Many patients would rather suffer in silence than bring up sensitive topics with their doctors. Their silence contributes to increased health-related anxiety, greater dissatisfaction their doctors' care and the need for more expensive and invasive medical interventions as little problems grow bigger.

"The inability to speak openly with doctors is a significant barrier to quality medical care. Coaching patients to talk with their doctors about embarrassing medical topics they prefer to avoid is a low-cost solution that reaps huge gains," says Dr. Rackner .

Rackner recounts the story of a patient who literally died of embarrassment. "Joan noticed blood in her stool, but embarrassment prevented her from telling her doctor. She died several years later of the colon cancer that caused the blood. Chances are good that she would be alive today if she had overcome her embarrassment and gotten treatment for an early-stage colon cancer."

"Patients encounter predictable embarrassing topics which I call the 5 P's: peeing, pooping, paying, procreating and psychic pain. The failure to discuss the 5P's can cause significant suffering," says Rackner. "One patient with what's now called a shy bladder had not used a public restroom in over 20 years. She was too embarrassed to talk with her doctor about this. Instead, she remained a prisoner to her bladder. Another patient was laid off from work. Money was tight, so he decided to forgo his asthma medication. He wound up in the emergency room with an asthma attack that could have been avoided with the regular medication. Yet another patient lost his appetite and slept poorly as his caregiver responsibilities for his aging father mounted. His wife asked if he might be depressed, but he told her that it couldn't be because 'real men don't get depressed.' "

Rackner offers some tips to help patients talk with their doctors about embarrassing medical topics, such as the 5 P's

Tell the doctor you’re embarrassed. Say to your doctor, "This is a taboo topic in our family, so it's hard for me to ask. Is it normal to have a funny smell coming from your belly button?"

Find and learn the words. Your doctor speaks a specialized language acquired through years of training. Sometimes patients are embarrassed because they don't know the "right words" or have a hard time describing the problem. Get a basic anatomy atlas for lay people. Use anatomically correct words with your doctor and teach them to your children.

Practice saying the words. Embarrassing words can be hard to get out of your mouth. Gertrude, a 90-year-old patient said, "You youngsters don't understand how much things have changed. When I got breast cancer in the 1962, the words 'breast' and 'cancer' were not uttered in polite company." Some words are still embarrassing to say. Practice saying these words out loud when you're alone. That will make it easier to say them at the doctor's office.

Find the right person to ask. You may have an easy rapport with the nurse or physician's assistant at your doctor's office. You can bring up the sensitive topic with them. Say to the nurse, "Trish, could you please give the doctor a heads up. I want to know why I should say no to those steroids my buddies at the gym are offering me.”

Find the right way to ask. Maybe it's easier for you to drop a note or a cartoon to your doctor rather than ask in person. Find the style that works best for you.

Remember that your doctor is there to help you, not to judge you. Your doctor has heard it all before. I promise! Your doctor will not think less of you for asking an embarrassing medical question; in fact, your doctor with think more of you for overcoming your fear and helping you take charge of your health.-- and for being so honest and direct.

Vicki Rackner M.D. president of Medical Bridges, is a surgeon who left the operating room to help patients partner more effectively with their doctors. She's a speaker, author and consultant.

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