~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?"

 And 

"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.

Tip #10 For The Best Hospital Care: Try Not To Be Alone ~ Insider Tips on How to Get the BEST Medical Care in the Hospital ~

Today we are concluding the series on How To Get The BEST Medical Care In The Hospital:  Insider Tips!  As always, this post is written to "you" but it can be equally applied to any family member or loved one. 


Tip#10:  Try Not to Be Alone!


The best piece of advice that I can give you is if you are sick enough to stay more than one night at the hospital, try to never be alone for long periods of time.  Try to have family members, friends, etc with you as close to around the clock as possible.  Don't have them come visit in a big group--that is a waste because their visits are more helpful if they spread out and give you coverage for longer periods of time.  Have them visit in small trickles throughout the day (and night for that matter).  

One way to spread a stream of visitors out is to explain the importance of shifts to everyone, have a point person volunteer and actually set up an email list or formal schedule for people.  This is what my own family did when my family member was in the hospital last month (the event that inspired me to write this series!) Unfortunately we as a family have had many hospitalizations & over time, creating a visitor scheduling system has become routine.

By making a formal schedule, it allowed my family member not to be alone & allowed each of us family members to manage our personal lives & keep working.  Important caveat--the family should actively encourage your primary caretaker (husband, daughter/son, parent) to try to minimize the time they need to spend at the hospital.  While you are in the hospital, it is an important opportunity to give your spouse or child or parent a good rest before you come home & they will be responsible for your care.  So ask for help from your church, synagogue, mosque, spiritual center, social club or network of friends instead.  Try to arrange to have someone looking in on you about every 2-3 hours.  

I recommend that you keep a notebook in the room that all the visitors should use to write down important things--like what doctors come into the room, any procedures that you get taken to, or anything nursing says that would be important to pass on to the next visitor (i.e.--nurse:  we need to keep an eye on her constipation.  You write down: f/u constipation.  Then the next person looks at the notes and sees they should remind you to ask the nurse about the plan for reducing your constipation).  My father has frequently been very ill--I have a large family & we practice this technique when he is in the hospital since we literally take turns sitting bedside & the notebook allows us to share what the doctor said on the first person's visiting shift so the last person's visiting shift knows what is going on! 

The notebook should have all important info clipped to it inside the front cover--like who your doctors are AND your Medical Info Sheet that we discussed here in Tip #4!

If you have a large enough family or friends and you feel comfortable asking, I encourage you to see if its possible to have one of them take turns spending the night.  


If you can't get anyone, and you are pretty sick than hiring a private-duty aide to sit with you during the night is worth the investment if you can afford it.  


If you are a family member caring for an elderly patient susceptible to dementia or confusion than I can't encourage you strongly enough to hire someone if you possibly can!! That aide however is not paid to watch TV--they are paid to let you sleep quietly, check on how you are doing, re-orient you to reality calmly and GENTLY if you are confused & be the family's eyes and ears.  Sometimes it is not possible to have someone stay over but I would lobby hard (AND BE VERY VERY NICE when asking) if it isn't usual hospital policy.

Remind everyone that you need to rest and your visitor point-person should emphasize this as well.  A hospital is for healing, not a party.  Please be respectful of other patient's needs as well. The point person should suggest that people bring a book or magazine to read, a laptop, a musical device with headphones, etc so you don't need to talk for most of the visit.  While they are in your room they shouldn't be talking on their cell phone or making a lot of noise.  Their purpose is to give you the gift of their time to help staff caring for you be able to perform to the best of their abilities.   

