Wednesday, January 18, 2012

~Part 2~ A ToolKit to Communicate with Your Doctor and Take Charge of Your Health!!

Today, for Medical System Tuesday (well it actually is a Wednesday this week because I didn't have time to complete the post earlier!) we continue to focus on outpatient topics to optimize your health BEFORE you become acutely ill.  As I mentioned last post, I completed my inpatient series of "Insider Tips" and now we've moved out the outpatient series.  

Before we get started, I wanted to ask you that after you read this post, could you please share in the comments below if you have ever had problems communicating with your doctor and/or understanding why various tests or medications were ordered?  What do you do to make sure you are getting high quality care? Any tips to share with your fellow readers?

My goal by the end of this outpatient series is for you to be able to:

  • get the BEST out of your doctor--in other words, to do your part to empower your doctor to optimally use their expertise to your benefit
  • understand what is going on with your own health--knowledge is power
  • learn how to organize your health information to improve the quality & efficiency of your medical care
  • know how to advocate for appropriate preventive care according to your age, gender & medical history
  • learn how to prevent medical errors (check out the last two of my reader Christy's comments on one of my older posts--she followed the communication tips from my previous post and actually was able to help prevent her doctor from making an error with her medications!!!-note--there are a lot of comments on that page, scroll down to the end to see what I'm referring to!)
  • be an active teammate in your wellness journey as opposed to a passive participant

Part 1 outlined the the first steps to seize control of your own health. How many folks followed through on the assignments?  Don't worry if you didn't--even if all you do is read these posts to become aware of ways to improve your ability to receive excellent quality healthcare, that is an important beginning!!!  

Oh!  And for all of you who haven't been to a doctor in years--please go.  As you can see by Part 1, you may be due for some important preventive screens that can actually save your life!!

Ok moving on.

Today, in Part 2, we'll get specific about what data your doctor need to really get a comprehensive view of your health.  Why does this matter? Lets look at an example:

You come into your doctor's office for a check-up and says the following:  "I'm feeling good doc--a few headaches over the last few weeks, but other than that, I'm ok."  The doctor has 15 mins to see you.  The doctor checks the chart--your vital signs (blood pressure, heart rate, etc) look good, your "finger stick" to check your blood glucose is mildly elevated.  So the majority of the visit you and the doctor talk about your headaches--what do they feel like, how long do they last, how severe are they, what makes them worse, what makes them better?  And then you get a quick physical exam, a prescription for some migraine medications and are sent to the lab to get your blood drawn.

Sounds ok right--well there is just one problem.  You forgot to mention that you've been urinating a lot more than usual, you feel thirsty all the time, and you actually came in this morning after not eating dinner last night or breakfast this morning because of your headache.  So when your doctor looked at your blood glucose "finger stick" they didn't become alarmed because they assumed you'd eaten breakfast that day and the elevation was due to that.  Instead, you may have diabetes.  It might show up on your labs but maybe not.  Next thing you know, three weeks later you are being admitted to the hospital with severe hyperglycemia and require IV insulin & an ICU stay.... 

Ok this is an extreme example, I know, but it could be really be anything--a black mole on your leg that is getting bigger but you forget to mention, some weight loss that wasn't intentional but didn't seem important to bring up, some increased shortness of breath with activity that you downplay to the doc....etc.  It is VERY hard to hit on all the points needed to make a good clinical diagnosis in a short interview.  That is where you come in!!  Docs need data from the patient to get the right diagnosis!!!!!!  It is 100% a team effort!!! And you can help them ask the right questions based on how organized you are before you come to the visit & how well you understand what is important to share with your doctor!

So to get you organized and keyed into the important parts of your history to share with the doctor, here are your assignments for Part 2. These are all key tasks to complete in the two weeks prior to your appointment. Your goal is to enter your doctor's appointment organized (see Part 1 as well) AND make sure you leave the appointment with a clear understanding of what your doctor recommended and most importantly, WHY!

