Your Doctor Wants to Know You

Historically, the doctor would lead and the patient would follow, for example - patient visits the doctor, patient answers the doctor's questions, and patient leaves with instructions for medications and treatment.

Today, expectations have changed on both sides of the care-coin and the flow of information now runs in both directions. Doctors are sincerely interested in getting to know patients and what ails them. Doctors know that they are better providers when they have more information about a patient and have a chance to connect better with a patient.

A study with the Massachusetts General's primary care network published in 2005 in the Annals of Internal Medicine underscores that connectivity with a doctor truly counts. After studying the visiting habits of patients to the primary care networks, results show, that over a three year period, 59% of the patients were connected to a specific physician, 35% were connected to a practice, and 6% were unconnected.

The findings also state: Receipt of preventive care varied more by whether patients were more or less connected to a physician than by race or ethnicity. Physician-connected patients were significantly more likely than practice-connected patients to receive guideline-consistent care.

The lead author of the study and Director of Primary Care Research & Quality Improvement at Massachusetts General Hospital in Boston, Steven J. Atlas, MD, MPH, comments, "Our results imply that continuity of care counts, that a longstanding patient-physician relationship is all about knowledge and trust, and that it's good for the patient's well-being."

The more information a doctor has, the better equipped he or she is to understand what the patient is really dealing with, what the patient's concerns are, and what course of action for treatment really makes the most sense for that patient. The more engaged a patient is, the more likely he or she will seek follow up treatments for conditions and maintain a plan for preventive-type care.

A quality health care situation is more likely to be realized when the patient is prepared to engage with the doctor and does his or her part in allowing for a connected relationship. This entails finding a doctor that aligns with your values and care needs, asking questions and sharing unsolicited information with the doctor, and finding out the best way to communicate with your doctor outside of office visits.

Finding the right doctor for you

The foundation of a solid doctor/patient relationship is finding the right doctor. It is perfectly appropriate to set up an appointment to interview the doctor, have questions answered, and discuss how the doctor would treat your specific issues. Co-pays or other charges may apply to the visit; be sure to ask at the time you call to make the appointment so you know what to expect.

Practical factors to consider: medical credentials; location and accessibility of the office; normal operating hours; who covers for the doctor in his or her absence; after-hours access to care; promptness with appointment times; payment options and insurance plans accepted; hospital associations; and how does the doctor typically communicate with patients – email, phone.

Value-based factors to consider: general philosophy about health care; treatment style – prescription drugs, alternatives, holistic; practices for preventive care; extent and approach to end-of-life care.

Planning for your visit with the doctor

As your appointment approaches, you will want to compile certain pieces of information. This saves time during your visit and it will be a more thorough list because you had time to think about it in detail. Remember, the more information, the better. This is your chance to really let the doctor understand who you are. Even if you may feel a bit reluctant to share some topics, remember that the doctor is a professional, bound by patient confidentiality rules, who wants to provide you with quality care and needs information from you to do that.

• List of symptoms – Include what the symptom feels like, when it started, what time of day it happens and for how long it lasts, anything that makes it feel worse or better, and does it stop you from doing certain activities. Include everything you are feeling, even if you think it is unrelated.
• List of your medications and any reactions you have to the medications – Include ALL medications that you take – prescription and over-the-counter; vitamins; herbal remedies or supplements; laxatives and eye drops; medicated creams and shampoos, etc. Also provide any symptoms you get from taking the medications you are taking, such as drowsiness, upset stomach, headaches, etc.
• List of a description of your lifestyle and habits – This includes any assistive devices (hearing aid, cane, walker, grab bars, etc.) you have to help you in your daily activities; where you live; how you get around; what your eating, drinking, sex, and sleep habits are; what activities you do each day and if any of these lifestyle activities are affected by your symptoms or condition.
• Compile a list of questions - Address all your concerns and get more information (sample questions below).
• List of all your doctors and contact information – The doctor can then be in communication with your other health care providers immediately if need be or to have this information for future reference.

Questions to ask

Questions are a fundamental part of solid communication with your doctor. You gain information about issues that concern you; the doctor gains understanding of what is important to you or becomes aware if he or she was unclear about something. Write down a list of questions before you have your appointment. Here are some questions to help you get started:

• What is my diagnosis?
• How is that term spelled?
• Is there a known cause for this condition?
• How would I have gotten it?
• What are the short-term and long-term effects of this condition?
• How long will it last?
• Will I need to adjust my activities, diet or other medications? If so, for how long?
• What are the side effects of the medicine you are prescribing?
• What are specific instructions for taking my medicine? Would you write them down?
• What do I do if I forget to take my medicine?
• Do I need any more tests? What kind and why?
• How do I obtain a copy of my test results when you get them?
• Are there any alternatives to surgery?
• What is the full explanation of the procedure you will do today or in the operating room?
• What are the risks?
• What is the success rate of the surgery?
• What kind of anesthesia will I have?
• Would you provide information to help me put my Advance Directives in order?
• Because of my age, am I at higher risk for certain things? If yes, what?
• Can any of those age-related conditions be prevented? If so, how?
• Are you willing to communicate with other doctors I am seeing? Would you call them or email or fax my records to them?
• If I would like a second opinion or need to see a specialist, would you recommend someone?

During your visit

As bodies age, it becomes even more important to talk comfortably with your doctor. More health issues are likely to occur, and your health directly impacts other parts of your life more profoundly. Your overall quality of life depends on your health. Some suggestions for getting the most out of your visit are:

• Share the lists of symptoms, medications, lifestyle and habits, and list of all doctors. Have the doctor make a copy of those lists to keep with your medical file. Keep one for your records and to share with every doctor, adding to it or changing it as you need to.
• Give information. Don't wait to be asked. Tell the doctor everything you think he or she needs to know to treat you completely and take care of your concerns.
• Ask questions and repeat back in your own words what you heard the doctor say to confirm your understanding. If you don't, your doctor may think you understood everything that was said.
• If at all possible, bring someone along with you to listen to information, ask questions and help remember the answers.
• For deeper understanding, ask your doctor to draw pictures.
• Take notes or ask for a copy of the doctor's notes about your visit.
  Let your doctor know if you need more time.
• If the doctor does not have time that day, perhaps you can speak to a nurse or physician assistant on staff, or ask if you can call later to speak with someone.
• Ask for written instructions, brochures or printed information about your diagnosis.

After your doctor visit

Just as important as seeing the doctor in the first place is following through on the instructions the doctor gave you. Now the effectiveness of the health care you received from the doctor is, to a large degree, in your hands. If your health condition should change for the worse or you experience changes in your lifestyle, tell your doctor immediately.

In addition:

• Closely follow the directions your doctor gave you – for medicine, limitations on activity, exercise, diet, etc.
• Call the doctor's office if your symptoms get worse, you have further questions, or you have problems with your medicine. If you had tests and do not hear from your doctor, call your doctor for the test results.
• If your doctor or doctor's office does not communicate with you in a timely fashion, that is a red flag.
• Consider if it is necessary for you to find another doctor.
• Make appointments for the follow-up treatments, tests or visits to a specialist that your doctor ordered.
• If you want to get a second opinion, call another doctor. Look at your insurance plan to determine how second opinions are covered.

Actively engaging in your own health care plan and taking the initiative toward better health is perfectly acceptable. It is your right to find a doctor who understands your desire and need to be involved in your health care. If a doctor is not willing to let you ask questions or offer information, interview more doctors to find one that suits your needs. A better health care plan is supported by doctors who want to know all about you and will work as a team with other health care providers and you in an effort to discover and support your best interest and health.

Good luck and good health!