How To Prepare For A Doctor's Appointment
In a scene from "Star Trek," Bones, the ship's physician, pulls a device from his pocket, scans his patient and within seconds pronounces the diagnosis. On the popular television series "ER," a patient is rolled into the emergency department while EMTs rattle off a litany of vital signs, history and medications and almost instantaneously the doctor diagnoses, simultaneously commencing treatment.
Neither demonstration accurately depicts the realities of medical diagnosis and treatment today; each ignores the primary element in any diagnosis: the telling of the patient's full story. Accurate diagnosis requires a conversation with the patient, thorough examination, and careful reflection on the facts -- all of which take time. The truth is, arriving at a diagnosis never happens as fast as it does on TV.
In today's managed care environment the time you spend face-to-face with your physician is limited. To get the most from your health care providers (HCPs) you'll need to meet them halfway, and preparation is the key. If you come prepared with the details and history of your problem, anticipate questions, know your medications, and bring medical records you increase the likelihood of an accurate diagnosis. And if you are anxious about doctor appointments, good preparation will go a long way to alleviate that anxiety. The following tips can help you make the most of your appointment.
Organize your history
What is the process of diagnosis? The majority is buried in the history -- a description of the problem. What "Star Trek" and "ER" fail to show is the process of sifting through that description to locate the nuggets of pertinent information. While it's true that additional information is gleaned from the physical exam, laboratory and imaging tests, it is the history that provides direction for the investigation. The more organized your presentation, the easier it will be for your HCP to arrive at a diagnosis. Keeping a journal of your symptoms may be helpful. If you feel it might be necessary, enlist a relative or friend to help you prepare and/or accompany you to the appointment. Physicians appreciate an accurate history whether it comes from the patient or someone who clearly knows the problem. (If someone does accompany you, be sure there's unified agreement to the story. Bickering in the exam room is counterproductive.)
In describing your problem, be specific. Telling the doctor you "feel ill" is not as helpful as, "I feel warm, ache all over, especially in my back, and I'm coughing up yellow stuff." Give as much information as you can. If you have more than one problem, talk first about the one that worries you the most. Prepare a separate history for each problem and strive to make it clear and complete. Present them one at a time so you don't confuse your HCP.
Anticipate what the doctor needs to know
Let's say that, for example, you have pain. (If you have more than one type of pain you may need to describe each pain separately.) You should be prepared to answer the following questions:
- Where is the pain most severe?
- When did it start?
- Does anything trigger it?
- Is there anything you could do to bring it on, make it better, make it worse?
- Is it present every day, or do you have pain free days?
- Is it worst in the morning, as the day goes on, or constant?
- On a scale of 1-10, how severe is the pain?
- Is it constant or off and on?
- Do you have any other symptoms with it, such as chest pain, shortness of breath?
- Does the pain stay in one area or spread to other areas?
- Does it interfere with your daily routine?
- What has been its course? (Is it stable, or getting worse?)
- Is this a new symptom or a recurrence of a previous problem?
These questions apply to most problems or symptoms. If you've thought about how you would answer them ahead of time you'll be prepared, your response time will be shortened and this may leave more time to discuss your concerns before the end of the appointment.
Know your medications
Another aspect of preparation is knowing what medications you take. Although you may recognize your pill as "the little blue one," there are probably hundreds of pills that are little and blue. The likelihood of your doctor being able to identify your blue pill is slim. Put ALL your medications -- prescription, non-prescription, vitamins, herbs, minerals, each in its original container -- in a bag and take them with you to your appointment. This way the doctor will know the medication, dosage, frequency and your need for refills. If you take medications chronically, keep an updated card in your wallet or purse with the names of the drugs, dosage and frequency. This is important if drug interactions are to be avoided. It's not uncommon for patients to be seen by several specialists each of whom prescribes different medications. Each doctor needs to know what drugs you are taking, including those prescribed by other physicians. They assume you will be able to list all medications you currently take. If you can't tell them, you may put yourself at risk.
Medical records
If you have any copies of medical records from other physicians bring them with you. Also bring X-rays or MRI's with you if appropriate. If you are being referred by another physician, try to expedite the exchange of medical records. Very often, you'll need to consent to your records being released to the new physician. Not every doctor's office will anticipate this or contact you beforehand to arrange for the transfer of records. To make the most of the appointment, call ahead and ask how these arrangements should be made. A transfer of your records may help you avoid repeat diagnostic tests which carry their own risk and expense. Also, if your H.M.O. (health maintenance organization) allows a consultation with a specialist, your first visit may be your only one with that doctor, so it helps to be as prepared as possible.
Request a verbal summary
In the stressed and compressed time of a doctor's appointment it's very common for communication to be impaired. A recent survey of how much patients recalled following a general exam revealed that most could not remember more than of the medical problems their doctor diagnosed! Would you consult your banker, tax preparer or clergyman and leave the meeting without making sure you understood what was discussed? While many HCPs are aware of the need to restate treatment plans or medication adjustments, others may not do so. Sometimes time restrictions decrease the amount of verbal reinforcement the doctor can offer. Ask for a brief summary to make sure all points are covered and necessary prescriptions filled out. Ask what kind of follow-up is needed. Be prepared to take notes.
Questions you should ask during a visit with your HCP:
- What is this problem likely to be, among the possibilities?
- Is further diagnostic evaluation necessary?
- What can I expect from the natural course of this problem?
- Is there treatment available to modify the course?
- How long before I should see the effects of the medication?
- Under what circumstances should I notify the doctor?
If your expectation is that all you have to do is show up for an appointment and the doctor will do the rest, your visit is likely to be a frustrating one, and you may put yourself at risk for misdiagnosis. Remember, unlike "Bones," your doctors don't have scanners they can pull out of their pockets to miraculously diagnose your problem. They need your help. The doctor's appointment is your opportunity to discuss medical problems and concerns. By preparing for the appointment you will be less likely to waste the opportunity, and more likely to gain a degree of satisfaction from the visit.