Most office visits are very different today than they were just 10 years ago. Why is this? Our health care system is overwhelmed by rules and regulations, there are more patients to be seen—and many of them have more severe problems—and diagnostic tests and treatments are more complicated than in the past, requiring more time for scheduling and explanations. All of this leads to a more hectic schedule for both patients and physicians, which translates into visits that seem more harried and less user-friendly than in the past. Long gone are the days of a leisurely office visit with your primary care provider, in which you would first carefully review your health concerns and then undergo a thorough and thoughtful physical examination, followed by a discussion to design a treatment plan and additional time to ask any remaining questions. Instead of a one-hour new patient appointment with your internist, some managed care organizations now require that physicians schedule new patients every 10 to 15 minutes. Due to these time and scheduling restrictions, some health care providers now limit the number of items discussed during an appointment to just two or three; other providers ask patients to come in for one visit where they review allergies, medications, and symptoms and then schedule another visit on another day for a physical examination. At the end of the second visit, a treatment plan is decided on (sometimes with little input from the patient) and, if any time remains, questions are briefly, and sometimes brusquely, answered. It is little wonder that so many people are disenchanted with our health care system.
Physicians will probably not be able to return to the more relaxed and leisurely office visits of the past. Unfortunately, this means that some of the burden for efficient care is shifted onto the patient. More than ever before, as a patient you must be your own best advocate, which means being as prepared as possible for each office visit. Follow the thirteen suggestions listed below to make your visits to your primary care provider or to specialists as useful as possible for you and for your health care provider. Most patients will not need all of the items on the list at each visit; others may find that this list is best suited for the first visit to a new primary care physician or to a new specialist. By following the suggestions below, you can dramatically improve the efficiency of your doctor appointments. Doing so will give you more time to coordinate a treatment plan together with your doctor and get all of your questions answered.
1. Make a list of your symptoms in advance and bring this list with you.
2. Set priorities.
3. Make a list of questions that you want answered.
4. If appropriate, bring a list of recently performed tests and their results.
5. Think about your goals.
6. Bring a list of allergies and any reactions to medications.
7. Bring a list of the medications you are currently taking.
8. Make a list of active medical problems that you are currently being treated for.
9. Arrive at your doctor’s office 20 minutes early.
10. Bring a list of any fears or concerns that you have.
11. Try to schedule your appointment so you are the first or second appointment in the morning or the first or second afternoon appointment.
12. Do a little research in advance.
13. Make sure you understand your treatment plan.
Each item is discussed in detail below.
Although this suggestion seems obvious, it’s a good one—for two reasons. First, it’s fairly common for a doctor who asks a patient “What’s bothering you today?” to hear, “Nothing, I’m doing fine.” Admittedly, this type of conversation is becoming rarer in today’s health care environment, since most doctor visits are prompted now by a specific concern or symptom rather than by a routine annual physical examination (routine annual exams in otherwise healthy adults are rapidly falling out of favor). Second, and more significantly, many people are a little nervous or anxious about going to the doctor, so when they arrive for the appointment they “freeze up” and forget many or all of their symptoms and concerns. If a patient forgets symptoms and concerns, the doctor can’t help the patient. People find it frustrating to arrive home only to remember the two or three urgent items he or she meant to talk about with the doctor.
Arrange the list of symptoms or issues that you want to discuss from most important to least important. Don’t use valuable office time discussing that small wart on your foot that only bothers you during sandal season, when the more important issue is urgent diarrhea or painful gas and bloating that occurs on a daily basis. If you bring a list of 15 to 20 issues, it is unlikely that your doctor will be able to address all of them. Address the top two or three most important issues, and then bring an updated list of symptoms and issues to your next office visit.
As you prepare for your visit and think about your symptoms, you probably also think about questions that you want answered. Some patients feel embarrassed about asking questions because they are not sure if they are using the right words or if they are pronouncing the words correctly. Remember that most doctors love to teach! Like artists, scientists, carpenters, chefs, and others, doctors like to talk about their work. They enjoy educating patients—this is what they are trained to do. So, don’t feel embarrassed about asking a question, and don’t worry about possibly mispronouncing a word. Bring a (reasonably sized) list of specific questions and make sure you get answers to them.
This may not be necessary if you are seeing your long-standing internist for a routine office visit or if you are going to a routine follow-up appointment with your gastroenterologist. However, if you are seeing a specialist for the first time (such as a gastroenterologist) or if you are seeing a physician for a second opinion, it will make your visit much more efficient if you bring a list of all tests performed for your symptoms (for example, colonoscopies, abdominal ultrasounds, CT scans, and/or blood tests), where and when they were performed, and the test results.
