How to Help Your Doctor Help You

By Nancy A. Alston M.D., Board of Medical Advisors, Hypoparathyroidism Association, Inc.

In general, your doctor is there to help you. There are a number of ways in which you can help her do that. You and the doctor need to form a team to carry out what ever will be of benefit for you. Ways in which you can do this include: come to your clinic visits prepared, be willing to learn about your health, and be willing to help yourself. You will get more out of your doctor and your health care team. And you will have better health.

Primary Care Providers

You need to have a Primary Care Provider (PCP). This is usually a doctor trained in family practice, internal medicine or pediatrics. A PCP will take care of the whole person. In some cases a PCP may be a mid level provider such as a physician assistant or a nurse practitioner. If this is the case, then the mid level provider will have a supervising physician.

Why do you need a primary care provider? Studies have shown that in the United States, an increase in the percentage of primary care doctors in comparison to subspecialists, increases the quality of health care and decreases health care costs. HPTH is not the only part of your health that needs attention. PCPs are trained to look at and take care of the whole patient. Even if you have one or more subspecialists, you still need a PCP to coordinate everything. Also, PCPs manage preventive health care such as vaccinations, PAP smears and other screening tests.

Communicating with your doctor

Many physicians are now under marked time constraints in the US. Their schedules are often controlled by insurers or clinic profitability or even just the volume of work that needs to be done. So it is not unusual to find that you are allotted a specific amount of time per visit. It is important that you use that time as efficiently as possible.

You should be able to communicate with your PCP. You can plan ahead and make it easy and efficient.  Keep it clear and simple. Stick to what is important. Avoid extraneous information; it will dilute the needed facts and make it hard for the doctor to sort out what is important, it also wastes time.

Let the doctor know if you have clear preferences. If the doctor wants to order an MRI scan, he should know if you have claustrophobia. Then he can work around that by ordering a different test or providing medication to help you get through the MRI. If you are seeing the doctor for allergies and hay fever and the doctor prescribes a nasal spray and you cannot stand anything up your nose, then you need to let her know so that she can prescribe something else. You don’t want to waste time and money with a treatment that you cannot use.

Don’t make the doctor guess what you are thinking. Doctors are trained to ask the correct questions but since every person is different, they may miss something. If the doctor has not asked about something that you feel is important, raise the issue. And don’t wait until he or she is leaving the room. Doctors dread the statement, “Oh, by the way.” It seems that it is usually the most difficult problem that gets left until the end and the time has already been used up and there are several other patients waiting. We, as humans, tend to be reluctant to bring up things if we find them embarrassing, or we are worried about how the doctor will respond, or they are things that we are just really worried about. So we leave them until last. Don’t. Bring up the most important things first.

Demonstrate an interest in your health. Doctors are willing to go the extra mile for patients who are interested in helping themselves. For instance; I have lots of information on smoking cessation, several different treatments that can help, and a list of other resources for people who want to quit. If a patient comes in stating he wants to quit smoking, but he has an excuse for not trying everything I suggest, I will give up and go on to something else. On the other hand, if the patient states he tried one and it did not work but is willing to try another, I will gladly work with him. Even if he fails several times but is willing to try again, I will keep working with him.

Come prepared; learn about your diagnosis if you already have one. This is much easier since the advent of the internet. The Medline Plus web site, Medlineplus, is an excellent source for medical information. It has an extensive list of topics and gives you direct information and links to other good sources. Other good government sources include those of the Centers for Disease Control and Prevention, and the National Institutes of Health.  Associations for specific diseases will often have their own web sites which can be helpful, like the one for HPTH. There are some other good general health sites such as WebMD and the Mayo Clinic.  Medical associations often have good patients.

However; don’t try to diagnose yourself from the information you read on the internet. The human psyche is very susceptible to suggestion. Sometimes a patient will come in and state that he has a particular disease and then list every symptom that he has read about when he actually would have reported a different set of symptoms otherwise. This can mislead the provider because you are not telling him what you have versus what you read. The wrong diagnosis can be very dangerous. Also, be careful of unreliable internet sources. For every good source there are at least 10 or maybe 100 unreliable sources. Too often they can be downright fraudulent.

The First Visit

There are certain things that your provider needs to know. You will be significantly ahead of the game if you already have the right information collected. The data needed at your first visit or a visit to establish care can be comprehensive. Some clinics will have a new patient questionnaire to fill out before seeing the provider that includes much of the information so you don’t have to take up face time detailing it. Or some will mail you a questionnaire so you can fill it out at home before you come for the appointment. Having everything written down prevents forgetting something and helps to keep things in order. Bring a list of questions for your provider or a list of the things you want to cover. If possible bring in copies of old records or be ready with the name, address, and fax number of previous providers. The office can send for the records if you sign a “release of information”.  Doctors usually organize the information they need in a certain manner. This order for the medical history varies only slightly from place to place. If you keep your information in this, or a similar order in your own records, it will be easy to present it to your provider. For your first visit you will need all or much of the following.

