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Make the most of your time with your doctor

DR. PATRICK NEUSTATTER

There’s a classic scenario that unfolds too often in doctors’ offices, when those precious few moments of an appointment have been used up—but then the patient brings something up something really important.

A colleague always cited the example of the patient who, with one hand on the door handle, casually says, “Oh, by the way, my wife thought I should mention this squeezing chest pain I get when I walk up stairs.”

Do I even have to tell you that symptom is the  sine qua non of heart disease or an impending heart attack? So, you have to start the whole visit over.

Being prepared for your encounter with the doctor can prevent this kind of last-minute mess, and benefit you and your doctor.

ANATOMY OF A VISIT

Your “encounter”—a term I always feel has a slightly militaristic, confrontational ring—starts with the taking of your medical history, which the nurse begins and the doctor elaborates on.

There is an inherent conflict here, though, because in our training, we are admonished to ask open-ended questions—“What can we do for you today?” or “How are you doing?”

Yet this is an open invitation to the patient to tell his or her story in glorious detail, with a host of irrelevant details—which is likely to eat up all that very limited time you have with your doctor.

In reality, in a time span measured in nanoseconds, the doctor usually cuts you off, with very specific questions.

So, I advise patients to  be aware of this time pressure and be a succinct historian—it will give you more time for discussion of important stuff later. I can’t help thinking there is something to be learned from Twitter. A history of no more than 140 characters?

And please, tell your doctor about symptoms, not a diagnosis. If you complain of “ulcer pain” and the doctor takes you at face value, the Pepcid or Prilosec he’s likely to prescribe you will not get you better if your pain is actually coming from your gallbladder. That organ  has a cussed habit of producing symptoms that can be an alternative cause for abdominal pain that is very hard to differentiate from “ulcer pain.”

After the history comes all that looking and listening and prodding and poking—the exam.

Patients should wear clothes that can be easily loosened or removed—the recent fashion for camisoles is a veritable nightmare when you are trying to listen to subtle breath or heart sounds, which are muffled by any clothing.

And maybe wear something you can throw back over yourself because you often have to sit around in some diaphanous paper gown for hours, feeling both cold and vulnerable.

Next comes the all-important “assessment and plan.” In other words: What’s wrong, and what needs to be done?

BRING BACKUP

If you have several problems, complicated issues that will be hard for you to understand or are forgetful, bring someone along with you. That person can write notes and also provide emotional support if what your doctor has to tell you is likely to upset you. An oft-heard comment is “After you tell a patient they have cancer, they just don’t hear anything else.”

Another useful and often recommended memory aid is to make a list of what you want to ask the doctor, and show it to him or her straight off to see if you both agree on priorities. This is not a poker game; it’s OK to show your hand.

However, the “laundry list” is another piece of medical folklore that doctors talk about. Again, since you are dealing with limited time, keep your list realistic. I had one patient bring me a drawing of a stick figure with bullet points of all the different parts/problems she wanted to ask about. It was very cute, but there were fifteen bullets for a fifteen-minute appointment.

So, though a list can be a great organizer, when you pull out something like the Dead Sea Scrolls, your doctor may balk.

Also important: If this is a first-time visit to a doctor, bring any records you have from other doctors—or take the trouble to obtain them before your visit.

BROWN BAG IT

Another help—or dare I say, necessity—is to bring all your medicines in their original bottles.

Yet another stereotypical complaint of doctors is about the little old lady who comes in asking for more of “the little, blue, blood pressure pills.” A doctor usually doesn’t get to see medicines he prescribes and  so doesn’t know what they look like. And even a medicine list usually doesn’t tell you the number of refills, the date prescribed and what the pills look like.

All the information the doctor really needs about your medicines is on—or in—the pill bottle. So, the person beside you in the waiting room clutching a large brown paper bag didn’t bring her lunch in case the doctor was late. She’s doing what you should do.

SPEAK UP FOR YOURSELF

Be your own best advocate during medical visits.

“Patients who have the best results are those who take it upon themselves to find out what they need to know and make sure the health care system is giving it to them.”

These are the wise words of Richard N. Fogros, writing about managing your doctor on About.com.

We’re in the era of  “patient-centered” encounters, where patients are much better informed—with the advent of the Internet in particular. Patients are much more involved in the decision making than in the “good old days” of paternalistic doctors.

I am all in favor of patients being as informed as possible and participating in decisions about their own care—unlike when doctors did it all—so long as they are getting good information.

So, be nice, but be empowered—by being prepared for your encounter. See the “to-do”  list below for more ways to get prepared.

TO-DO LIST:

Use this list to prepare for visits to your doctor:

  • Bring any records you have—or obtain them from previous doctors if this is a first visit.
  • Be aware you have limited time. The norm is for first visits to be 30 minutes long and follow-ups 15 minutes. Make your medical history succinct to use the time wisely.
  • Make a prioritized list of what’s important to you, and show it to the doctor. Or, if you are in an ongoing course of treatment, get or make a Care Journal. I discussed this in a column in November; you can learn more about the journals at josieking.org.
  • Bring a friend or relative if you may have trouble understanding or remembering the encounter, or might be upset by it.
  • Bring all your medicines in their original containers.
  • Wear clean, easily removable clothes.
  • Know your insurance company’s requirements—what medicines or specialists are covered, for example. Ideally, know in advance, or be prepared to check that your insurance plan covers any medicines the doctor prescribes, or visits to any other doctor you are referred to for care.
  • Be empowered by being informed about your condition.

—Dr. Patrick Neustatter

ON THE WEB:

To be an empowered patient, you need information, and there’s a massive amount online. (I’ve read that the number of medical sites is second only to the number of porn sites.) But be careful: Some of that information “is seriously wrong,” says Dr. Paul Cundy, chairman of the British Medical Association’s technology committee.

Nettop20.com lists the three most popular/highly rated medical sites as webmd.com, healthcentral.com and wrongdiagnosis.com. My experience with these sites is that they seem reliable, but it can be hard to be sure.  Fairly sure bets for good information are the sites cdc.com and mayoclinic.com.

—Dr. Patrick Neustatter

Dr. Patrick Neustatter, a longtime family practitioner, is the medical director of the Lloyd F. Moss Free Clinic. He can be reached at healthyliving@freelance star.com.

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