“By failing to prepare, you are preparing to fail”- Benjamin Franklin
It is inevitable. No matter how healthy we perceive ourselves to be, at some point, we will need to consult the doctor. Some doctors are so busy, we might only get a few minutes with them, and getting an appointment can be tedious. It is, therefore, helpful to make some preparations prior.
We could see a doctor during a routine health check-up, at an outpatient (clinic) consultation for a problem, while admitted to hospital for a more substantial illness, or, less commonly, in the casualty when we are acutely ill. Since most doctor visits happen at the OP clinic for a focussed problem, how to best use the time spent during that visit will be the theme of this article.
Regardless of how brilliant the doctor is, his or her ability to solve our problem depends largely on the quality of information that we can provide during the visit. A good part of this information is our history in our own words. Subsequent lab tests and scans are only used to confirm or refute a diagnosis that the doctor already has formed in mind after taking our history and performing an examination as indicated.
The following tips will help us make the best out of the doctor visit.
1. Stay focussed. It would be helpful to give precise detail of the chief symptom. For example, if we have a tummy ache, we must be able to say how long it’s been since it started, duration of each bout, the location of the pain, severity, aggravating or relieving factors, associated symptoms like vomiting, treatment taken so far and the response.
2. Bring a list. Sometimes we come home after the doctors’ visit and realise that we forgot to ask about something. This commonly happens due to the stress of seeing the doctor in a crowded clinic in the limited time available. Therefore, if we have more than one problem to discuss, it would help to keep a short list handy.
3. What did the doctor say? Studies have shown that by the time they get home, patients recall very little of what the doctor had said, and even less afterwards. Asking the doctor for relevant printed brochures, or writing down notes soon after the visit can help improve retention. Taking a friend along with us will help have a ‘second set of ears’ in case we forget what the doctor said.
4. No question is silly. We must be able to talk freely with the doctor; remember that no question is ‘silly’ when it comes to a doctor visit. It can be from such ‘silly’ questions that the doctor will be able to help us better.
5. Being direct with the doctor. People go to the doctor for different reasons. Most people want to know the reason for their symptoms and get some relief. Some already know their diagnosis and would like more information about it, such as how long the illness would last, and whether it would occur again. Others are worried if there is cancer. Still, others want to get themselves checked just to make sure everything is fine. A few might be going for a second opinion. It would be helpful to tell the doctor exactly what is on our mind upfront so that the doctor can respond accordingly.
6. Knowing our history. The diagnosis of our present problem can depend on our past medical and surgical history. Ideally, we should have our written medical history with us when we see the doctor, so that we don’t always have to depend on our memory. This must include our past illnesses, family history (major illnesses that run in the family, such as cancer or heart disease), and the details of past operations or procedures we might have had. With the widespread use of smartphones and computers, keeping this list shouldn’t be a problem. A typical format for printing one’s medical history is as follows:
7. Maintaining our own medical records: Though the doctor’s clinic or hospital will have their own records, it is worthwhile keeping all relevant medical documents in our own personal file, with investigation results filed in chronological order. This is particularly important because we might have visited more than one healthcare facility. It is useful to bring this file each time we visit the doctor.
Digitization using Google drive or email is a smart move, so that we can access our records when away from home too. Doctors’ prescriptions, lab results, ECG, radiology results and other investigations fall under this category. Old ECG/scan/X-ray results can be helpful to compare with the present, to detect any change over a period of time.
People with chronic illnesses like diabetes, liver cirrhosis, and kidney disease may maintain a notebook detailing relevant lab results and treatment administered, by date.
8. Know our pills. The doctor will need to know what medications we are on, regardless of the system of medicine we follow. Those of us who take medications regularly may have them written down on a small card and keep it in the handbag or wallet, preferably encased in a protective plastic folder. This list must be periodically updated.