Chief Complaint: why are you coming to the doctor today? This is a quick summary of 1-2 sentences describing what you are primarily concerned about. For instance; “I have a pain here” or “I am new to this town. I have hypoparathyroidism and I need a provider to help me with it.”

History of the present illness: this is where you elaborate on the chief complaint State how you are feeling today, current symptoms, what, where, how much, when, how long, quality, exacerbating and relieving factors. The better you can describe your symptoms, the easier it is to find the reason. Or, if you already have a diagnosis, what were your symptoms to begin with and how are you feeling now. What has been done so far such as blood tests or imaging studies. What treatments have you received for this problem and how have they worked, medicines, physical therapy, surgery, etc.

Past medical history: includes all your major illnesses, times you were hospitalized, surgeries you have had, and any major injuries.

Social history: includes things such as marital status, number of children, education, and type of occupation. (Parenting is a valuable occupation as is housekeeping and homemaking. Never say you are just a housewife. No society can function without housewives.) This also includes where you have lived and traveled. Sometimes religious beliefs or cultural customs can be important.

Medications: Always bring a written list of all your medications or bring in the bottles. List each medication that you take, including vitamins, herbs and supplements, with the dose and how frequently you take it. Knowing the color and shape is no longer of any help as there are many different generic medications with different appearances It is a good idea to also let the doctor know how often you forget to take your medicines. List all of your allergies and adverse reactions, what the reaction was and to what drug. List your vaccinations and when they were given or bring in your vaccination record for the office to copy. List any habits that involve substances, i.e., tobacco, alcohol, and illicit or street drugs such as marijuana or methamphetamine; what route, how many or how much, how often, and for how long. Sometimes we feel embarrassed about things like this but it is important that your primary care provider knows as it often affects your treatment. For instance, I have had several patients who were past heroin abusers. One woman had long since quit, was a caring wife and mother, great homemaker, and ran a successful business out of her home. However her heroin history became important when she was hospitalized with acute abdominal pain and in spite of its severity, she refused all narcotic pain meds.

Family history: most important are first degree relatives; parents, siblings, and children. Are they alive or dead? If alive, what is their age, how is their health, what diseases do they have. If dead, how old were they at death and what did they die of. This is for blood relatives, not adopted ones, as we are looking for inheritable diseases that we need to watch for in you or that give clues to diagnosing your problems. In some cases, second degree relatives become important also, for example, the BRCA gene mutations would be suspected when all the first and second degree female relatives on your mother’s side had either breast or ovarian cancer at young ages and several of the men had cancer as well. We would then manage your preventive health care very differently from someone with no family history of cancer.

Follow-up visits

Come prepared with an organized or written history and a written list of questions or concerns  (recognize that there may not be time to cover them all in one visit). Always, at every visit, bring a written list of all your medications, including vitamins, herbs, and supplements, including dose and how you take them. Or bring in all the bottles. Include drugs prescribed by other physicians. Start with your biggest concern, the chief complaint. Move on to the history of the present illness, how you are feeling now, your current symptoms, and what has been happening since your last visit. State what therapies have worked or not worked and what else is going on.

How to deal with problems

What if things are not going the way you want? State your concerns; “I am worried about–“or “I would feel more comfortable if we did thus and such“. You can continue restating as often as necessary. Be open minded, sometimes the doc has reasons that you would not have thought of for his suggestions or the way she is doing something. If something really doesn’t work for you and you don’t see it being acknowledged, use the “I feel–about–because” statements. To do this, you state how you feel, frightened, frustrated, sad, etc. Then you state what it is you are feeling that way about. The “because” part is why you feel that way. For example; “I feel frustrated about the clinic’s billing system because the bills are late and incorrect and I am having a terrible time with my insurance.” This works because no one can argue with the way you feel but you are not accusing anyone either. Thus people are usually more willing to work with you. It is OK to change care providers if you just don’t feel you connect. If you are changing providers once a month, then the problem may not be with the providers. But at times we all find people we just don’t feel comfortable with and you should feel ok with your PCP.

Don’t

Don’t storm in yelling at everyone. If you put people on the defensive, they will subconsciously sabotage you. That includes the front office receptionist. Don’t attack your previous providers, it won’t get you anywhere and you don’t need to. If your present doc is worth anything then any problems with your previous care will be obvious.

In Summary

Come prepared. Write things down. Bring a list of your questions. Demonstrate an interest in your health. Learn about your diagnosis. Demonstrate a willingness to help yourself.

You will get good health care.

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