***KEY:  Do not allow visitors to interrupt the hospital routine.  When the nurse comes in to give you your meds, change your wound dressing, give you an enema or any other indelicate thing that your really don't want your family or friends to see, do NOT tell the nurse to "come back later."  You have to be a teammate remember--keep them on schedule & it will be to YOUR benefit-- you'd be surprised how many things about your care get missed as they are passed on to the next nursing shift if the nurse wasn't able to execute your care on schedule!***

See here for questions that your visitors should remind you to ask staff EVERY DAY & things to bring to staff attention.  Always remind who ever comes that it is critical they behave politely and respectfully towards staff members (see my post Tip #8).  To behave otherwise WILL reflect on you and affect your care. Remind your visitors that the staff is very busy and has other patients in addition to you.  If the visitor can safely & comfortably do a task for you--i.e. get you a washcloth and help you wash your face, pass you your urinal & dispose of the results, etc--than they will endear themselves to the staff to no end! 

That said however, don't let staff disappear on you just because you have someone in your room (it happens sometimes, especially if you are a family member & a healthcare person like me or my husband).  If you have waited a reasonable amount of time for a nurse/tech to respond (15 mins or so) and no one has come, then send your visitor to the main desk to ask for assistance. (Visitor Tip:  just standing at the nurses station can be quite a motivator for the administrative assistant or other nurses--wait there in full view until someone comes to assist your loved one..)  In fact, I recommend sending your visitor to the desk for help first instead of you buzzing your call light, but either method is ok. 


Ok!  This concludes this Tip AND this series!!  I hope that this series will help you and your loved ones get outstanding care & make you feel empowered with understanding about how hospitals work.  


It has been a pleasure to share this information with you--please update me in the comments if you have used these techniques & let me know whether they work for you & your family!!


Here are all the previous posts in this series:  

Tip #1: Be a Teammate & Tip #2: Be concise & organized: http://happyrehabdoc.blogspot.com/2011/11/how-to-get-best-medical-care-insider.html

Tip #3:  Key Questions to Ask Your Doctor: http://happyrehabdoc.blogspot.com/2011/11/tip-3-key-question-to-ask-doctor-in.html

Tip #4:  Know Yourself--How to Make a Medical Info Sheet:  http://happyrehabdoc.blogspot.com/2011/11/tip-4-key-things-you-need-to-know-about.html

Tip #5: Know the Hospital Routine: http://happyrehabdoc.blogspot.com/2011/11/tip-5-what-is-hospital-routine-part-4a.html

Tip #6:  Know the Role Everyone Plays in the Health Care Team: http://happyrehabdoc.blogspot.com/2011/11/tip-6-know-role-that-each-person-plays.html

Tip #7:  Know Your Doctors: http://happyrehabdoc.blogspot.com/2011/11/tip-7-know-your-doctors-short-guide-to.html

Tip #8:  Be Nice!  http://happyrehabdoc.blogspot.com/2011/12/tip-8-for-best-hospital-care-be-nice.html  

Tip #9: PAY ATTENTION!! http://happyrehabdoc.blogspot.com/2011/12/tip-9-pay-attention-more-insider-tips.html

Coming Up:

• SuperImmunity for Kids ~Part 2~!
• A Truly Healthy New Year
• Treating Pain with Food--more thoughts

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.

Tip #9: PAY ATTENTION!! ~More Insider Tips on How to Get the BEST Medical Care in the Hospital ~

Ok so today we are continuing our series on how to get the best medical care while you are in the hospital. This post does put bodily functions front and center but I can't tell you enough how important it is to be aware of the following items.  You can save your own life ten times over just by making sure these aspects of your care are properly managed.


For my new readers, look to the bottom of this post for links to Tips #1-8!:-)


Tip #9:  Pay Attention


As much as I hate to admit it--hospitals are dangerous places.  There are so many sick patients and so many opportunities for error.  If you know what to look for however, you really can prevent nearly ALL of these problems.


Ok, now here are the KEY things to pay attention to (I developed this list in consultation with my husband, the Happy Nurse, since he is an ICU nurse & therefore an expert in skin, bowl, bladder, eating, meds & mental status.  So now you have both the nursing and the physician perspective).:-)  This post is written as if YOU are the patient, but you can also apply this information if you are a family member or friend of a person in the hospital.  If the patient is too sick to "pay attention" than you as a family member can advocate as I suggest below & pay attention on their behalf.


