Neha Pathak, MD, FACP, DipABLM: Welcome to the WebMD Health Discovered podcast. I'm Dr Neha Pathak, WebMD's Chief Physician Editor for Health and Lifestyle Medicine. I'm sure that most of you have had a medical appointment where you left with more questions than answers. Maybe the visit felt rushed. Maybe your healthcare provider spent more time looking at a screen than looking at you.

Or they spoke in unfamiliar medical terms, and you nodded along in the moment, only to get home unsure about what your diagnosis was, what treatment was being recommended, or what you're supposed to do next. I know for a fact that all of these things have happened to me. And these moments can be frustrating.

They can also affect whether you feel confident seeking care in the future, following a treatment plan, or trusting the healthcare system at all. In this episode, we'll talk about how patients can become more empowered partners in their own care. You'll hear practical ways to prepare for appointments, ask clear questions about diagnoses and treatment options, and make sure that your values and priorities are part of the conversation.

We'll also explore why communication is essential for better health outcomes, stronger trust, and a relationship in which you and your healthcare provider can truly work together. Whether you're managing a new diagnosis, caring for a loved one, or simply trying to get more out of your routine visits, this conversation will help you walk into the exam room feeling more prepared and leave with greater clarity.

First, let me introduce my guest, Dr Neil J. Farber. Dr Farber is Professor Emeritus of Clinical Medicine at University of California San Diego, and he's also the author of "Treating a Broken System: A Physician's Cure for the Healthcare Crisis."

Welcome to the WebMD Health Discovered podcast.

Neil J. Farber, MD: Thank you very much. Thank you for having me.

Pathak: Well, I think we are about to have a very important conversation. I think that patients will benefit from all of the expertise that you have to share. But before we jump into our topic, I'd love to ask about your own personal health discovery, your own aha moment when it comes to the work that you're doing and what led you to write your book.

Farber: Well, it's very interesting because I had been an, an attending physician in general internal medicine and an academic physician for 40 years. So seeing patients, teaching, doing research. And I saw changes in medicine, but it didn't really impact me or my fellow physicians that much. And then two years ago, I had my own healthcare issues, acute appendicitis, and when they were doing a CT scan of me, they found a, a four-centimeter renal tumor that had to come out. And going through all that, it suddenly dawned on me that there were two major issues that are really causing a healthcare crisis. One is the fact that physicians, even though we had taught physicians about how to communicate with patients, many weren't doing so. And more importantly in some ways, it was difficult to get appointments with physicians. And when I did the research, did a literature search, I realized that there really is a healthcare crisis in, terms of physicians not communicating and physicians dropping out of medicine.

Pathak: Yeah, so let's start there and talk about that interaction that patients have with physicians in the office, where as practicing physicians, we think that we are-- we're having a conversation at least, but we're not necessarily communicating in a way that allows patients to leave feeling like they've been heard or that they've been supported in their concerns.

So can you talk about the research that you did? Why is that? Why is that happening?

Farber: Well, it's interesting that there was-- there's been sort of shifts over time. When I was taught about quote-unquote, "communication with patients," it was basically a half day. We were given a list of questions to ask patients, and that was how we were taught to communicate with patients. There was really no substance to it. And then over time, that changed so that now physicians who are medical students as well as residents are taught about how to actually communicate with patients. But I think a lot of the time physicians as they get more into their practice and into their specialty sort of lose that, if you will. They don't pay attention to it as much 'cause they're more into the scientific aspects of medicine.

And and that becomes a problem.

Pathak: I'd love to hear from you in terms of what good communication-- what does the ideal actually look like?

Farber: That's a good question. I think the ideal is basically where the physician really wants to know who this person is, what their values are, what's important to them. Not only their problems, their symptoms, et cetera, but who is this person? And Faith Fitzgerald wrote this wonderful article in the Annals of Internal Medicine entitled "Curiosity." And in it, she talks about the fact that physicians need to have curiosity, an appropriate curiosity. Who is this person that they're seeing?

Pathak: And that's really, um, the heart of what, you know, you asked me what, what does communication, good communication look like, is the end result is that the physician and the patient are, as you said, are working together for the benefit of the, of the patient.

So talk to us a little bit about what most of us these days experience when we go into a clinical encounter. And I will say I've certainly experienced this on the other side as a patient in the office as well, where you feel rushed, dismissed. You come in and the focus is just on this one very narrow thing when you kind of had this expectation or this hope of a more general visit.

