How to Organize an Officit Visit
During the chat last Sunday, the question came up on how to get your doctor to listen to you. I have been thinking about that question and here are some of my thoughts. I am posting this before the chat this Sunday so you can ask question during the chat if you want.
I was taught to organize an office visit during my training. Most doctors were probably not taught this so they either learned it on their own or feel rushed and try to end the visit before you are ready. When someone comes in with a list, I just ask them to give me the list. I do not go into detail on each item at first. There are two reasons for this. First, studies show that people do not list their items in order of importance. Usually, you start the list and just add to it. As a doctor I can sometimes address several items with one explanation. As a patient, you may not know the connection between the items.
The second reason is that if it is a very lengthy list, you and your doctor will likely run out of time to address each item. That is when I ask the patient to give me the three most important issues. Have the three most important questions ready for your physician. Write down the answers during the office visit. That way, they will be covered, and if time is available more items may be addressed. Then there are the items the doctor wants to address. The visit in a way needs to be negotiated between you and your doctor.
The visit needs to address the patient’s issues and the doctor’s issue. Let me give an example:
You have been dx with PAN for one month. You started to read as much as you could but you need to help find out what is happening to you. You may have many questions.
- I am getting fat on pred
- I have trouble sleeping at night
- My feet fall sleep
- I have pain in my back
- My weight is out of control
- What are my test results?
Then the doctor has a list of question she or he want to address which may not be on your list but is medically important. A doctor does not want to spend 20 minutes with a patient ready to end the interview to have their patient say "by the way I have been having this crushing chest pain." As this considered a life threatening condition this take precedence over everything else(this by the way happens to all doctors at sometime, and you wonder why you have to wait :-).
Since most doctors are not used to organizing a visit, by you doing so, the visit may go smoother.
The first thing to do is to prepare ahead of time. Make a priority list. Think of the three most important questions. When you give your list to your doctor, list the items without going into further detail at first. Let your doctor know how you plan to give him/her your information, such as, "I have a list of questions, I am not sure if we will have enough time to complete the list. I will give you my complete list first as you may be able to see a connection between the items. Then I will tell you my three most important questions." This will give your doctor an agenda.
They are used to that and will know what your expectations are. You will need to allow time for the doctor to address his/Her concerns as well. An example of the later, you do a complete list and are ready for the office visit when the doctor may hit you with some not so good news and blow you out of the water. You may be so surprised that your mind goes blank.
The relationship between doctor and patient is just that, a relationship. It is one that takes a lot of trust on the patient’s part. As in any relationship communication is the key, but it is two way street. You may have disagreements, hurt feelings, misunderstanding, sometime anger as well as times of agreement, joy, feelings of working together for good, and almost being part of a family. Just remember, we are all human, we all have good days and bad days, and that plays a role in any relationship.
When you go to see your doctor, you may have waited one to three months to see him/her. When your doctor comes in you may be the 15th patient of the day, they may have been in the hospital with a very sick patient all morning and not had lunch. This could set up for a not so good visit or you could work on communication. If your doctor tic’s you off, tell them. They may not realize how they are presenting their self. Doctors get angry with patients(as hard as the is to believe :-). I have had patients misunderstand me, I have been grumpy and I am thankful when someone has the courage to tell me. I apologize and we talk things out. Sometimes the patient may not tell me for six months.
The qualities of a good doctor include may traits and not all doctors have them. I believe that a doctor needs to have knowledge, or what is more important, know their limits. They need to know what they know, if they do not know look it up or send the patient to someone who does know. This is a hard part for some doctors, they get defensive if you challenge them. If this is a problem with your doctor and you are not satisfied, get another doctor.
A doctor needs to listen to his/her patients. Sometimes that goes beyond the actual words. I watch body language, how the patient usually in the office and is there something different. On the other hand, you need to listen to what your doctor says. That does not mean to take it as gospel truth, but if your doctor gives you a suggestion and you do not want to or do not follow it tell them why. I tell my patients that my job is to give them advice, it is their body and we negotiate treatment. What is frustrating to a doctor is when a patient says they will do whatever, and at the next three visits has the same complaint and had not made any changes. This can happen for many reasons. I will try to find out why but as a relationship goes two ways the patient needs to communicate why they are having a problem with the treatment.
The hurdles to treatment are many, patients are afraid to get their doctor angy, too bad, you have a right to tell you doctor how you feel, if they do not allow you to work out difference then get another doctor. Patients can not always afford expensive medication and are reluctant to tell their doctor. There are patient assistant programs though the drug companies that can supply the medication free depending on financial need. Sometime there are samples. You may be having a side effect that you are shy about talking about, such as a sexual dysfunction. You need to communicate so the doctor understands and can help find an alternative.
This is getting very long so I will stop here. Key points:
- Set a plan for your office visit
- Prioritize you concerns
- Realize that time is limited so get the most of the time you have
- Remember that you doctor is human and so are you
You are in a unique relationship with your doctor(as a doctor I feel honored to be able to have that relationship with my patients, you become a part of the family)
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