(Aug. 13, 2009) Going to the doctor can be a harrowing experience. Many of us feel rushed, confused, and dissatisfied when we leave. Some of this comes from the extraordinary pressures of our current health care system. Doctors have less and less time to spend with patients because they have to see more patients just to pay their own bills. Very few doctors are getting rich these days from practicing medicine.
Sadly, though, there are many doctors who do not have a good bedside manner or even ordinary manners. And, given their time constraints, many cannot afford to take the time to answer more than a few questions from their patients.
This is a two-way street. Patients can be difficult. They sometimes have unreasonable expectations of the doctor or treatments, insist upon being prescribed an unnecessary medicine or test, come for visits but ignore all medical advice, are verbally abusive, or continue to complain bitterly despite the doctor’s doing everything possible to help the patient.
Some patient anger comes from waiting too long for the doctor. But some of the dissatisfaction comes from not getting their questions answered, and not really understanding what is going on. We can always blame the doctor, or the way the office is run, but perhaps it makes more sense to think about things each of us can do as a patient to make things go better. As is usually the case in life, the only behavior you can change is your own. As an alternative to playing the blame game, here are some positive suggestions.
Get organized. You wouldn’t dare go into your accountant’s office without having your financial records with you, and pretty well organized. The same thing applies with the doctor’s office. You need to do your part to make the encounter meet your needs.
Doing a bit of homework before the visit can make all the difference. Write down your medical and surgical history in chronological order, as well as allergies and all medications you are taking, including vitamins and supplements, with brands and dosages. Many patients I see don’t know what they are taking, and then they want me to call another doctor’s office to find out. This brings the office visit to a screeching halt.
Keep a list of your doctors and their contact information. If there are any significant illnesses that run in your family, please write these down. Make a note if one (or both) of your parents is deceased, how old they were, and what significant illnesses they had. The health of any siblings is important too.
Please bring copies of your lab work and X-ray and M.R.I. reports with you, or make sure they are faxed to the doctor’s office. It’s best to check the day before your visit to see that they actually arrived. Very often these tasks do not get done, so start the process early.
Under the federal HIPAA laws (the Health Insurance Portability and Accountability Act of 1996), only you can say who can have access to your personal health information. And a doctor’s office can only release your records with your written permission. So you’re the boss here.
Ideally, you should have copies of all your medical records. It is your right to ask for copies to keep. If it involves copies of the actual scans (CT or M.R.I., etc.), you may have to pay a small fee for getting these, as they are typically in the form of a CD or DVD, in addition to the written report.
Read the reports before you go to the doctor. If you do not understand something, you can ask for clarification. In this day of electronic records and voice-recognition dictating software, there may be unintentional errors in the report that you can have corrected. For example, one patient read in a report from one of her scans something about her prostate! Another found a sentence about an aneurysm that she did not have.
A great organizing tool is called a personal health record or PHR. The best right now is probably from MyPHR.com. You just keep it filled in and bring it with you. If you don’t use the Internet, your local reference librarian can help you.
The day before your visit, write down the critical issues that you want to cover and exactly what questions you need answered. If some questions are not strictly medical, or could well be answered by someone else in the office, such as the nurse or office manager, then ask that other person. That’s what these support folks are there for, and often the doctor doesn’t even know the answers to, say, insurance questions. The time with the doctor should stay strictly medical.
Most doctors are allotted about seven minutes per patient by your insurance company. As you are aware, most of our complaints don’t fit into that time. Try to keep the chatting and extraneous detail to a minimum. We really need the Reader’s Digest version, and we can ask more questions of you once we have the outline. Please don’t talk about your cat, unless you were just bitten!
It often happens that patients feel overwhelmed during the doctor contact time, and then can’t remember anything that was said. If this is you, I suggest that you bring a small electronic recorder ($30) or a good friend to take notes. Go over your list of critical issues, and make sure your questions are answered.
The best way to know you understood is to repeat back to the doctor what you think you heard. For example, you could say, “So you’re telling me that my new chest pain is coming from some partially blocked arteries in my heart. But you are recommending medication and lifestyle changes rather than bypass surgery?”
This gives the doctor the chance to clarify and explain more precisely. It assures that good communication has occurred.
Many physicians today are forced to schedule patients tightly, yet they want to give you the time you need. The result is that after the first few patients they are already behind. Yes, your time is valuable also, but remember that many of these doctors start early in the morning and work late hours. After seeing their last patient they may begin returning phone calls.
If doctors are running late, it may be because they are giving other patients the time they need and will do the same for you. Bring something to read. Please appreciate the time and commitment they are making for their patients, especially if there is an emergency or a very complex patient. However, if you consistently don’t get the time you need, then maybe you would do better with another doctor.
If you come in well prepared, the doctor will be more effective and the whole visit will be much more successful. Doctors all start out as our own bright young people, and they want to help you.