How to get the most of your doctor's visit.

I am writing this blog to help you prepare for and get the most out of your visit with your doctor. So little time is available for you that it will help you to use it to your advantage. This blog is a bit long. I welcome feedback to make my blogs more useful.

It is common for people not to be in their "normal self" state when they pay a visit to the doctor. After all, most of us pay to visit the doctor even if some doctors give us the impression that we bother them beyond compare as we interrupt their daily work with our tiring list of problems. I hope those are few and far between, I hope yours is great. That said, even in the best possible doctor-patient relationship you can optimize your visit. The key point is to understand what the doctor is actually doing.

First, of course, you'll be welcomed by someone on the phone who would like to know what you are seeing the doctor for. It is a reasonable question because that is how they decide how much time they need to book you for. An answer like "I need my blood pressure checked" or "he asked to see me" or "she is going to do my annual physical" is enough. Or try: "I have a new medical problem to discuss with my doctor." They will want your insurance information, they will want to know if you have seen somebody else for the same problem, that's all OK. It is NOT OK to insist that you tell them what the problem is if you don't want to. All you need to say is: "I would rather just speak only to the doctor about that". After all, who wants to be welcomed by the receptionist with a happy "Oh yes, you are having lots of diarrhea. I'll tell the nurse you are here". And that 'for my doctor's ears only' line is also OK as the only thing you say to the physician assistant who takes you from the waiting room to measure and weigh you and who will take your blood pressure and go through your medications. They do not HAVE to know what you are there for.

Now that you know that you do have control over information you share right away, I want to tell you about what happens when the doctor is in the room with you. I am going to put it in simple terms. Lots of you know this, some of you don't. Help yourselves to whatever piece of information I can share with you.

Doctors have a rigorous system for investigating a medical problem. It is called History and Physical. It may be followed by Tests (X-rays, labs, MRIs, the lot) and by referrals to specialists. If you understand in what form your information is obtained it may be easier for you to get the information in your medical dossier.

In this blog I am going to discuss History. This is the most important part for you to get right. Whatever you don't talk about will not be in your file so if you would rather not have some information in there you are in control. However, you will want to have in there as much information as is relevant to your current condition. It creates a groundwork for the evaluation of your current problems and helps to get more done more quickly the next time you need to consult even if it is for a completely different problem.

History is divided into several parts and your doctors will try to get it organized in this way. The history of the complaint, the previous health history, the family history and the history of treatments, drugs and others, and their efficacy for everything you ever had before.

You can see right away that you could make the list of what you ever had and what treatment you got before you even make your appointment. And you could write down the family history, the list of what all your relatives on your side of the family have suffered from and how they were treated and if that worked or not, if you know. If you do that and give it to the doctor he/she will not have to spend as much time on it and more precious time will be available for your consultation. You won't be spending your time on trying to remember on the spot who had what and what the little blue pills were that you got from another doctor a year ago. Ask your pharmacy for a list of what you are currently taking and whatever you were on in the past while their customer.

So then, as you sit there armed with your list of stuff, the doctor will start with asking what you are in the office for. Try to be clear. If it is hard for you to talk about it, write it down and read what you wrote. Feel free to bring someone with you to the office who can help. But don't bring someone who keeps interrupting you and the doctor. After all, it is your problem and you are seeking the doctor's advice, not theirs. And it is perfectly OK to tell the person that came with you that you would like him/her to go to the waiting room while the doctor is examining you. That is not rude. In fact, it would be extremely polite on their part to offer you privacy.

Describe your complaint. Example: "I have had backaches for 6 months, mostly in my lower back, on and off. Especially when I am standing for a long time such as in the kitchen do prepare dinner. I have tried aspirin and other things like anti-inflammatories (Aleve, Advil, etc). It is not getting better. I have tried exercises, hot packs, my husband has massaged it (wonderful guy, he's a keeper). Nothing really works." If you had it before, some long time ago, say so. Such as: "I had this when I was in my thirties and I was playing a lot of tennis. It would hurt afterwards for hours." Say if you had relief from those pills and potions. If you don't say it yourself the doctor will ask so thinking of this before your visit will make it easier for you to answer the questions.

Then the doctor will ask a lot of follow-up questions. In a case like this: "Does it hurt more if you stand or if you sit or when you lie down, when you bend over, etc, etc.? Does the pain go down when you change position? Do you have pain elsewhere or only in your back? Are you experiencing stiffness? If so, when? In the morning? Does it go away when you move around. What do you do to make it go away and does that work? Do you have other symptoms like tingling or loss of sensation?"

I use an example. The list of questions would be completely different when you come with a different complaint so don't feel that you should have anticipated all these questions. You can't unless you are a medical professional yourself. That said, you may have looked into it using the internet. Don't be shy, tell them you did. They'll help you understand why it is or isn't what you thought from your reading. I always much preferred people who did read about their stuff. For me it made the conversation easier if I could relate what I found to something they had read. If you are wondering if it has anything to do with what you did/didn't do, what you ate or drank, anything you might think, DO ask. Don't you want to know? The saying is that there are no stupid questions. And if your doctor says "that is a stupid question" you need to start thinking if you want to stay with that person. No doctor in their right mind would ever do that.

Once the inquiry of the complaint is done, there will be a "systems review". It means that you are going to get a lot of questions about all the other things your body is supposed to be doing normally. Breathing, eating, drinking, moving your bowels, emptying your bladder, walking, etc., everything.  I am going to do a separate blog on this in which I will put a list you can work on before you come to your visit. The purpose of the systems review is to get any and all information about your health otherwise, from head to toe and anything in between. If there is a problem, say so. If you are seeing a specialist much more time may be spent on this then at the office of the family doctor. They are drilling down further, they are looking for the more uncommon things.

After that piece comes the personal history. Everything you ever had and what happened with you then, what investigation, what treatment, what outcome. Every time you were in a hospital for an illness. Every time you went to the ER for something. The other medical problems you had and have that you didn't go to the hospital for but did get treated for. Accidents, broken bones, and so on. It is a really good idea to write that down beforehand.

Then comes family history. Everything your family members on your side have or have had. That means your parents, grandparents, siblings, children, grandchildren. Maybe cousins if you know. Again, that is a really good thing to spend time on before you even go to your appointment. And no, your spouse is not your side of the family. What he/she has is not relevant for a family history unless you are indeed related.

They will want to know if you do now or ever did in the past drink, smoke, use drugs, exercise, diet, take supplements, etc. Answer honestly. Make a list. It doesn't help you to withhold information. These habits and substances may have helped or aggravated the problem. If the doctor understands what you did in the past he/she will be better able to make the right diagnosis and give you the right treatment.

They will want to know all the medicines you are taking. Can't remember? Go to the pharmacy and have them print out the complete list. It should say when you had what. You can bring that with you. One from each pharmacy you use. Now you know why it is easier if you use only one. Take all your pill bottles and put them in a bag and bring them to the doctor's office.

Does that sound like a lot? It is. Does it seem like an impossible task to do within a 30 minute visit with your doctor? It is just about impossible. So the better you prepare, the more you info you have ready, the more time there will be for your current problem. Maybe give some thought about going to the doctor's office and picking up a copy of the forms they are going to ask  you to fill out. So much easier to do those at home before your first visit.