Goals are completely separate from the questions you want answered or from your fears and concerns (see below). Maybe your goal is to improve or eliminate episodes of urgent diarrhea. Or maybe your goal is to minimize bloating. Try to be as specific as possible, because knowing your goal will help your doctor coordinate an individualized treatment plan.
This list is usually reviewed at the first visit and updated at subsequent visits. For most patients, it will only take a few seconds to make such a list; however, some people who have irritable bowel syndrome are very sensitive to medications. It is more efficient to bring a list of allergies and adverse drug reactions that can be quickly reviewed in 30 seconds than to spend 5 to 10 minutes trying to remember which medication caused which side effect.
If in doubt, or if you don’t have enough time, bring the pill bottles. Similar to the suggestion of bringing a list of allergies and adverse drug reactions, your doctor’s visit will be much more efficient if you bring a typed list of the medications you are currently taking. Ideally, this list will include the dose of the medication (for example, 81 mg of aspirin or 25 mg of phenergan) in addition to a notation of how and when the drug is taken (such as 30 minutes before breakfast or 1 tablet with each meal). The more specific the information, the better. For example, it is much more helpful to bring a list that says “20 mg of omeprazole taken each day 30 minutes before dinner” than to tell the doctor “I take a pink pill some time during the afternoon.”
Also bring a list of any surgeries you have had, along with the dates of surgery (this list of surgeries is especially important if you are seeing a gastroenterologist or if your major symptom is abdominal pain). Patients who have had multiple surgeries over time, especially if those surgeries were performed at different institutions, can easily get the type of surgery and the date confused. The first 5 to 10 minutes of an office visit is then spent just reviewing the surgical history, instead of focusing on more pressing symptoms. The more prepared you are, and the less time you spend reviewing your past medical and surgical history with your doctor, the more time you’ll have to discuss your current symptoms.
Every office needs to gather demographic information (age, date of birth, gender, ethnic background, occupation, etc.), and even if you have been to that office before, they will need to check to see if the information they have is up to date. In addition, all offices have to gather insurance information, and this process is becoming increasingly more complicated and more time consuming with each passing year. Although frustrating, this process has to be repeated for each health care provider you see. Arrive early. Let the office staff gather all of your information and update it if necessary. That way you’ll be finished with the paperwork when your doctor is ready to see you.
This list may be different from your list of questions. Your list of questions may include why you have specific symptoms or why you developed IBS. But many people who have IBS are worried and concerned that having IBS increases their risk for cancer (it doesn’t) or that IBS will change into IBD (inflammatory bowel disease—it doesn’t do this, either). Write these concerns down and discuss them with your doctor to relieve any unnecessary stress you may be feeling.
If your provider has a busy schedule, it is probable that as the morning wears on, she or he may fall behind schedule. This can happen because patients arrive late, patients come in with unexpected problems that require more time, or because the doctor must address an urgent or emergent problem. You can minimize your chance of being inconvenienced by scheduling your appointment for first thing in the morning or first thing in the afternoon, after lunch. If your doctor is running late from the morning, he or she will usually be able to catch up during the lunch break (a time most doctors use to finish dictations and notes, make phone calls, and fill out forms). In addition, it is likely that your doctor will be more alert and attentive first thing in the morning or after lunch than late morning or at the end of the day.
This seems obvious, but if you have had painful heartburn for 3 years, and this is the first time you’re going to see a doctor to discuss your symptoms, it is worthwhile to spend 10 or 15 minutes reading about that topic either at the library or online. Sometimes this research time is best spent just learning the language and specific terms that are used to describe that disorder. If you know something about the subject and are familiar with some of the key words and terms, you and your doctor will find it easier to communicate. A brief list of consumer-oriented medical websites is presented at the end of this book.
Do tests need to be scheduled? If so, when and where? How will you get the results? If a prescription is provided, how should it be taken? Once a day, twice daily, or more often? Should you take it every day or only if you have a symptom? What are the side effects? Can it be used safely with other medications? And, given the cost of medications these days, is there a less expensive option? If you need to return for a visit, when? If you have a question, who should you call?
I provide each of my patients with a written plan at the end of the visit. Office visits can be confusing—new information is provided and questions are answered, and if a patient does not feel well, it may be difficult to concentrate and remember everything that is said. A written plan helps both the health care provider and the patient understand the plan of action, and it also serves as a nice reference for the patient later, if questions come up.