For many the idea of going to see the doctor is stressful and anxiety provoking. To get the most out of your next doctor’s visit, consider these simple suggestions.
James was referred to my office for evaluation of congenital heart disease. As a child James had undergone a surgical procedure on his heart, however he knew none of the details. He was unsure of what had been performed and could not name the hospital where he had the surgery. Not having this information meant that it would be difficult for me to truly understand what type of follow-up evaluation James truly needed.
I spend much of my time speaking with patients in the office. When I do new patient consultations, at times I have no medical records. I rely on the patient to provide the key and necessary information. Unfortunately patients who come in for a doctor’s visit are often unclear about their own medical history. Obviously, this handicaps the physician who will need this information to guide medical care. Knowing and understanding your own medical history is a key part of being an advocate for your own health.
In an ideal world, all medical record systems would communicate with one another. You could see a primary care physician on one day and assume that your specialist would automatically have access to that information. Unfortunately, this is not how many private practice medical environments work. The medical record systems often do not communicate, and therefore it is up to people to make sure that information is appropriately transferred from one provider to the next. As an example, I often see new patients for consultation with no access to their most recent laboratory results. As a cardiologist, understanding what someone’s LDL (bad cholesterol) is an important part of the counseling process that goes on with regards to risk assessment. Requesting a copy of your records and bringing them to your office visit is a clear way to ensure that your physician will have the necessary information to make the best decisions for you.
It’s common for patients to not know their own medications. If you’re on multiple prescription medications, it can be hard to remember the exact names and doses of the medications. Unfortunately, without this information, the details that are input into the electronic medical record system can be inaccurate, which leads to problems when the medications are renewed or refilled at a later time.
A simple way to get around this type of error is for patients to simply bring their pill bottles with them to the clinic. It should be also noted that various supplements can interact with prescription medications. A good example is St. John’s Wort which is an herbal remedy used for mild to moderate depression. This agent is an inducer of the hepatic P450 system which is involved in the metabolism of various prescription drugs. As a result, taking St. John’s Wort can lead to significant interactions with your medications. Another example would be fish oil or omega-3 fatty acids. Fish oil can be used to reduce the levels of triglycerides in the blood; however taking such supplements can also increase bleeding risk.
There are many conditions which are transmitted genetically. Knowing that a sibling died suddenly at an early age may raise the level of concern for specific conditions such as long QT syndrome, hypertrophic cardiomyopathy, or premature coronary artery disease. Having a clear understanding of one’s family history does improve risk stratification for an individual. In many families, it is not common for individuals to talk about disease and illness. For this reason, many times this information is unknown to family members. Although it’s difficult to get around this, there can be tremendous benefits to knowing and understanding this information. For this reason, I would recommend having an open dialogue with one’s siblings and other first-degree relatives with regards to key medical information which should be shared.
This may sound crazy, however one of my favorite experiences in the office is seeing a patient who pulls out a long list of questions before leaving. It is so important for patients to participate in the health care that they receive. Without asking questions it’s impossible to ensure that a patient truly understands not only their health condition, but also the goals of the treatment plan. It is unfortunate when patients have the perception that the physician is too busy to answer questions. Asking questions is a key part of any patient-doctor interaction and patients should feel empowered to be able to question the physician with regards to their diagnosis and treatment.
I recently saw a patient, who I will call Joe, in the office for the first time. I performed a detailed review of systems with Joe and asked many questions with regards to his current symptoms. I asked Joe about fatigue and he did admit that he was often sleepy during the day time. I probed further and Joe’s wife who was present during the visit offered that Joe has been snoring loudly for years and even has witnessed periods of apnea at night. The information obtained from Joe’s partner was invaluable and allowed me to make a clinical diagnosis of obstructive sleep apnea. Joe was referred for a split night sleep study which did confirm the presence of sleep apnea and allowed for Joe to initiate appropriate therapy. Examples like this make it clear how just having a friend or family member along for the visit can sometimes make a difference in the quality of care that one receives. A family member may be more likely to ask certain questions and, also may recall certain details of the visit at a later time.
One of the first physicians I interacted with when I went into private practice was a physician who saw more than 50 patients a day in the office. An average of every 7 ½ minutes, he was able to see a new patient. Somehow despite this crazy schedule, he was successful with completing all of his paperwork, dictating on his patients, and occasionally even running over to the hospital to perform procedures… still to make it in time for his afternoon clinic. Clearly this physician had mastered the art of doing everything really fast. I describe this not to say that there is necessarily anything wrong with having a fast doctor, but I certainly would contrast this to my own clinical style. In an ideal world, the patient-doctor interaction must involve an exchange of information, and this takes time. The physician should be present to be of any true service. So what if your physician is so fast that you feel that they do not truly hear you or connect with you? I am not an advocate for doctor shopping; however, I do recognize that just as people are varied so are physicians in their bedside manner. If you’re finding it hard to connect with your physician despite multiple visits and you simply feel unheard, it may be time to consider finding a new physician.
For preventive medicine to work patients must able to take information given during an office visit and act on it… leading to meaningful changes in behavior. Unfortunately, most physicians are not like personal trainers or health coaches who make multiple contacts with the client each week/month to ensure that things are progressing as desired. A physician will often see a patient every three or six months, and in some cases once annually. This is not enough time to ensure changes in behavior. This is another reason it may be helpful to have a family member or friend present who can encourage the lifestyle modifications that were discussed during the office visit. Although your physician may discuss smoking cessation, dietary changes, and a program of exercise, none of this discussion will translate into health benefits without follow-through. Everyone is different in terms of how they respond to clinical information, however being an advocate for your own health means being willing to change one’s own behavior when needed.
According to the CDC, chronic conditions such as heart disease, stroke, cancer, type II diabetes mellitus, and obesity are among the most common, costly, and preventable of all health problems. Keeping in mind these simple suggestions for your next doctor’s visit can help improve the quality of your doctor’s visits.
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Board Certified by the American Board of Internal Medicine, Dr. Andrew Atiemo is a talented clinician, teacher, and author. He currently serves as an Interventional Cardiologist with Mountain Heart in Flagstaff, Arizona.