9. Know our allergies. We are not talking about dust allergy or allergy to cats here. Some people have allergic reactions to certain medications; these can’t always be predicted, and can even be fatal. If we had a known allergic response to a medication, we must show the diligence to write down the name of the medication involved, as well as the type of reaction that happened. For example, was it a rash, a wheeze or a more serious reaction?
This information needs to be updated every time we see the doctor. That is because a person who was once allergic to only one medication could develop a new allergy to another medication later on in life. The doctor needs to know about this before prescribing.
10. Book an appointment: Some clinics can be crowded - and waiting times can be frustrating, especially when everyone wants to be seen first. Booking an appointment will help alleviate this, but remember that the doctor might take longer for certain patients, or might get called in between to attend a sick patient admitted to hospital. Taking a good book along will help reduce the monotony.
11. If acutely ill, go to casualty. The OP clinic is meant for patients who are relatively stable. If we are acutely ill with pain, breathing trouble, dizziness or vomiting, casualty (E.R.) is the place that will get us prompt attention.
12. About the new pill. How long to take the new medication? What about the timings, and is it before or after food? Should we forget about it once the course gets over, or check back with the doctor after stopping? Should the medications be refilled without seeing the doctor? Are there any lifestyle changes to be made?
13. Not all medications can be taken together. Can the new medication be taken along with the others? Obviously, the doctor needs to know the names of the existing medications to decide on this. Some medications can have minor interactions that can be ignored; the doctor will help us decide if it is significant in our case or not.
14. Follow up plans. When should we come for a follow-up visit? If investigations are planned, how to get them done and how to appraise the doctor of the results? It is always better to schedule a follow-up visit in order to go over the test results and to assess the response to treatment. Any subsequent visits will depend on the decision of the doctor at the follow-up visit. Based on the diagnosis, the doctor might either ask us to return after an interval or on an as-needed basis.
15. Ask thy neighbour? Soon after the doctor visit, some patients have an inclination to check the internet, ask the neighbour, a colleague or a relative. Though this tendency to second guess the doctor is only natural, it can, in fact, be counterproductive. Once we have seen the doctor whom we are satisfied with, it is generally unwise to ask around for more opinions - as too many cooks will spoil the broth. A half-baked opinion – no matter how well-intentioned - is no substitute for a professional medical consultation.
16. What if the pills don’t work? It is useful to ask the doctor beforehand about the approximate timeframe for improvement to occur, what should be done if we do not improve, and where to go if sudden deterioration happens - so that there is no break in continuity of care. It can be difficult for another doctor to get up to speed with our case - that is if we get admitted to a hospital where our own doctor does not have privileges.
17. Effects vs. Side effects. If medications are prescribed, then are we aware of the side effects? The term side effect refers to the actions caused by the medication in areas other than those intended. Most legitimate medications will have a list of side effects, but this does not mean that everyone will get those side effects or that the medication is harmful. For example, anti-allergy medications commonly cause drowsiness.
18. How to reach the doctor: We can ask the doctor if it is okay to call with a question in the future. Remember that the doctor’s advice or decision is only as good as the quality of information provided prior. The majority of doctors prefer to see patients only in their clinic – that is, along with complete medical records, so that decision making is professional and precise. As they see thousands of patients, doctors, in general, prefer not to rely on memory alone when a random phone call comes in from a patient. Likewise, it is generally not advisable to seek consultations by social media – an inefficient medium for exchange of complex ideas and information.
One might wonder if these steps would prolong the consultation time with the doctor. On the contrary, being well-prepared will only make the process more efficient, so that the doctor can diagnose our condition with greater confidence, and ensure a better long-term outcome.
In summary, providing an accurate history is the most important part of the consultation. Most of our homework towards this boils down to keeping an updated card of essential medical details in our wallet, having a sheet of paper outlining our medical history, and maintaining a personal file with all past health documents stored in chronological order.
(The author is a Senior Consultant Gastroenterologist and the Deputy Medical Director, Sunrise Group of Hospitals, Kochi. His column, Everyday Health, will appear every alternate week)