What does that do in terms of impacting a patient's health and willingness to seek care in the future?

Farber: It's interesting, we did this study where we looked at patient satisfaction with the encounter, and we measured the amount of time that the physician was actually looking at the patient, and that was the main determinant about whether the patient was satisfied or not. And so a physician who is sitting there and typing at the computer or talking to the computer and not to the patient is going to have the patient be dissatisfied with the encounter. And studies long ago found that when patients are dissatisfied in some way with their physician or with the encounter with the physician, they're much less likely to engage in the activities that will benefit them in terms of their health: taking medications, appropriate diet, et cetera. So that basically you find that patients are not getting the kind of care that they need.

Pathak: And this is often where patients feel like they're not empowered to ask those questions or they don't know when to.

So can you give a little bit of advice about how patients can do this?

Farber: Yeah. It's interesting that there is this power differential. I mean, the physicians control everything, and it's only when a physician allows a patient to be empowered that the communication is really the way it should be. I think that patients need to sort of have written out questions that they have when they develop them so that they feel able to read off the question rather than trying to get it on the fly. And if they have the questions written out and just read the question, the physician then is going to be more likely to give them the answer to the question they're asking.

Pathak: Are there certain questions that you would expect or you would encourage people to sort of have as part of their routine, these are some of the basic questions that I'm gonna ask when I go into my doctor's appointment?

Farber: Sure. Patients need to find out what their specific diagnoses are, what treatments, the physician is recommending for those particular diagnoses. And we now know that-- we now teach physicians to engage in shared decision-making so that the, the physician gives a number of options to the patient, g-gives the patient their recommendation.

But if they do that, the patient needs to ask, "Okay, you're recommending this. What else is there? And what are the, not only the benefits of each of them, but the side effects of each of them?" So that a patient can weigh the pros and cons of the different treatments and decide what's right for them.

That's probably the most important thing that a patient can do.

Pathak: How do you think we should counsel our patients to really ensure that those most important questions are answered when they're coming into an office? They might not know everything that's going on. They're not speaking with a provider who's kind of going through all of the different options with them.

What would be your advice in that situation?

Farber: So I think that if there's any time where it's an important decision to be made, that the patient either bring someone with them who can take notes. If not, that have an important person, relative, close friend, et cetera. Either if they can't come, or for whatever reason the patient's alone, ask the physician if it's okay if there's a Zoom interaction with this other person, or at least telephone interaction with the other person so they can listen in and remind the patient what questions needed to be asked.

And, and/or the patient needs to record the visit, audio record the visit, so they can review it later and say, "Hey, I didn't find this particular thing out."

Pathak: So how do you encourage patients to speak up if they're alone, or how do you help their caregivers speak up when something like that is going on?

Farber: As I said, I think the patient needs to ask, "What are the pros and cons of each treatment?" And if they're uncertain that this is the best thing for them, or like that, that this is the physician's recommending this, but why? I think they need to ask why. But if they're still not getting enough information, they need to ask the physician for a referral for a second opinion.

Pathak: What do you suggest people do if it's the situation that you were talking about earlier, where the doctor's explaining things to you, but they're not looking at you? They're just typing their note. They're just looking up everything in the computer. So it seems very reasonable, the things that they're doing, but you're not really getting that human connection with the doctor. How do you address that?

Farber: Well, that's an interesting question. And there are gonna be physicians who would respond positively to this and others who would not. So I think the patient has the right to say, "Can we talk for a minute? Can you just look at me and talk for a minute?" And some physicians are gonna take offense at that. And if the physician continues to just type and doesn't respond to that, 'cause that's a warning sign from a patient. I mean, really is a warning sign, like you are not having a good relationship with this patient. Then I think the patient needs to find a different physician, unfortunately. And I think, in addition, I think it's important to let the patient representative or the questionnaire that always comes out, let them know that your physician, not that they are incapable of it, but didn't have enough time to spend with me in really looking at me and discussing this. That they were so consumed with having to get their note done, et cetera, that we didn't have enough time. And that I think is something that needs to be expressed so that administration knows, "Hey, we've got a problem here because some of our physicians are not having enough time to really spend with the patient."

Pathak: I think that's really important feedback to give not just to your provider, but to the system itself. And that brings me to another question, which p- I think this is a part of why we're seeing trust in healthcare decline so much in recent years. So I'd love to know from you, what do you think needs to change so that we can rebuild the trust between patients and doctors?

