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Clean Set Up: A Strategy for Building Confidence and Control in Medical Consultations


If you’re anxious about a doctor’s appointment, what are some things you could do to prepare for it? Even if you don’t have control over how a doctor treats you, what are some things you can do to increase the chances of getting what you want during a consultation?

I had to ask myself these exact questions recently. I’d been thinking about Hormone Replacement Therapy (HRT) for more than a year, having suffered hot flashes, brain fog, sleepless nights and joint pain. And I had done lots research - including listening to Davina McCall’s Menopausing, which I highly recommend. When I was ready to speak to a doctor I made an appointment with a gynaecologist that my friend had recommended, and arrived ready to explore and to share my concerns and questions. Except that’s not what happened.

Instead, the doctor repeatedly asked me questions or made statements that undermined my confidence and this in turn made it harder and harder for me to advocate for myself, or to be clearheaded about the kind of consultation I had a right to expect from a doctor. She also did two invasive procedures on me, one of which was painful and expensive, without my consent. Despite being in shock, anger made me lucid enough to lodge an official complaint.

Nevertheless, I decided to persist with HRT. I didn’t want that experience to derail my efforts to have better healthcare in my menopause. I made an appointment with another gynaecologist, an old classmate.  As determined as I was, however, I hadn’t considered that the trauma of the first doctor’s experience would make me anxious about seeing my doctor friend. As I was driving to the appointment, my heart was thumping so hard it felt like an echo in my chest, my mouth was dry, and I kept wanting to turn my car around.

But I didn’t. And it was while I was waiting to see this doctor that I asked myself how I could prepare myself for what was to come – and realised that the best thing I could do was a Clean Set Up for this consultation, something I hadn’t done for the previous one.

No rush to get on the path

And so with all my anxieties and the earlier traumatic experiences in mind, I wrote my Clean Set Up on my phone for the kind of doctor’s visit I wanted this time around:

Q1: For my consultation with the doctor today to go just the way I would like, it will be like what?

It will be like a conversation between me and a navigator as I embark on this path. The navigator will give me information and options. I will go away and have a think and then decide. There is no rush to get on the path. It is in front of me and there is more than enough time before I need to step on it. I will feel heard. The doctor will be interested in my experiences and concerns. And if she isn’t, then she is not the doctor for me.

Q2. For it to be like that, I’ll need to be like what?

I’ll need to say: “I am here just to find out about the process and cost of HRT. I haven’t yet decided when I will go on it. I don’t want to be rushed into doing any tests today. Cost is a major factor for me. It’s important I have time to do my own research. Give me as much information as you can, and I will take notes and go away to do my research. And after that I will come back with questions or a decision.” 

Q3. What support or resources will I need?

I need to be clear. It is my body and my money. I am here for me and my body. Doing this Clean Set Up is helping. I’d like to text my insurance agent so I have a friend who can hear me say this to myself. Another resource is my own research into HRT, which will continue to happen after the consultation today and before I make any decisions.

What happened next?

Because I was clearer about what kind of consultation I wanted, I was able to say to this doctor, soon after our hellos: “I am here to find out more about the process and cost of HRT. I don’t want to be rushed into doing any tests.” That set a clear frame for our conversation. And even if that wasn’t the frame the doctor was going to follow, I was clear that that was my frame and I had a right to want that frame.

This doctor heard me. She understood I’d been through a traumatic experience with another doctor. She let me have a cry. Then she took out a blank sheet and wrote down what my HRT options were, and what the cost of each option was. Then she said, “You don’t have to make any decisions now.”

But I was ready to start HRT. I think I’ve been ready for a while now. And the information I was receiving from this doctor provided me with the kind of HRT options I was looking for. And it really felt like I was making decisions for myself, with the help of a professional navigator. I asked her to write me a prescription, and I left the clinic feeling so much better but emotionally spent.

Then, because I’d said in my Clean Set Up that one of the resources I would need was to continue researching, I found myself doing that when I got home. I researched the different options on the sheet, and took note of which options best matched what was really important to me. Then I texted my doctor to say I’d changed my mind and would she write me a different prescription.

I haven’t yet started on my HRT path. And I know there will be a period of adjustments once I do, maybe even physically uncomfortable ones. And I feel so much better for having made my own informed decision about my next steps getting on the path.

The fact is, what happened during and after this second consultation wasn’t made magically better compared to the first just because I’d done a Clean Set Up. There were other factors like having two different doctors with different motivations and levels of professionalism.

But doing the Clean Set Up helped me define clearer boundaries with an expert I would normally defer to, like a doctor. That made it so much easier for me to advocate for myself, and to have more control over how my path will be navigated next.

Related blog posts


Clean Set Up

14th Apr 2008

By Marian Way

About Jacqueline Ann Surin

Jacqueline Ann Surin's avatar

Jacqueline Ann Surin is a Level 1 Clean Facilitator, the first Master Level Systemic Modeller in Asia, and is qualified as a Professional Certified Coach (PCC) with the ICF. She is an associate of Clean Learning and Training Attention in the UK, and a specialist-partner of the Singapore-based BeInClarity. She was previously an award-winning journalist and has a published chapter in Clean Language Interviewing: Principles and applications for researchers and practitioners.

She can be found on LinkedIn.

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