Shannon Garrett, RN, CHLC, CNN
How to Talk to Your Thyroid Doctor
Like most thyroid and autoimmune patients it took me a very long time and
several doctor visits before I received an official diagnosis. In my case, it was eight
years and nine doctors before I finally found physician #10, a highly qualified and
compassionate doctor who I credit for saving my life. I was diagnosed not only with
Hashimoto’s thyroiditis, but also celiac disease and pernicious anemia, yay! Prior to
those diagnoses, I had been diagnosed with interstitial cystitis which today is
viewed to be closely linked with autoimmune disease. I was relieved and perplexed
at the same time over my diagnoses after eight years because it validated that I
wasn’t crazy after all, which was how I felt for such a long time as I searched for
answers. It was frustrating to feel so intimidated and mocked by various
healthcare practitioners along the way who missed my diagnoses altogether. As
of today, my autoimmune thyroid disease and interstitial cystitis are in remission
and I feel and look better than I have in years. I discuss my journey in detail in my
eBook Hashimoto’s: Finding Joy in the Journey soon to be released July 2015.
The most important thing in communication is hearing what isn’t said ~ Peter Drucker
Unless you are one of the lucky ones, you have experienced frustration during and
after your doctor’s appointment. I know personally that I have walked away many
times thinking “what the heck just happened”, when the appointment did not go the
way I had expected. You know the routine…the doctor listens to your complaints of
an inability to lose weight or gaining weight, feeling cold all the time, hair falling
out, nails peeling/splitting, constipation, extreme fatigue, muscle & joint pains,
inability to sleep, and more. You’ve shared your most private emotions and
communicated in much the same way you would talk with a trusted friend. The
doctor nods his head, smiles, and steps out leaving you with the impression that
just maybe you’re making headway, only for him or her to return to the exam room
with a prescription for an antidepressant along with a recommendation that you
should exercise more & eat less, and learn to deal with stress! What?? Did this
doctor not hear a word?
Well, the short answer is no – the doctor did not really hear you. You see, although
they are supposed to be trained in the art of assessment and patient
communication, our medical system has changed. Doctors have very little time
in their daily schedule and must meet requirements for patient care quotas
making it a challenge to process patient’s verbal reports of symptoms and to listen,
assess, diagnose, and speak, etc. Essentially, the amount of time we as patients
have at best to communicate our issues is less than 10 minutes during the standard
20 minute appointment. When we do not quantify our symptoms or make them
measurable, the physician hears what is perceived to be a situation of depression,
stress or anxiety in our tone and verbiage. Not to defend their shortcomings in not
diagnosing us properly…but they are human and they hear these same sort of
vague symptoms that apply to many health conditions almost continually all day,
every day. It is of utmost importance that we don’t communicate our symptoms
to them in the same way we do our girlfriends!
I can remember thinking to myself “okay, I am an integrative nurse and thyroid
& autoimmune wellness nurse specialist for goodness sake, and I know how to
talk with doctors professionally in the clinical setting whether it be about
patients or private clients – so why do things change when I’m the patient?
Even though finding the miracle doctor I did, that was only the beginning. Then,
it occurred to me that if I were to use SBAR during my own appointments, we
might begin to see “eye-to-eye” on my issues. It was a win/win for us both!
SBAR is a unique and simple yet effective form of communication that is
typically reserved only for use by healthcare providers. For example, SBAR is
used when a nurse is calling a physician, when nurses are giving reports
during hand-off and when nurses are transferring patients to other facilities
or other levels of care. It is also used for doctor-to-doctor communication.
