This video provides tips for working with your child’s pediatrician and makes some good points. We probably will all need to see a doctor at some time. This post has some suggestions, born in the trenches, for getting the most out of your doctor’s appointment. This article is a bit long, but if you think your health or the health of your loved one is important, and you choose to go to a medical doctor for healthcare, being involved is the best way to receive the best that system has to offer. Of course there are other healthcare providers such as naturopaths, chiropractors, nurse practitioners, acupuncturists, nutritionists, & others you can go to for health care, and some of these suggestions apply there as well. Click here for the shared video "Relationship with Pediatrician" from Studio4Kids A lot of people have told me their stories of how the medical system let them down. While I think there are many reasons for this, one very large contributing factor is a lack of communication from both the patient and the doctor (&/or medical staff). I will say at the outset that extremely short doctor’s appointments (between 10-15 minutes) are not conducive to good communication. We can argue about why medicine is run this way and why it should be changed, but that is a subject for a different article, on a different blog. At least your doctor’s appointment is longer than a round of speed dating…. so far… although who knows about next year… . In the meantime you have an appointment coming up and you want to get the most out of it. Your appointment running smoothly actually starts the minute you call to make an appointment. And by the way, if the receptionist is unfriendly or unhelpful, you should definitely let the doctor or the office manager know (in a nice way, of course). The last thing the doctor wants is an employee setting the stage for an angry patient. A new patient seeing a primary care physician will probably have an initial appointment as long as 30-45 minutes. I would have expected that a specialist’s appointment would have been about 25 minutes (and that’s pretty short), but I would be wrong. I was just informed it’s down to 15 minutes for a new admission! Returning patients are usually given an appointment generally scheduled to last just 10-12 minutes. Yikes! My friends and I aren’t even done saying “hello & how are you?’ in 10 minutes. So... 1. Change Your Expectations Expect delays. Do not schedule your appointment so that you must be somewhere after the appointment within a tight window of time. If your doctor has a patient with more complicated problems than you, know that he /she must spend more time on that patient and will fall behind. Know that: · he/she is not doing it to aggravate you. He doesn’t like running behind either. · you are not less important than the other patients. When you are the patient with complicated problems, you’ll want that extra time spent on you. · It’s not personal, it’s business (that’s the awful truth, believe me when I say, most doctors are not happy about this. Many feel like a cog in a wheel, just as you may.) · If you go with low expectations about a quick, efficient appointment, you won’t be disappointed when you have to wait. · Bring a snack if you need to and something to read or do (bring some for your children or elderly patient too!) Hopefully the office has recent reading material. (Don’t you hate reading about a sweepstake for a free trip to · Take some pain medication or whatever you may need to get through a long wait (as long as it’s legal) unless you have been told not to take anything. · If you have questions, talk to the doctor’s nurse, prior to the appointment. 2. Get Off to a Good Start If you are starting with a new doctor, you will have paper work to fill out before you ever see the doctor. Office staff is usually good about asking you to show up early to fill paper-work out. This will take more than the 5 minutes you read about somewhere else. Start early. Ask if the paperwork can either be sent or FAXed to you, or if it is available on-line (many are). Fill it out ahead of time, especially if you are: · bringing a small child or children to the appointment, taking care of an older, infirmed patient, need help filling out the work yourself. · distracted by the sights, sounds, smells, & activity of a medical practice. (Doctors’ offices bring out old fears, and fear chisels away at your memory. Not what you need while filling out forms.) · always running late. (This is not the time to be in denial.) Being late causes the staff to have to rearrange the schedule. Expect your lateness to delay your doctor’s visit even if you have another important place to be. This is a sticking point with some people; they feel they are expected to be on time, but then the doctor is not on time. No fair! (More on this later) · taking numerous medications &/or supplements. You need to write them all down (including prescription and over the counter medications, supplements and herbs) including dosage, frequency taken, length of time on medication, any problems you have noticed. Possible side effects of medications are especially easy to forget. Write them down when they happen. Track their frequency. Did it occur after you ate, 3 times a day, continually, when you were upset? 3. Write Down All Your Health Complaints even the ones you don’t want to talk about and prioritize them as to which you feel is most important. · Include pertinent details: when, how long, how much, temperature, appetite etc. · Give the list to your doctor when he asks what he can do for you. This will help make sure that both of you don’t forget something. · Your doctor will ask questions for specific information. Some may seem totally unrelated and he/she won’t explain why. There is a reason (You can ask if you think you have the time.) · It will also make it easier to discuss potentially embarrassing topics. · It will prevent “Door Knob Syndrome” (As in: the doctor’s hand was on the door-knob exiting the room after the appointment was over, when the patient said, “By the way, Doc, can you tell me what this might be?)