial relationship. And that's why I steer away from the word like advocate. Like you have to self-advocate, but not in a negative way. It's not about like, oh, standing up for yourself to make sure you get the right treatment, it's about having sort of the confidence and the focus, the being really focused to talk to the doctor and share who you are and what's going on with you. And it takes usually takes preparation before you go into that appointment, meaning, take a notebook and write down what are your highest priorities? What do you really want the doctor to know? What questions do you have? What research you've done that you have sort of questions on? What else could happen? What are the risks? What are the benefits? What else should I be doing for my health? All those kinds of things. So I think that the communication will be enhanced. And for doctors who have a day like filled with 15 patients, and a patient comes in like that, this is a breath of fresh air for a professional who is now like, oh, somebody really wants my help. That's a really great thing. And I think most doctors go into this profession thinking, you know, I want to help people, particularly the doctors who have a direct patient practice.

Prep Methods That Make Visits Work

Manya Chylinski 15:20

Right, right. Wow. I think about some of those questions that you asked. And I've thought about those after the appointment on the way home, thinking, oh, I should have asked X, Y, or Z because I didn't write it down. And I'm also thinking about a relationship where I walked in to a doctor and was very scared. It was the third or fourth or fifth doctor that I've seen to try to track down what was going on and was very scared. And the appointment happened quite quickly, and I wasn't able to prepare in the way that I would have liked. And it all went wrong from the start. What's the step to take before we go to the doctor in order to have the best experience in the examination room?

Bring Support Or Record The Visit

Dana Sherwin 16:57

So I I always start with preparation. It's very important. And if you have the time, I mean, most times you have to wait either weeks or months to have an appointment with the doctor, right? Unless it's an emergency, that's you know, a different story. So you have that time beforehand to prepare. I would you really start by like, what do I want to and and write it down. So the pre preparation and writing it down is so important because you might want to like accumulate your thoughts over time. It may not just be one session with yourself of 15 minutes or 30 minutes to let me make this outline of what I want to accomplish, what my priorities are, my questions, but to then leave it and come back to it. Or if something you learn in between, then you have that written down that you can add to that list and you can think about it a little bit more, and particularly if you're meeting the doctor for the first time. I still I see, you know, been seeing doctors for like 20 years, like routinely, and I still take that same approach, even if it's a repeat visit. So that's one thing. The other thing is now that there's AI, it's not just Googling or an internet search. Now that there's AI, it gives you a little bit more in-depth analysis. If there's something you want to either understand better about, and it's not like it's not about self-diagnosing, it's about keeping yourself more informed, number one, informed, what is this disease? What manifests, what are the symptoms of this disease, um, what else should I be looking at? What other kind of specialists might be involved for? Let's say you have uh for all cancer patients, there's usually a cardiac uh component as well. So just get yourself educate yourself and get familiar. You could use AI, you could use Google, but not to overwhelm, to educate yourself. And also one of the best things to do is to use it for developing the questions, the best question. So I am feeling these symptoms, I think I might have this, or this has been my history. What question should I be asking the doctor? And it's incredible. So instead of like racking your brain, because not everybody really has the capacity, or even I think, like imagination to say, what is that question I should be asking? You can ask AI and do it through whatever your, you know, your favorite program is. Um, there are a lot more sort of proprietary uh programs that are popping up now. I haven't really tried any of them, so I don't really talk about it to recommend them. I am planning to look at that a little bit more closely, but I do find enormous opportunity to learn more through using AI because AI also references scholarly sources, the research that has been done on populations. So it's really not about individual. You want to really get a feel for what this is, what the disease might be, and how it manifests itself. And but I my experience has been I try to learn as much as possible, try to develop more questions than I already had for the doctor, you know, write those down, but also to, you know, to sort of make myself more curious about how I can help myself. What else could I be doing? So it may, it may say, okay, well, they don't have a treatment for this disease yet, but these are the clinical trials that are happening. And maybe you want to ask your doctor about clinical trials. Additionally, addition to AI, there is uh there are what I call patient communities or disease-specific communities. And you can find these. Find these, you know, they usually have their own websites, like the American Cancer Association, American Diabetes Association. They have such amazing resources, and they usually include questions. If you're seeing your doctor for the endocrinologist for the first time, what questions to ask? Maybe even by age category or by a previous disease that this is a secondary disease of. It's like there's so much there. Yes, you could get overwhelmed, but it's really just to, you know, start a process of being curious and developing questions you want to ask. So when you are then have this very valuable 15 minutes with your doctor, then you will be making that visit as productive as possible. And then I also like to tell people that if you really, if there's like a lot there, and there's all particularly a first visit, a lot to discuss, you say to the doctor, you know, I'd like an opportunity to think about all the things that we've discussed today. How can I reach you in between this appointment and the next appointment to ask that question or to get more information and let the doctor be able to respond to you that way? And some doctors will say, call the office or contact me through the portal, or my hematologist oncologist, because it's very specific, complex kind of treatment. She gives out herself her cell phone number, her cell phone for texting purposes. And I always feel bad texting her. She goes, Don't worry, just text me anytime there's something new that comes up for you, or something really bothering you. So, yeah, not every doctor is going to do that, but I can understand why, why she does that.

Manya Chylinski 22:13

Right. Absolutely. Wow. Okay. I love the um, I love that you use the word curiosity. I think often when something happens, especially something that feels serious, I don't know. It's easy to kind of shut down and just, I'm just gonna let the doctor tell me what's going on. Um, and you know. I don't want to see what the internet has to say about this. Now, one thing I've experienced both when I've been the patient myself and when a friend has been the patient is um bringing a friend with you to the appointment. And you know, how does is that okay? And how do doctors feel about that?