Hand Washing:  You need to ask EVERY single person who walks in your room (staff, friends, family) to wash their hands or sanitize them with the alcohol gel.  This in an uncomfortable thing to do but it also is the MOST important thing you can do to protect yourself in the hospital.  Just say "Excuse me, if you don't mind, I didn't see you wash your hands.  Can you please clean them with the gel before coming in further?  Thank you!"  


Meds:  KNOW your meds (remember my "How to Make A Medical Info Sheet post: Tip #4: Know Yourself) and also know what meds you will be taking in the hospital--your inpatient medications may be very different than your home meds.  ASK FOR AN INPATIENT LIST OF YOUR MEDICATIONS WHEN YOU ARE ADMITTED AND KEEP THAT LIST NEXT TO YOUR HOSPITAL BED AT ALL TIMES.  As your nurse gives you your meds, she/he is required to tell you what she is giving you.  Cross check the names of EVERY med that the nurse gives you with your list.  If there is a new med, ask her/him to explain why it was added.  Sometimes you will find that the nurse may accidently have nearly given you the wrong meds.  Make sure the nurse manager knows but be compassionate to the nurse--unfortunately this happens all the time and sometimes its the pharmacy's fault!  Try NOT to refuse meds without letting the doctor know first.  Ask questions and advocate for yourself (like I suggested in Tip #1: Be A Teammate!) but remember--we have been in school/training for a minimum of 12-18 years + our years in independent practice.  Sometimes its good to trust that judgement (not always, but most of the time its a good idea). 


Skin: This is VERY important. EVERY day, your family member & nursing should:
-check ALL points of contact of your body with the bed & check skin from head to toe for dryness, rash, cuts, bruises, etc.  Many of these skin issues are normal (particularly bruising & dryness) but they should be documented.
-The Happy Nurse recommends checking specifically for ULCERS/SKIN BREAKDOWN in the following areas:  the back of the head, elbows, shoulder blades, buttocks & heels.  At the buttocks, check between the folds because many ulcers start at the sacrum.  Also, staff should daily check the genital region for any skin issues.  An ulcer is NEVER a normal finding and should be treated immediately that day.
-Send modesty out the window my friends, skin issues take FOREVER to heal and are very susceptible to infection.  Let them look!

Urine: Watch for dramatic decreases or increases in output, change in color from yellow shades to reds or browns.  Bring all of these to nursing & the physician's attention.  Dramatic increases may mean a Urinary Tract Infection is brewing or it could just be because you've gotten IV fluids!  Dramatic decreases are VERY serious--make sure they check your kidneys.  If you have a foley catheter in make sure you consistently ask your doctor if it can be removed.  The longer it stays in, the higher the risk of infection.  Sometimes it is necessary to keep the catheter in, but other times, doctors forget to discontinue them so ASK!


Stool:  Watch for absence of bowel movement, increase in bowel movement (particularly if very liquid), change in color to black, tarry or bloody.  If you are taking pain medicine of any kind, I put my patients on a bowel regimen of stool softeners & laxatives daily.  Ask your doctor if that is a good idea (there are contraindications).  If you haven't had a BM and are not passing gas and are having severe abdominal pain, this can be a medical emergency.  Tell your nurse immediately. If absent BM but still passing gas for more than 3 days--ask for aggressive bowel management (from both directions--oral meds & rectal meds) if its safe for you & insist on an enema if nothing by day 4.  If liquid, very frequent and FOUL smelling--ask to be tested for C. Difficile or other infection.  