Farber: I think there's two major things that need to be done. And all of this needs to be done, as I said, with physicians and administrators sitting down together and working this out. One is that physicians need more time. They need more time not to goof off, not to play video games on their phones, but rather to have time to interact with patients so that they really get to know patients, they get to address the patient's issues. And this can only be done when administrators and physicians sit down and work out the problems together. Besides that, I think some physicians, because they've been in the system so long, have forgotten some of the things that are really important in terms of communication skills and have forgotten the joy of communication with patients rather than the day-to-day drudgery which they see it as. And so I think that basically, in addition to having more time, I think physicians and administrators need to come together to institute ongoing educational programs for physicians about how to communicate with patients appropriately. And I think if you do both of those things, I think you find that the lack of trust that patients have with their physicians and with the system will absolutely turn around.

Pathak: I think that's just such an important point, and I think, makes so much sense. You have to know your physician in order to trust your physician, and if you don't have time to get to know them, it's really hard to sort of engender and create that trusting environment. So I think that's such an important point.

So as we come to the close of our time together, I'd love to cede the last few minutes to you and really dig into key messages from the book that you hope will empower patients so that they can have the best clinical experience, the best experience of communication possible with their doctors.

Farber: So, that's a good issue. And I think one of the things—so there are many things I can talk about. One of them is that patients need to let the physician know who they are. Not just as a patient, not their problems and symptoms, but who are they as a person. Let the physician know this so that they can enjoy the joy again of what it is to be a physician. Let them know, "Okay, so I'm a space freak." That was always my hobby. And the patient who came in the office, who was very modest and didn't wanna disclose what he did, he had retired. And when I probed further, admitted that he was one of the main engineers for the lunar module.

And it was like I was talking to one of my idols. He knew all of the astronauts who walked on the moon. And it's like, "Oh my God." So this is the kind of thing physicians can find out, and patients need to let the physicians know this. Patients also need to let physicians know their values, what things are important to them so that physicians can tailor the treatment to the patient. And patients need to ensure that they have a physician who will listen to them. Ensure that when they go to a visit, they have all their questions and issues raised, in a written format, so they can remember what to ask the physician about when they see the physician. And bring someone with them or allow someone to be on the end of a Zoom or a phone call so they can take notes and at times also audio record the visit. I think patients need to let the administration know that if they're having problems with their physician, that it's not the physician who's the problem, it's the system, and that things need to be done to improve the system.

Pathak: These are great points. I think this is really important for people so that they can come in empowered to have conversations. And really, I think your first point really moved me, which is that physicians themselves want to know who their patients are. They want to know these stories.

So you're actually giving them an enormous gift by going in and telling them about who you are in addition to why you're there, which I think is just such a beautiful way to start that journey of working together from the very beginning, setting that intention.

Farber: Yeah. And it really is a joy when physicians are empowered and given the ability in terms of time to interact with their patients in that way. It really is a joy to get to know people.

Pathak: Well, I want to thank you so much. It's been a joy to have this conversation. I really appreciate your time, and thank you so much for the insights.

Farber: Thank you.

Pathak: My key takeaways from this discussion are first, come prepared to be an active participant in your care. Before an appointment, write down your main concerns, symptoms, medications, and questions. Ask questions and take notes during the visit. Before you leave the visit, make sure you understand your specific diagnosis, and if you don't have one yet, what is the plan to get you closer to one?

You also wanna know the treatments that your provider is recommending and the next steps. Second, stay curious and ask about your options, not just the first recommendation. A helpful question is: What are my treatment choices, and what are the benefits, risks, and side effects of each one? Shared decision-making means your healthcare provider brings medical expertise, and you bring your goals, values, daily realities, and preferences to determine the best path forward together.

Finally, you deserve communication that helps you feel seen, heard, and informed. Bring a trusted person to important appointments. Invite someone to join by phone or video when appropriate, or ask permission to audio record the visit so you can review the information later. If you repeatedly feel rushed, dismissed, or unable to get your questions answered, share that feedback with the healthcare system and consider seeking another clinician who may be a better fit.

To find out more information about Dr Neil Farber and improving communication and trust during appointments, make sure to check out our show notes. Thank you so much for listening. Please take a moment to follow, rate, and review this podcast on your favorite listening platform. If you'd like to send me an email about topics you're interested in or questions for future guests, please send me a note at [email protected].

This is Dr Neha Pathak for the WebMD Health Discovered podcast.