1)  If you have any of the following chronic diseases, prepare CLEARLY PRINTED OR TYPED logs for your doctor on ONE PAGE:

  • If you are a diabetic or have hypertension (high blood pressure) and you don't keep a log of your blood sugars or blood pressure, in the 2 weeks before you go to the doctor record daily at least 2 "finger-stick" values (at least one before breakfast) and get your blood pressure measured each day (use a home blood pressure cuff or grocery stories sometimes have them).
  • If you have angina record the number of times you have been symptomatic in the two weeks prior to your visit and what you were doing at the time.
  • If you have an inflammatory bowel disease or irritable bowel syndrome, write down your daily bowel symptoms for two weeks prior to the appointment as well.
  • If you have depression or anxiety try to keep a "mood diary" for the two weeks prior to the appointment
  • If you have a pain disorder, try to keep a "pain diary" of your pain levels at four different points throughout the day, when you needed to take your "as needed" medications and what effect the medication had on your pain level.  

2)  For EVERYONE:  Sit down before the doctors appointment & review your health in every body system you have so you will able to answer your doctor's questions quickly & clearly.  

Here is a link to good old Wikipedia's "Review of Symptoms". (currently down due to the Jan 18th protest--check it out tomorrow!)  There are also twenty million "review of symptoms" forms that pop up on a google search.  Don't get overwhelmed.  Just quickly go through each category and not any abnomalities.  For example:  Eyes: blurry vision, Heart: nothing, Lungs: cough, etc.

6) Read through everything you have organized (including the medical info sheet & history from Part 1) and make a list of questions to ask your doctor.  

Try to limit the list to less than 5 questions in order of priority.  Make at least two questions the following:

"Doc if you could pick two things for me to work on healthwise this year what would you choose?"
"Are there any medications I could potentially get off of if I changed my eating habits or exercise level?"

You can also use this Free Online "Question Building Tool" that the AHRQ put together to help patients prepare for doctor's appointments!

7) Once you have finished your question sheet, clearly PRINT/TYPE it and make 3 copies:  

1) Give 1 to the receptionist at check-in and ask her to give it to your doctor's nurse so your doc can look over the questions (if they have time) before entering your room. 
2) Give 1 to the doc when he/she walks in the room--just say: "I made this brief list because I want to make sure that I ask you the questions I have but also help you stay on schedule because I know you are very busy" (the doc will LOVE this statement).

3) Keep one in your lap with something hard to write on. leave enough room after each question on your copy so you can write down AS THE DOC IS TALKING so before they leave the room you can *quickly* repeat what they said so you make sure you understand.  Just say:  "Doc, I want to quickly repeat what you said to make sure I understand so I can follow through on what we discussed."  Don't be intimidated if you doctor appears to be in a hurry--keep it short but make SURE you repeat everything back to them--you'd be surprised how many errors can be prevented this way!!!

Ok!  Well that concludes this series!  I am hopeful that with this information you will be able to overcome the extremely frustrating & dangerous constraints on the patient-doctor relationship due to insufficient time to do a proper clinical interview!!!    

If you do end up using any of these techniques, please report back and let me know how it goes!!  I hope that this information is helpful to all of you! 

The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.  Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition. The Happy Rehab Doc expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this site.  By visiting this site you agree to the foregoing terms and conditions.


  1. My bestie & I go with one another to our doctor's appointments as much as we's convenient that we go to the same doctor. :) We spend so much time together that we often remember what the other forgets (about symptoms such as not eating, which you mentioned, or when a complaint started). Also, if it's her appointment, I'm the one taking notes (even though we both have a copy of the questions as well) & she takes notes for me when it's my turn to be "up on the table".

    1. Ok Jackie this comment was so cute! How wonderful to have such a fantastic best friend!! Love it! :-)

  2. Things are a bit different in the UK... Our national health service is pretty grim, we are told what to do & expected not to ask questions. I have challenged (just asked questions) every doctor I have seen over the last 6 years regarding my Graves Disease & have been branded a troublemaker! I've had to fight to get my blood results (I like to know my T4 & TSH levels) & because I've refused to have radioactive iodine - I've been lectured, reduced to tears, told that my thyroid will never recover & that it will kill me... One doc even ended with "if you love your family - you wouldn't put them through this". Luckily, my Husband always comes to appointments & is brilliant at fighting alongside me! Anyway, have heard today that my Thyroid is normal at the moment... Keeping my fingers crossed that I can keep it that way & am confident that the supplements I've been taking for a few weeks & our new eating regime (Esseltyn's book arrived yesterday & we are hooked!) are all going to help me go from strength to strength!
    I haven't felt this good in a long time!
    Kay :)

    1. Kay I am SO happy to hear you are feeling well! And I totally expected you to LOVE the Esselstyn book (with your nutrition background and all!!)

