A reader asks How can I be a better patient?
- Here's another question. How can I be a better patient? What habits or attitudes could I adopt that would allow my doctor to do a better job for me?
Thanks for stopping buy. In order to get the most out of your health care experience here is what I recommend.
- Have a list of your current medications with you when you go to see the doctor.
- Keep an updated list of your medical problems and surgeries as well.
- If your doctor wants to order anything, ask them what the risk of not doing it is. Discuss the risk and benefit of not doing it. Remember you always have the right to say no to a study or test. Often times tests are performed for low probability rule outs to cover one's butt. Sometimes they are done out of practice style without evidence based medicine to back it up. Sometimes they are done out of greed. If you are willing to accept the risk of low probability, then by all means, refuse a test. Watchful waiting is what makes comprehensive care physicians cost effective. Many problems will go away by doing nothing.
- Mutual respect. Yelling and demanding things from physicians is no more right than if they did it to you. If you don't 'respect your physician, find another physician. It does you no good to be in an adversarial relationship with your doc.
- Be proactive. Ask that your test results be faxed or mailed to you. That way you guarantee someone looks at it, you. And if it looks abnormal discuss it with your doctor. In the massive paper trail of medicine we live in, it is just too easy for things to slip by unnoticed.
- Care about yourself. Don't expect your doctor to make you healthy. Heal thyself with healthy lifestyles.
- Pay your bills. Your doctor provides a service. If they want to give it away, they will let you know.
- Come with a limited focus. Your doc does not have time for "Oh, by the way." Every time that happens, your 10 am appointment becomes 10:45, and nobody is happy. If you need to address multiple issues, make multiple appointments.
- Ask questions. I would much rather have a patient understand what I'm saying than one who doesn't care.
- Understand that medical care is filled with unknowns. That means schedules are often changed at the last minute and appointments may be canceled or run very late.
- Just because the doctor doesn't agree with what you say or describe doesn't mean they aren't listening. If the doc doesn't understand what you are saying, more than likely, the explanation is that there isn't one. Certainly zebras exists, but the most likely explanation of the unexplained is that it will forever remain unexplained. Watchful waiting usually wins on average.
- Usually when a patient says the doctor isn't listening, it's because the patient isn't either. Generally, in my experience, patients who complain that they aren't being listened to don't want to hear what the doc has to say. Usually because it is something they don't want to hear. If you find yourself complaining that the doctor isn't listening, it's time to find someone else who you think will.
I'm sure you all can think of others.
so true. great list.
ReplyDeleteExcelent post, nice one Dr. happy.
ReplyDeleteOrder your ideas, dont go to physician without ordering your thoughts, start from the very beggining, even if you symtopms are mild, they are related to your condition. most of patients start the from the end of the history.
Dont let your family talk for you, you are the main protagonist of your history, no one knows better than you, your symptoms, if a relative wants to add something there is nothing wrong with that.
Dont ask for exams, just for asking or demanding something without having a clue what is that for, a good clinical evaluation is consistent with assessment and examination, a good physician is not the one that ask for tons of exams without looking at your face. is the one that took the time to talk to you.
Be polite, Always Knock the door before entering for consultation, wait for other patients to go out, say always Hi.
Be carefull implying diagnosis by yourself, remember that your doctor is the one qualified to give you a diagnosis, it is dangerous if you are condicioning a doctor with a diagnosis, he/she could believe in your words, leading to a improper diagnosis, if you think it could be something else, you can say your opinion right after doctor's diagnosis.
Thanks for the answer. I think I'm doing pretty good on this except for the first two. I always get stuck writing down my medications because I don't know how to phrase it properly. Maybe I will post something in a minute and let you guys critique it.
ReplyDeleteOn being proactive, my view is that *I* am ultimately responsible for my health. I see doctors as experts who can help to steer the boat, but I have to row. I don't want them to row it for me. I need from them broad general direction, and it is up to me to figure out the details.
I actually don't ask a lot of questions. Before I ask any question, I first filter it with, "will the doctor's answer to this change my understanding or the way I am doing things? Do I need the doctor to answer this question?" If not, I don't ask it. I have lots of curiosity but I also understand that there is limited time in an appointment to satisfy my curiosity. My questions home in on what I really need to know that I cannot learn later another way.