* · Recognize that your doctor may see other signs & symptoms (S/S) as more important than the ones you have listed as most important (that’s what you are paying him for). · Again, write all your complaints down, even the embarrassing ones. Be truthful about your S/S & your health history. These details could provide the very clue(s) to help him figure out your diagnosis/treatment. Watch a couple of episodes of “House.” The producers are not far off the mark. However, if I ever had a doctor communicate the way he did, he wouldn’t be my doctor for long! 4. Be Involved in your Own Care Because there is so little time to discuss your problems (Thank insurance companies and businesses running medicine. Remember, it’s not personal; it’s business) you have to do your part on the communication end & hope and perhaps, prod, the practice at the other end. You may feel that you shouldn’t have to do this, but the reality is, this is your health, your health care, & your being actively involved in it will be important in receiving the best care. · Always bring a note pad of paper and a pen or pencil & remember your reading glasses (and hearing aide) if you wear them. · Be prepared to give your doctor a copy of all your medications. Keep one for yourself. If he discontinues any medication or changes any, in any way, record it in your notebook. Do not rely on your memory! · If there are certain side effects or contraindications with a certain medication write it down in the note book so that you can be on the look out for it. (Record in same notebook) · Bring copies of tests that you may have had done elsewhere if you have access to them. · If you are being treated for high blood pressure take 3 readings at home during the week at different times of the day, record & give to your healthcare provider. This will give a truer reading than a blood pressure taken in the doctor’s office where sites, (white coats), sounds (screaming babies, moaning patients) and smells (alcohol and worse) often cause a spike in blood pressure. · If you are diabetic, record the last couple of day’s blood sugars, and let the doctor or nurse know when your last dose of insulin or oral medication was taken. · On a personal note, I hate telling my doctor about the supplements and herbs I take and apparently a lot of you do too. Studies show that patients often do not tell their doctor what supplements they are taking (for the same reasons I don’t like telling them) I don’t appreciate the “hrrumph! “ I have gotten in the past and the “what are you taking that for?” which implies it’s pointless. I have good reasons for taking the supplements I do & have read extensively about, it, thank you very much) · There are a number of doctors who would rather you just stop all of that (nonsense) especially if you are getting ready for a surgical procedures. RDA doses and optimal doses are generally not a problem. Mega doses of vitamin E can cause some bleeding, but for the most part, vitamins/minerals help you heal and fight off infection; two things you definitely want on your side when you have surgery. If you feel strongly about it you can discuss the point with your doctor to get him to agree that you can take your supplements after your procedure. But realistically with just 10 minutes for the appointment you probably won’t have time. · There really are some herbs that you definitely do need to stop before surgery & that includes minor surgeries such as in-office biopsies. Ginko Biloba & garlic are just two. They slow down your clotting time. You don’t want to end up bleeding all weekend for a wound that should have stopped in a few minutes; so bite the bullet. Tell your doctor what you are taking. Follow his instructions to stop days or weeks ahead of time. It can take that long for the herb to clear your body. · A few medications do interact with herbs. Keep in mind that if you don’t tell your doctor about your herb and there is a problem, the herb, and rarely the medication, will be blamed. It doesn’t take much for an herb (think ephedra) to be yanked off the market, unlike many dangerous medications that are allowed to stay on the market for too long before being pulled (think Vioxx). Yes, I am editorializing & I digress. 5. Keep a Copy of Your Health Record In the military we were allowed to have access to our health record so that when we moved, it went with us. I highly recommend keeping a copy of your health record. Ask each doctor you go to for a copy of everything. There are a lot of people involved in your health care besides your physician. Test & lab results can & do get lost. It could save you some money and extra testing if you keep a copy of everything. It is also easier to get a second opinion or change doctors when you have all the data at your fingertips. You probably will have to ask repeatedly. Keep at it. 6. Expect 2-3 Concerns to be Addressed 10 to 15 minutes does not give the practitioner enough to time to adequately address more issues. Although back to back appointments may be recommended by others allowing for a longer visit, know that most, if not all insurance companies will not pay for this. They will pay for appointments made on back to back days. Check with your insurance to see if they will cover back to back appointments to be sure, otherwise be prepared to pay out of pocket. 7. Stay on the Subject It is very easy to get side-tracked talking to your doctor while he or she is trying to establish rapport with you and you with him. Keep in mind that he is on a tight schedule. Many doctors would love to be able to take more time to speak with their patients. If they work for a PPO, HMO, or even private practice, they are expected to see a patient every 10 minutes. This explains why so many are in such a hurry.