SBAR was originally developed by the US Navy as a communication technique
used on nuclear submarines and was introduced into the healthcare setting in
the late 1990s. Since that time SBAR has been adopted by hospitals and
healthcare facilities as the gold standard for standardized communication
between HCPs. Believe it or not, you too can adopt the principles of SBAR to
prepare for your appointment (every time) as a better way to communicate
with your doctor especially for thyroid or autoimmune issues and ultimately get
the care you need and deserve out of your visit. I’ve shadowed some of the best
functional & integrative medicine practitioners out there…and believe me when
I tell you that they are overwhelmed with autoimmune & thyroid patients. One
reason is simply the reality that their time with each patient is limited. Another
reason, as it applies to those of us who have a thyroid disorder as one physician
stated, “thyroid patients carry a lot of baggage.” He did not intend for this to be
derogatory, but rather it was his way of recognizing that we are in fact, very
unique individuals with complex issues and symptom descriptions that are
often ambiguous to them rendering the process somewhat of an obstacle. The
truth is we’re not their typical primary care “in & out” patient for sure, and these
circumstances overwhelm them. All the more reason to be armed with targeted,
concise, quantified (when applicable) communication. SBAR communication
fosters a greater potential for thyroid patients to feel empowered and underscores
their credibility as a respectable and contributing member in their own health care.
SBAR will allow you to get the most out of the time you have with your doctor. I’m
serious when I tell you that the first time I used SBAR as a guide to communicate
my main points, my doctor’s ears perked up! And it makes so much sense when
you consider that this is the primary form of communication they are trained to
understand and actively use on a daily basis. SBAR is actually their primary form
of communication all day most days of the week; however, it really doesn’t matter
who it is with or what the topic is about – effective and direct communication
applies to all important conversations – it’s not exclusive for healthcare providers.
Preparing for your appointment by applying SBAR principles: I teach all my clients
to prepare for their doctor’s appointment in advance. It’s so easy to forget details
when we are not feeling well (foggy brain, anyone?), scared, worried, anxious,
emotional, or trying to think of everything at the last minute. Even if it is only a
simple follow up visit, establish the good habit of preparing for your medical
appointments each and every time. I believe that taking the time to prepare is
one of the most important investments you can make for your overall well-being
and it’s one of the most important tasks you will ever do. Think about it…you
prepare for other important events in life, like dates, meetings, events, and
presentations at school or work. Preparing for an appointment, a meeting about
your overall health, mind-body-spirit and emotions is no less important and you
are worth it! If this ever seems like too much of a task, ask a trusted friend or
family member to help. One of the most valuable services I offer my clients is to
attend physician appointments with them to advocate and speak on their behalf,
The first step in preparing for your appointment is:
1. To reflect upon what it is you hope to gain from your visit. Whether it is your
initial visit or a follow-up appointment, you will want to make a basic plan as
a rough draft.
2. Make a list of the things you want to discuss and give some thought as to how you
are going to describe your symptoms by quantifying them.
- “I’ve been feeling cold and my basal body temperature has been 95.0 to 96.7
for the past week.”
- “I’m gaining weight despite eating healthy and exercising, I’ve gained 1.5 lbs
every week for the past month.”
- “I’m losing more hair than ever before, and I’m counting 50-60 strands of
hair in the drain when I shower.”
- “My bowel movements have changed and I’m constipated – I used to go
every day, and now I’m only having one BM every 4-5 days and it’s very
3. Assess yourself and how you really feel – and your emotional well-being
4. Put your concerns in order of importance so you are sure to address the most
important issues first.
5. If this is a new patient visit, be sure to document your allergies, food sensitivity/
intolerance issues, and other pertinent history.
6. Despite completing this information on your new patient intake forms, note
these on a separate sheet of paper and hand it to the doctor in person (trust me on
7. Ask your pharmacy to print out a list of your medications instead of listing
them yourself and include it along with a list of nutraceuticals and herbal remedies.
8. Summarize your objectives and then rewrite them in SBAR format to take to
your appointment. I like to write things down on index cards, one for each SBAR
letter and in order.
Then, I simply read them to my doctor. Don’t laugh – this really works! It may feel
awkward at first but you will get comfortable with it when you see how effective it is.