On paying the doctor--my PCP co-pay is $25, which I always pay at the time of service. And I laugh when I pay it, because it's far less than I would have to pay someone to mow my yard. I know he's also being paid by insurance, but it still feels like such a bargain, $25. I can go in and get that kind of expertise for $25--it seems unreal to me. Medical care is such a bargain in this country.
(I have a private insurance policy. No one is footing the bill for me, I pay 100% of the premiums.)
Alexy, thanks for the additional thoughts. Actually I have asked for a blood test in the last year, but I prefaced it with "would you humor me by also ordering..." since he was having blood drawn, anyway. But you are right, I try not to do that.
I also agree with your thoughts on not coming up with your own diagnosis. If I think the doctor's diagnosis might be wrong, I give his suggested cure a try, anyway. I've been surprised a couple of times when what they said to do, that I was sure wouldn't work, actually did work. Those little experiences have taught me a LOT about the difference between what a doctor does and how I figure things out.
OK, here's a question that I don't have a good perspective on. I truly understand the need to focus, and it's one of the reasons I ask only the really important questions, which I prepare in advance. But sometimes I am not sure if I should bring something up or not. I had a dizzy spell a month ago, but I didn't tell my doctor when I saw him this week. I never can figure out if I should or not. The patient has to develop some kind of judgment about what to filter out, and I'm sure I get it wrong lots of times. This is hard without a medical background. Most of the time I limit what I tell him to the one or two things that are most concerning to me, but those might not be the most important things. The dizzy spell seemed innocent enough to me, but how can I know whether it should displace something higher on the list?
Another example--my doctor always asks me certain questions, among them if I have had any chest pain. Well I did have some chest pain, but I diagnosed it as heartburn--my first experience with that. When it started hurting, I decided to take some baking soda in water. A few burps later and the pain was gone. So I filtered that out of what I told him. Because I was playing doctor, some will say, by forming my own diagnosis. But honestly, a patient has to have some common sense about these things, right?
OK, does this work:
ReplyDelete50 mcg levothyroxin, morning
10 mg Singulair, bedtime
12.5 mg atenolol, bedtime
81 mg aspirin, every other day, bedtime
0-1250 mg calcium, throughout the day
800 mcg folic acid, bedtime
etc. other vitamins
albuterol as needed
pseudoephedrine as needed
acetominophen as needed
ibuprofen as needed
etc.
Good? Bad? Improvement?
Everything you have to say INITIALLY is important, so it’s ok to tell everything to your doctor, the most important thing is start from the beginning, and give details related to it. If you have dizzy spells its ok to tell that to your physician, whether it’s important or not it up to your physician to determine it.
ReplyDeleteI have seen many patients that ask for hemoglobin, white count and plaquets all the time for dizziness and headache, but this kind of test aren’t related to it. There are more than 250 potential causes of headache. I particularly prefer to ask and exanimate. Because there are few conditions, that actually can change Hemoglobin or white count, and people ask for regular test (the ones they know) when other kind of tests might be needed, anyways if you need a test, im pretty sure your doctor will ask for it.
Coming up with your own diagnosis, it’s dangerous, I have seen it, and people that say that got asthma end having, heart failure, lung cancer, renal failure and diabetes, and some physician for laziness or lack of interest end conditioned by patient’s thoughts.
Your list its just fine, the thing is having an idea what medications a patient take, for possible interaction on other drugs, secondary effects, or failure on a treatment.
N e v e r take a family member with you in to the exam room...ick. Who would want to do that anyway? (unless the patient is very young or somehow incapacitated or really wants the support). i always hear about people taking someone with them and i just can't imagine it...
ReplyDeleteThank you for a great list, Dr. Happy
Also check out the book "How Doctors Think". Great book about clinical reasoning and avoiding cognitive errors. The last several chapters are dedicated to being a good patient, and helping your physician avoid cognitive errors. I'm a physician, and I enjoyed the book.
ReplyDelete