      And I think its important to be your own best advocate, while balancing that against doctor's expertise. I'll be honest, sometimes it is hard to be challenged by patients particularly when I feel that they are incorrect & not respecting my medical expertise--my clinical assessment & all my years (12+) of training. That isn't an ego thing, it is a reality.

      That said, it is very obvious to me that you are not being treated properly because it should NEVER be difficult to obtain your laboratory results (um, they are YOURS) & doctors certainly should not be pressuring you to do something you obviously are uncomfortable with! Part of using medical expertise involves taking a patient's concerns into account and if they are not willing to do the "prescribed" treatment than working to find them other options!!! There is never just one way to approach a disease--you should leave your appointments feeling that your doctor is YOUR biggest advocate---not the reverse!

      I'm so sorry that has been your experience and really hope that in the future you will be able to find a doc who respects your feelings about YOUR body!

      Keep up the great work!! Thanks for commenting!

    2. Also I smiled when I thought of your husband being your teammate and advocate--you and I are both very lucky in our marriages. It is such a blessing to have a husband that supports your needs & is willing to battle for them! Well done Mr. Smith!!!!:-)

  3. I have a rare connective tissue disorder that gives me a heart murmur that sounds like mitral stenosis (but isn't that serious), mild chemosensitive asthma, digestive issues that respond very well to a HIGH fiber diet with plenty of fluids, and joint problems (all hypermobile) that are aggravated by inactivity or over-activity. My hormones have also been irregular from age 24, with hot flashes starting at 31(on high-dose birth control) and hypoglycemia if I do not eat every 3-4 hours. This combo in a thin woman (normal thyroid) causes real issues with physicians who do not believe in the power of diet and exercise. There are no medications/surgeries for the joint problems. My asthma reacts to carcinogens/ lung irritants in smoke, cleaning products, and perfumes. A doctor in your specialty told me he would not treat me or refer me for PT because X-rays were normal, though I can easily demonstrate the joint abnormalities. I had to get a primary care physician (who does believe in self-management) to do the referral. I have tried presenting doctors and nurse practitioners with a brief medical history (one page, chart of injuries and treatment, and what worked) and an article from a medical journal describing the life history of the disorder (mostly easy-to-scan charts and pictures), but have had a doctor and a nurse practitioner look at me like I handed him/her a dead fish. The PT people were much more appreciative. How do people with weird health problems, complicated but not deadly or hospital-worthy (yet- though I should have gone for the knee dislocation and a few of the asthma attacks) communicate adequately that we are not hypochondriacs or drug seekers, but just trying to stay functional in a world where it takes a lot of time to manage our diet and rehab on our own, and we'd like some professional assistance once in a while?

    1. Mitzi--thank you so much for your extremely honest and articulate comment! It sounds like you may have a Ehlers-Danlos type disorder? All those connective tissue disorders are such difficult diseases to cope with because of just what you share--the difficulty in being validated to the reality of your diagnosis AND the challenge in finding respect, empathy & treatment from my medicine colleagues.

      I was going to rush and type out a comment for you but I believe your question deserves much more reflection on my part because, first of all--it really angers me to hear that your concerns were dismissed by other physicians--particularly one in my specialty. That is so unacceptable. Of course I don't know the circumstances surrounding each incident but I sadly do have may jaded colleagues who have lost their empathy and willingness to think outside the box. It frustrates me. So I need to step back from the anger before I respond to your question. Second, I want to make sure that I give you solid, practical advice that you can use to feel safe, well cared for and validated as a person & a patient.

      I will say also that while I do have many colleagues who have lost their compassion, I also have many who inspire me every day with their patience, kindness & brilliance. In every profession there are a potpourri of people, and medicine is no different. But that information doesn't help solve your problem so I digress!

      Please be patient and I'll think about this and get back to you this week, ok? Thank you SO much for your comment!!


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