How to get the care you need in a fast-paced world
By Natasha Persaud
The average doctor's visit is 20 minutes or less—which means you need to come prepared to get the care you need. Here, Davis Liu, M.D., a practicing medical doctor and the author of Stay Healthy, Live Longer, Spend Wisely, shares time-saving and health-saving tips.
1. How can I get my concerns addressed thoroughly in such a short visit?
"Bring up your top concerns right at the start of the visit," says Dr. Liu. "It's easy for your doctor to get interrupted by a ringing phone or another pressing matter."
When setting your agenda, mention no more than four health issues; any more and your doctor probably won’t get to it. It is usually better to discuss a few issues in depth rather than too many items superficially.
"In addition, tell the doctor what's really on your mind: If you've been experiencing splitting headaches, and you're concerned about it, say that. We may be able to rule out certain conditions that you're worried about based on what you describe to us, the physical examination and test results.
"Finally, ask questions. Your doctor can help you understand your diagnosis and explain the treatment options."
2. What's an easy way to describe my symptoms to the doctor?
"Focus on the 4 Ws: when, what, where and why When did you first notice the problem, when does it seem to occur, when was the last time you had it, and how has it changed over time?
"For the 'what,' describe the activities or behaviors that seem to make the problem better or worse. If you're experiencing pain, describe what the pain feels like: Is it sharp, dull, burning, gnawing, pressure-like, tight, achy? On a scale of 1 to 10, how does your pain rank? Is your pain constant or does it come and go?"
"Then, tell your doctor where on your body you're experiencing pain or symptoms. Did it start in one place, then radiate to another part of the body?"
"End with the 'why.' Are your symptoms worrying you or interfering with your lifestyle? Is your spouse concerned? Let your doctor address your real concerns."
"What you tell us is often far more useful than test results," summarizes Dr. Liu. "One detail from you can send us in a different direction for making a diagnosis. For example, when one of my patients was experiencing chest pain, it sounded at first blush like heart disease. But then he mentioned that he had developed a rash on the skin above his heart. That led me to believe that the real cause was shingles. Tests later confirmed the diagnosis."
3. What is a medical history, and why is it valuable?
"A medical history includes surgeries you've had during your lifetime, health conditions, current medications and allergies. Your medical history is unique to you as an individual and it helps your doctor treat you more effectively."
Tip: Download a medical résumé form that you can fill out and take to your doctors.
4. What information do patients sometimes fail to mention that could be vital to their care?
"Patients often neglect to write down their childhood illnesses and surgeries on their medical histories, but the information could be important. For example, if a patient were experiencing pain in the abdomen, but her appendix was removed at the age of ten, a doctor would rule out appendicitis as a possible cause and not order certain tests."
"Patients also neglect to detail their family medical histories, which can tell a doctor the conditions and diseases they’re at risk for. When I asked one of my patients what chronic conditions ran in his family, he told me 'Nothing too serious, doc. Just the usual stuff: heart trouble and high blood sugar.' Those are major risk factors for disease!"
Tip: If you haven’t compiled your family health history, get started with My Health Portrait, a tool from the surgeon general's office.
"In terms of medications, patients often forget to note over-the-counter medications and supplements they are taking. It's important to know about all of these substances to avoid potential interactions and side effects. Since supplements don't share the same stringent oversight and approval as drugs do, it’s important to check these substances with your doctor. Supplements include a wide range of substances, including vitamins, minerals, herbals, botanicals, amino acids and enzymes. Supplements with the same name may also vary in ingredients and potency."
Tip: For helpful information on supplements and prescription drugs, try www.nlm.nih.gov/medlineplus/druginformation.html, a service of the U.S. National Library of Medicine, or www.crbestbuydrugs.org, a Consumer Reports site.
"Chat with your doctor about your lifestyle, too, including what you do at work and during your leisure time, because it could be important to your health. Even if you don't smoke, for example, your doctor needs to know that your spouse does. If your work requires a lot of typing, your doctor might consider carpal tunnel syndrome as the source of your wrist pain."
5. You mentioned that an annual physical isn't necessarily a good investment of time because it rarely prevents disease. What kind of preventive care is more worthwhile?
"There is no evidence that having an annual physical is necessary for individuals who are healthy and don't take medications regularly for conditions like diabetes, high blood pressure, or high cholesterol. However, it doesn't mean that if you feel well that you should skip necessary preventive tests and screenings."
"I urge patients to see an internist or family doctor for regular preventive care, which includes important basics, such as checking for high blood pressure; health screenings, such as mammograms, Pap smears and tests for early detection of cancer; and immunizations (yes, adults still need them)."
"Your doctor may recommend additional or more frequent screenings than the general schedule if you have increased risks or certain medical conditions. People who take medication regularly should see their doctors at least once a year for a checkup."
"How do you remember to get the tests done? Every year when you have a birthday, ask yourself if you are doing everything you can to be healthy for the next year and if there are tests now due because of your age."
Tip: Print these schedules from the CDC of general screenings and immunizations that adults need.
6. After the appointment, what's an easy way to remember what the doctor told me?
"Remember to leave with the D-A-T-E: diagnosis, additional tests, treatment plan and examinations and evaluations. Research shows that patients only remember half of what doctors tell them, so write it down."
"It’s vital to get your diagnosis in actual medical terms. When my brother was evaluated for a lump on his shoulder, he was told that the lump needed to be removed, but not why. I asked him to get the specific medical diagnosis, and we discovered that his lump was in fact a rare muscle cancer with a high rate of recurrence. That diagnosis prompted us to seek a specialist to perform the surgery. The surgery was successful, and his cancer hasn't returned. If we didn’t know the exact medical diagnosis, we may not have sought that level of care."
"If your doctor orders additional testing, x-rays or procedures, record the names of the tests and why you need each one. After you have the test, make sure the results are communicated to you. Remember, no news is no news; if you don't receive the results, call your doctor's office."
"For your treatment plan, know the medications you need to take and your next steps: Are you changing medications or dosages? Does your knee pain require a visit with a physical therapist? Find out."
"Finally, write down when you need to return for a follow-up examination. Find out who makes the appointment, and ask what symptoms you should watch for that would indicate that you need to be seen sooner."
7. Technology is making it easier for patients to communicate with their doctors. When is it useful—and when is it not useful—to email the doctor?
If you would normally call a doctor about a matter, then it's appropriate to email; for example, you might ask for a prescription refill or inquire about test results. Because of the convenience, more and more doctors are offering email as a way to communicate with their patients.
"To protect your privacy, make sure your doctor uses a secure email channel with a log in and an encoded password. That way, your personal medical information can’t be viewed by others."
8. I’m switching to a new doctor. What's an efficient way to bring the new doctor up to date on my health?
"When meeting a new doctor, the most important visit is the establish visit, your first appointment with the doctor to introduce yourself and communicate your medical historyeven before you have a problem. It's particularly helpful for patients with chronic medical problems or multiple prescription medications.
"Before you make the appointment, request your medical records from your previous doctor. In some cases, there is a charge, but it's worth it. That way, your new doctor doesn’t have to repeat expensive tests or procedures that were already performed."