Dana Sherwin 22:55

Yeah, I think um I think it's a very accepted practice now. I really do. A lot of people have told me, particularly when it comes either to older people or you older people who might need someone, because you really need to, whether it's at the appointment or after the appointment, write things down. What are the things I need to remember? What do I need to follow up on? What are my questions for next time? And you need to do that. So sometimes it's very important just to focus on the act uh interaction with the doctor so then you can react. You have no time to write things down, really. Or maybe you're just your hands are shaky, or whatever it is. It's not necessarily an older person, but it tends to be more common that older people will bring somebody with them. Um, or again, if it's something very complex or very overwhelming, you bring a trusted friend who will take notes or ask questions on your behalf. And I think that it's very doctors can't say no to that request. The other thing that I'm hearing um sort of adjacent to that is that um some people like to record the conversation because it is really only 15 minutes. There's a lot there, it may be a lot there, but and I don't know if there's a rule on this from a healthcare perspective. I will try to find out. But usually people ask the doctor, is it okay if I record our visit? Now, I don't see why it wouldn't be okay, because today, in today's world, uh it's the uh healthcare physician practices, hospital practices are all moving to uh the virtual dictation, meaning the room hears every word that is said, or every word the doctor, I mean it has to be every word the patient says too. The room hears it, the system hears it, and we'll record it. But we as patients don't get a copy of that recording. Right. Which and and I I sort of understand why it's not moving in the direction of we're gonna record it for both the doctor and the patient, because theoretically the doctor needs to read everything over to make sure that everything is correct. But really, if that's happening, the patient should also be able to access that recording as well. Right, right.

Shared Decision Making In Practice

Manya Chylinski 25:09

I had an instance where I wanted to record, and uh the doctor said absolutely not. And I unfortunately then that set the tenor for the whole meeting because then I was feeling adversarial and I was feeling like I couldn't trust him because what was he gonna say that I couldn't record? But I'm glad to know that is an option, and I guess you know, one of the things I'm hearing from you is is that it is um it's a conversation, it's a sit down with this person and share what you know, share what you want to do, share what your concerns are, and you know, if it's a good relationship with a doctor, it will be a a back and forth.

Hope Through Tech And Genetic Testing

Dana Sherwin 25:53

Absolutely. I mean, that's the goal is, and I they do teach them in this in medical school now. The goal is to get to the point where the doctor has enough information to understand and perhaps make some recommendations or have some thoughts about what's going on. And then the third step is that there's this sharing of okay, what should we do next? Is that okay with you? It's called the technical term is shared decision making. And that's the doctor and the patient together make the decision about what happens next.

Manya Chylinski 26:27

Yeah, I love that we're moving in this direction. And my own story have slowly been getting closer to this side of things. Um, but I've learned so much from you today about ways to do things um even better and advocate for myself even more strongly. So we're getting, we're at the end of our time, but I'm curious, when you think about the future, what's giving you hope?

How To Reach Dana And Wrap

Dana Sherwin 26:53

So, what gives me hope is sort of the the advancement of medical technology. That's one thing, actually, when I was first diagnosed in the early 2000s, they really didn't have the medication and the technology to uh give better chances of uh success for a stem cell transplant. So by the time I got the stem cell transplant, like 10 years later, they have so advanced through clinical trials and other things, the right combination of drugs, the right kind of monitoring. And I believe that it's not because I wait, thank God I was able to get in there in time and still be eligible and have it because I did put it off. But I really believe that my chances of success were enhanced by medical technology. So I think that it's a very big piece of it for all kinds of cancers, the kind of technological reading of a per, whether it's blood tests or other tests that could detect cancers. I think very big treatments of cancers. Um, and also the early detection part. So there are genetic tests available now. I I had um I got my battery of tests way after my diagnosis, which I wish I would have gotten it earlier, but really only in the past five years have they really expanded. Genetics, the science of genetics has really progressed so quickly in the last five years that a lot of even practicing doctors aren't really up to date on everything. But the great thing about it is just alerts you to the risks, the risks that if you're at high risks is something that you then monitor and pay attention to. And I'm not saying it's hard not to stress over it. But one of the reasons I delayed having getting even the BRCA gene test is my mother and her sister had breast cancer. And I figured, I know I have the gene, I must have the gene, I'm not gonna get the test. How so I didn't, but when then I was diagnosed with this disease, which is genetically based, and they had this test and said, Well, do you ever have the BRCA test? No, okay. Do you want okay? I was ready then to get that test, and I tested negative.

Manya Chylinski 29:09

Okay.

Dana Sherwin 29:10

So the fact is, if I tested negative the 15, 20 years before, maybe that would improve my, you know, the or lowered my stress levels, but I didn't. And now I encourage young people to get a battery of genetic tests because then there's more ability to monitor and do preventive health measures. So yeah, I have a lot of hope for the future. I hope the future comes sooner than later.

Manya Chylinski 29:35

Yes. Agreed. Agreed. And as we wrap up, Dana, can you tell our listeners a little bit about yourself and your work and how we can reach you?

Dana Sherwin 29:45

Okay. So um I write on LinkedIn pretty much on a weekly basis. So I do a little blog post on something that is, I guess, important to the field of patient physician communication that gives people practical tools and skills and things to think about. You can always reach me there. My website is at the thinkingpatient.com where organizations, healthcare organizations, employers can reach me to um help support their workforce, take better care of their health and be more engaged in their care. And yeah, I'm on the podcast circuit as well. And it's been a thrill to get to know you over the course of our discussions. And um, I look forward to keeping in touch.

Manya Chylinski 30:32

Oh, thank you so much, Dana. And thank you for sharing everything you did with us today. I really appreciate it. And I also want to say thank you to our listeners for checking out this episode of Notes on Resilience, and we will catch you next time.