8. Be Prepared to Take Notes
· We only remember about 10% of what we hear (and often times, less than that).
· Ask the doctor or his nurse if they have some handouts available. Most of them want to tell you first, then send you out the door with papers in hand. I prefer to follow along a sheet of information, that way I don’t have to take notes on some things and can just add the extras.
· You are more likely to think of questions and get them answered at the same appointment by reading along with the information.
9. Bring a Second Set of Ears
If you are expecting bad news, complicated instructions, or just think you would benefit from added moral support & another pair of ears, have a trusted friend or family member go to the doctor appointment with you. Decide at the outset how much involvement you want them to have. Do you want them to ask questions, if you are too upset? (Or perhaps they know more about the subject) Do you just want them to take notes? Introduce them to your doctor and let him/her know you would like them to be there with you.
10. Note on Door Knob Syndrome
If you wait till the end of the appointment to let the doctor know why you are really in to see the doctor, and a lot of people do this, know that it puts your doctor in a very difficult position.
· No doctor wants to kick you out and say “Sorry, we’ll catch that next time,” although I’m guessing some do.
· More than likely he will try to address the problem by cutting into someone else’s appointment time.
· Taking the extra time is risking getting chewed out by an angry patient because they had to wait extra time to be seen (and didn’t read this article). He may lose that other patient too. ( Although some may think that is okay, others may need the business)
· Health care professionals understand that some subjects are difficult to talk about, but, I can almost guarantee you that your health professional has already heard somebody else say what you are hesitant in saying.
· They are not there to judge you. If you feel that they are, you might want to discuss this with them &/or just find a new health care professional.
11.Hurry Up & Wait
Many people understand a doctor’s dilemma: there are appointment times and then there is the reality. It just isn’t possible to predict if your doctor will be running on time. Then there are the other people. The doctor is running behind and they are late and angry and take it out on everyone around them. It is my hope that they will consider the thoughts above and chill out. Medicine is still considered an art and a science. You want the doctor to get an accurate picture of what is ailing you, not a distorted view brought on by an angry tirade. Anybody can draw a picture, but great art takes time and dedication and passion. Your doctor most likely has the dedication and passion. The time is fixed by other forces. The patient who insists that it is disrespectful for them to have to wait displays a great misunderstanding about their doctor and medicine today.
12.The Doctor is Not God
(I thought we had established that a long time ago! I know I did.)
- Doctors are human & fallible (aren’t we all?)
- They cannot stop time or speed it up.
- They cannot suspend the free will of other patients who choose to talk about their uncle’s health problems, or who wait till the end of the appointment to tell the doctor their real concerns.
- They cannot wave a wand and have their patients understand everything without asking questions.
- They cannot always prevent a patient from passing out and needing extra care.
- They cannot always expect the unexpected, though they often try hard.
- They cannot change the nature of Medicare reimbursements: a system that keeps dropping reimbursements so that the fee paid to the to the doctor's office more and more frequently does not cover the doctor’s expenses. [Older patients and their families (which means just about everyone) should be concerned about this.This has a trickle down effect of making older patients afraid to complain to the doctor; afraid he will drop them from his care. This can dramatically impede communication and unintentionally result in a reduction in the quality of care.]
- Write your Senator and Congressman/woman & complain to them. Make a real difference with your voice. Make a difference with your vote.(hopefully)
- They cannot prevent your insurance company from dropping reimbursements in the same way that Medicare has done, which ultimately drives the need to see more patients who get less time with the doctor.
- Ditto about your representatives.
Yes, it’s a flawed system. But if you want/need to use it, these suggestions should help you and your doctor communicate more efficiently. And if you want to complain about the system, that’s okay too. Just complain to the right people.