Eating:  If you have "no appetite," force yourself to eat unless you want to stay in the hospital!!  This is particularly important for older patients!  If you just can't manage any food, ask for Ensure or Glucerna or another oral supplement.  If you simply don't like the food, get permission from your doctor to have your family bring you HEALTHY food with lots of green vegetables & also foods with iron in them if you are anemic.  Dark leafy greens are particularly good but make sure your doctor knows you are eating them if you are on Coumadin (warfarin) so they can adjust your Coumadin dose appropriately.  Never eat food from home without your doctor's explicit permission.  DRINK a lot of water & other fluids, unless you are on a "fluid restriction."  Ask your nurse before drinking a lot--if its ok, then drink b/c you will help with constipation and prevent dehydration.  Do NOT drink sodas!!!!!


Mental Status:  Sometimes in the hospital you may get confused at night and may act in bizarre ways.  You may not remember this in the morning.  Make sure to ask your nurse about this because delirium can actually be deadly.  It may be due to medications or infections.  If you are confused at all during the day or night--bring this up to your doctor on rounds (remember how rounds work, check my post: Tip #2: Be Concise & Organized).  Family members with older patients, make SURE to ask nursing about this and bring it up to the doctor--common causes of delirium include: infection (particularly urinary tract infections), disorientation due to lack of glasses/hearing aids, loss of day/night cycle (make sure that the hospital room is dark & quiet at night and bright during the day to orient you properly), medication side effects and cardiac issues.  Unless it is absolutely necessary according to the doc, ask the doc to stop or reduce the dose of any meds if they are producing this effect.

***CAVEAT--if you find any problems with your care, please point it out politely.  Please also bundle your requests into ONE conversation, like I discussed in this post: Tip #8: Be Nice.   You will DRIVE STAFF CRAZY and really make them massively annoyed if every time they come in the room they are being peppered with requests. This annoyance level WILL effect your care.  Mention it ONCE at the beginning of the nursing shift (Remember what I told you about the the nursing shift schedule Tip #5: The Hospital Routine).  I recommend you ask the nurse as follows:

"I'd like to make sure that I get my skin checked thoroughly today & I know you are super busy but when you have a moment today, could we also talk about how my bowel, bladder, eating & mental status is doing?"  

Pick a time during the day to remind the nurses to check all these things before the end of his/her shift if they haven't gotten back to you from your inital request.  Good reminder times:  1pm for day shift.  10pm for night shift. ***

OK!  I think that wraps it up for this medical system post!  Hope this was helpful to you!  Next time we finish this post series with Tip #10:  Try Not to Be Alone!


Here are the links to my previous posts on these subjects:

Tip #1: Be a Teammate & Tip #2: Be concise & organized: http://happyrehabdoc.blogspot.com/2011/11/how-to-get-best-medical-care-insider.html
Tip #3:  Key Questions to Ask Your Doctor: http://happyrehabdoc.blogspot.com/2011/11/tip-3-key-question-to-ask-doctor-in.html
Tip #4:  Know Yourself--How to Make a Medical Info Sheet:  http://happyrehabdoc.blogspot.com/2011/11/tip-4-key-things-you-need-to-know-about.html
Tip #5: Know the Hospital Routine: http://happyrehabdoc.blogspot.com/2011/11/tip-5-what-is-hospital-routine-part-4a.html
Tip #6:  Know the Role Everyone Plays in the Health Care Team: http://happyrehabdoc.blogspot.com/2011/11/tip-6-know-role-that-each-person-plays.html
Tip #7:  Know Your Doctors: http://happyrehabdoc.blogspot.com/2011/11/tip-7-know-your-doctors-short-guide-to.html
Tip #8:  Be Nice!  http://happyrehabdoc.blogspot.com/2011/12/tip-8-for-best-hospital-care-be-nice.html

Coming Up This Week:

• BOOK REVIEW:  "29 Gifts!"
• SuperImmunity for Kids ~Part 2~!
• Practical Stuff:  Kitchen Tools That Help & Products I Like! (Gift Ideas?!)

Coming Up Next Time on Medical System Tuesday: 

• Tip #10 For The Best Hospital Care:  Try Not to Be Alone! ~ Insider Tips on How to Get the BEST Medical Care in the Hospital ~

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.