Saturday, June 8, 2013

Maximizing Your Healthcare Visits

In a perfect world, your physician would evaluate all of these things in a single visit.  An empowered patient needs to team with their doctor to maximize the completeness of each visit.  

Thanks to Rob Lambert, M.D. for the mind map

Things that you can do to maximize your visit
Winslow W. Murdoch, M.D.

Realize that you and your doctor have a limited amount of time to spend on goal setting and problem solving. Evaluating a given problem may take several visits and be done in a sequential way. Many conditions evolve over time, so even the best and brightest doctor and patient may not come up with the correct diagnosis or treatment plan at the first or even third visit. Keeping track of the "story" helps clarify and focus both parties. You will immeasurably help your doctor by relating your story in a way that they are trained to make a diagnosis. See my "History of Present Illness" Questionnaire at the end of this segment.

Other valuable tools include;  

 Keep a “personal health notebook,” or password protected computer file, where you write down any routine questions you have for the doctor and take the notebook with you when you go to your appointment.

Better yet, type your notes and ask your doctor’s office if you can send/share the list via secure email or a patient portal prior to your visit.

If appropriate, Include some blood pressure readings, and make sure to note your range (highest and lowest) as well as average results of home or community acquired blood pressure results.

Record your weight if this is pertinent to your medical history as well.

If you have diabetes, and are monitoring fasting or after meal blood glucose levels, include the ranges (high and low fasting and after meal readings) and a guesstimate of averages of the fasting and after meal numbers.

Keep a written record of your medical history and bring it to the doctor’s office.  They will really appreciate it.  They can copy it and put it in your chart and you should take your copy back home with you.

Ideally, note all of your medication, food, and environmental allergies, all of your medications (see below) and each substantial medical or other problem on your list. 

It is also very helpful if you are aware of how the problem is controlled and note this after the listed problem; 

Well, not so well, or not at all well, etc.

Please, always bring a list of current medications to every visit. The list should include things you take as needed every once and a while, as well as any and all vitamins, minerals and supplements.  Be sure to write the dosage and how often you take the medication and supplements.   If this is too hard to do, bring a bag with all our medications and supplements with you. Prior to the appointment, call the office and ask if you can arrive 30-60 minutes early (depending on the size of your bag!) and have a clinical assistant to go through your bag and make a list before your doctor’s appointment.

If you are presenting with a new problem or concern, or a significant worsening of an existing problem, ask if you can complete or at least review a triage sheet or questionnaire ahead of your appointment. We maintain a list of these for the more common and serious problems that we encounter on a daily or weekly basis. In addition, with new acute, or complex chronic problems we often ask our patients to review and or complete a “History of Present Illness” form that improves the accuracy of the visit immensely.  

Write down the names and telephone #s of any specialists you have and take the notebook with you when you go to see them.   

If you have been hospitalized, gone to the emergency department or urgent care, or to another doctors office or had any lab, radiology or other studies done since you saw your doctor last, call ahead and make sure that your doctor has received results or communication from these outside sources prior to your visit.

History of Present Illness Questionnaire; pg 1 of 3- (in context of personal and family history)

Name:                                                                                                             Date:

When did the problem start?  Describe the onset of the process.

Have you had the problem before?  If so, was there a diagnosis made? Was it exactly the same- what is different now?

If there is pain, discomfort or an unusual feeling, where exactly do you feel it- see diagram on last page- mark “x”s  where you feel the sharpest strongest pain and “o”s where it radiates or if it moves around etc.

Describe the quality of the pain or unusual feeling; sharp dull cramping stabbing burning pressure squeezing pulling spasm etc and how it changes etc;

Describe the severity of the pain or unusual feeling, how uncomfortable is it (on a scale of 1-10, where 10 is the worst imaginable pain- screaming with a hot poker in the eye) at its   worst,   best,   on average   and how long does it usually stay at the different levels etc;

Describe the timing of the problem/pain- day or night? Wakes from sleep? Keeps up all night like a tooth ache, constant intermittent? etc;

Describe any factors that seem to modify the pain- make it better or worse and specify if they make it better or worse; eating pooping, peeing, drinking, exertion, rest, certain activities (walking running hopping up and down, postures (laying standing sitting bending twisting), sex, taking a deep breath, bearing down, leaning forward, pushing on certain areas   etc;

Describe how if any activities you are unable to do because of the problem/pain- any disabilities due to the pain?

What if any treatments have you tried so far? Include physical modalities like Heat Ice Rest Physical therapy acupuncture etc, over the counter treatments or Rx treatments. Have any of them helped, what hasn’t worked in the past?

What diagnostic tests (specific blood test, X ray, Cat Scan MRI, Stress Test, internal scope procedure or surgical tests etc.) have been done so far to evaluate the problem? Who ordered or did the tests? When were they done and what if anything did they show?

Describe any associated signs or symptoms- fever chills nausea sweats weight loss dizziness shortness of breath belly cramps skin changes, swelling redness heat over area etc. that seem to come on along with the problem if you have noticed any.

 Draw a diagram of your body that best describes your problems in a schematic way if it applies

Form copyright Winslow W. Murdoch, MD