Below is an explanation of SBAR, and you always want to communicate your issues
in this exact order:
S = Situation: This refers to “why” you are visiting the doctor. Example: “I’ve been
experiencing significantly more fatigue & I’m also feeling colder than usual.”
B = Background: This refers to details in support of the Situation. Example: “I
used to take daily walks in my neighborhood, approximately 1 mile. For the past
month I can’t even make it past the stop sign at the end of my street which is less
than ¼ mile, I get very tired and have to stop. Also, I’ve been checking my basal
body temperature every morning and it’s always 95.0 to 96.7. I understand that
A = Assessment: In the case of patient-to-physician communication, this
refers to your intuition and research as a non-medical person for what you have
learned or discovered with respect to your symptoms. Example: “Based on what
I’ve read via ____________ (cite a credible source) I believe I may be experiencing
R = Recommendation: This refers to your opportunity to state what you want
done…lab tests, ultrasound or other imaging, referral to a thyroid wellness coach,
nutritionist, bodywork or massage therapy. Example: I would like for you to order
thyroid labs for me (FT4, FT3, RT3, TPO & TGB antibodies, TSH, Ferritin,
Vitamin D3, 25-OH, & a full CMP, saliva testing for adrenal function, stool analysis
testing, vitamin/mineral testing, etc., and a prescription for massage therapy.
Side note: Notice that emotional comments are left out of SBAR communication.
Be concise, specific, to the point, and quantify the Situation in your Background
statement as applicable. Using individual index cards for each SBAR topic, you
should be able to read all details in a matter of a few minutes. Your doctor will
Remember to take the rough draft you made in the preparation phase and
finalize it by reformulating it into SBAR format. I’ve been using SBAR for years now,
and I’ve taught it to more clients than I can count. I have the index cards with me
and I literally read them to my doctor – he not only listens better than ever before,
he respects my efforts to proactively prepare and we both get more out of the
short time we have together than we would have had I gone in totally unprepared
and sharing vague to mixed emotional symptom statements. SBAR has fostered
a new level of healthcare and one that has truly elevated my quality of wellbeing.
I’ve established a more solid partner-relationship between me and my doctor
and I value that. I want this for you too!
Another idea I love is to keep a SBAR “journal,” as your own history of what you’ve
communicated along the way. If you are having any difficulty whatsoever
understanding how to apply SBAR in your own unique thyroid situation, no worries,
Contact me HERE, if you need
guidance and I’ll help you to get started.
“I saw the angel in the marble & I carved until I set [her]free” ~ Michelangelo
What are you waiting for? Starting today, I want you to take an active and assertive
role in your thyroid care. Do everything you can by using your power, wisdom and
insight to get the best care possible. No one is going to care more about your
well-being than you (except for maybe your mother, or your wellness coach!).
About the Author
Shannon Garrett, RN is a thyroid and autoimmune women’s wellness specialist, integrative registered nurse, holistic lifestyle & wellness coach, certified nurse-nutritionist and detox specialist. She is passionate about guiding and supporting women to discovering optimum well-being; mind, body, spirit, and emotions. She offers unique wellness programs specific for autoimmune and thyroid issues and works in tandem with your healthcare practitioner or wellness team. Shannon was recognized as one of the Top Thyroid Clinicians & Health Coaches Directory compiled by Dr. Izabella Wentz, PharmD based on submissions offered by patients. Shannon is the author of Hashimoto’s: Finding Joy in the Journey and its companion guide Thyroid Happy: Tips & Strategies for Abundant Living. She has expertise in over 100 dietary theories, behavioral therapy, societal therapy, anxiety, stress, and emotional well-being. Although Shannon no longer practices nursing in the clinical setting, she has experience in the following specialty areas: cardiac nursing, oncology, neurology, orthopedic, pulmonary, and clinical skin prevalence study teams. Shannon attended the prestigious Aquinas College School of Nursing in Nashville, Tennessee and completed her degree Magna cum Laude. Additionally, she was recently featured as a co-host on Thyroid Nation RADIO. Follow her on Twitter.