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Medical column: Getting the most out of your doctor’s appointment

Many years ago, my 82-year-old mother made an appointment with her doctor to discuss recent complaints of wheezing and hip pain. Following her appointment I asked, “How did it go, Mom?”  She replied, “Great!” “What did he say about your wheezing and the pain in your hip?” I asked. “Oh, I forgot to mention that,” she said.

Believe it or not, this is an all-too-common scenario.

Every day in my office I see patients who don’t know or recall why their doctor referred them to me. Or they don’t know which medicines they’re taking.

Or they don’t recall details of their past medical history.

Or they forget to tell me about bothersome symptoms or past adverse medication reactions.

And following their office visits, patients may have forgotten my explanations or suggestions. I often get phone calls from their children or other relatives asking about details of the visit.

Very often, these problems arise from patients’ misconception about how doctors do their job. They may assume that I’ve spoken to their primary doctors who have given me a detailed report on their symptoms, abnormal test results and past histories.

Or that all of that information will be available in their electronic medical record.

Or that I will somehow be able to figure things out just by talking to and examining them.

In the case of elderly patients, memory or other cognitive difficulties may interfere with taking an adequate medical history, understanding my explanations or following through with my recommendations.

Some patients are hesitant to disclose new symptoms because they fear they represent a serious illness or may lead to further testing.

Years ago, in the Marcus Welby days, primary care doctors knew everything about their patients. They usually spoke with consulting specialists before and after consultations. Patients’ medical histories were less complex and their medication lists were brief. Office visits were less rushed.

Treatment options in those days were also usually quite limited. Patients were given a pill to take or a chest X-Ray was ordered or surgery was recomended to remove their gallbladder at their local community hospital.

These days, patients commonly have seen multiple primary care providers and specialists and have been hospitalized at many different hospitals that span different health networks that may not share their health records. They are often on long lists of medications, some of which may be unfamiliar to me.

In order for your doctor (or other healthcare providers) to make an accurate health assessment and provide appropriate recommendations, you will need to provide them with as much information about your medical history and symptoms as possible.

And let’s face it, many of today’s doctors lack Dr. Welby’s empathy, patience and communication skills. They often rush each patient encounter to get through their long, busy days.

They also often rely excessively on tests rather than face-to face time to guide their diagnoses and treatment plans. The fragmentation of modern medical care through involvement of multiple sub-specialists and hospitals has exacerbated these problems.

For all of these reasons, doctors may do an inadequate medical assessment and patients may be left with unaddressed concerns and vague impressions about their health problems and treatment plans.

So, to get the most out of your next doctor (or other healthcare provider) visit, I recommend the following:

• Before seeing a doctor for the first time, gather as much information as possible regarding your past medical history, including prior tests, hospitalizations and prior physician assessments.

• Bring an updated list of your medications and dosages as well as prior medications that were either ineffective or caused side-effects.

• Have a clear understanding of the reason for your visit Is it a routine follow-up for chronic issues like high blood pressure or diabetes? Do you have new symptoms or questions that need to be addressed? Did your primary care doctor refer you to this consultant for a specific problem?

• If you were referred to a consultant to address an abnormal blood test, X-Ray or EKG, bring those results with you.

• Make a list of all of your new symptoms or questions.

• If you have difficulties related to cognitive or educational issues, language barriers, or if you are simply not a detail-oriented person, try to have an attentive close relative or friend accompany you to your visit. If your relative cannot accompany you, have them available for a phone call during your visit.

If a new medication is prescribed, ask about its benefits, potential side effects and costs.

• If a new test is ordered, ask how the results will impact your care (Is it really necessary?).

• If a surgical or other procedure is recommended, ask for a clear explanation of its potential benefits and risks and if there are less invasive alternatives.

• During your visit, make sure you receive a clear explanation of your condition and that all of your questions are addressed.

• Write down important doctor’s comments and recommendations. If you don’t understand something, ask your doctor to repeat or clarify it.

• Upon leaving the doctor’s office, make sure you know if and when a follow-up appointment is needed.

Finally, make sure your doctor forwards copies of his office notes, test results and recommendations to your primary provider and other relevant consultants. Please encourage your doctor to confer with any of your other doctors if necessary and to reply to calls from family members who may have further questions.

If you follow these suggestions, your next doctor visit should be both informative and productive. If not, ask for your money back (just kidding).

Have questions for Dr. Zisfein? Email them to [email protected].

Dr. Jerome Zisfein is a practicing cardiologist with a special interest in education of medical trainees as well as providing information to patients and the public.