Patient practice

Guide helps optimize encounters with medical professionals
By Richard A. Marini
April 19, 2005

Given the go-go pace most doctors must keep to meet the
demands of modern health care and/or the managed-care
bureaucracy, it's little wonder that many of us go blank
when we finally do come face-to-face with our physician.

Often enough, we forget some of what it is we wanted to
talk to the doctor about until we're driving home.

"These days, most doctors don't have the time to spend an
hour with each patient," explains Dr. Patricia Gallin, a
New York physician and author of "How to Survive Your
Doctor's Care" (Lifeline Press, $24.95).

"So you've got to go in prepared to capitalize on the time
you do have with him."

Here's a how-to guide to making the most of your time with
medical-care professionals, whether it's at the doctor's
office, with a specialist or in the hospital:

CHOOSE THE RIGHT DOCTOR. In addition to asking friends and
family for referrals, use the AMA's "Doctor Finder" service
available at www. ama-assn.org/go/doctorfinder. The site
includes basic professional information on more than
690,000 licensed physicians in the United States. And find
out if the physician is certified by contacting the
American Board of Medical Specialties at (866) 275-2267 or
www.abms.org.

To find out if you and the doctor "click," make an
appointment to meet her before you're feeling sick.

ORGANIZE YOUR THOUGHTS BEFOREHAND. Write down any medical
complaints you have, questions you want answered and
concerns you want to discuss. Tell your doctor everything.
Even the smallest complaint can help reveal patterns that
may not be obvious to you. Vague abdominal pain, irregular
spotting and unexplained fatigue, for example, could
indicate ovarian cancer.

MAKE A LIST OF YOUR MEDICATIONS. Write down everything -
prescription and over-the-counter alike – that you take
regularly, including why you take them. Or put it all in a
paper bag and bring it with you to the appointment. This
can help the doctor avoid potentially dangerous drug
interactions.

KNOW YOUR FAMILY HISTORY. Tell your doctor if your parents
or siblings have diabetes or high blood pressure, for
example, so she can take that knowledge into account when
treating you. "This will become even more important in the
coming years as new medications are prescribed based on a
person's genetic makeup," says Dr. Edward Hill, president-
elect of the American Medical Association.

BRING A FRIEND ALONG. Having someone with you can ensure
that nothing gets lost in the translation from the doctor's
medical-ese to plain English. The person can also serve as
an advocate if you're uncomfortable asking questions or
challenging the doctor's pronouncements.

QUESTION ALL PRESCRIPTIONS. Ninety percent of all office
visits end with the doctor writing a prescription. Ask why
you need the drug and what to expect in terms of benefits
and side effects. Also, ask if there's a generic version of
the drug available, or an older drug that will do the same
thing. Both are likely to be less expensive.

WHEN YOU SEE A SPECIALIST, DO YOUR OWN RESEARCH. The more
you know, the better you can protect yourself. For example,
studies show that most men over 70 should not immediately
have surgery for prostate cancer. At this age, tumors
usually grow very slowly, so risks of surgery are greater
than simply watching the cancer carefully. Yet each year,
half of all prostate cancer surgeries are done on men over
70. Your doctor should have helpful educational materials,
and the Internet can be very useful - if you're careful.

The Harvard Health Letter recommends www.intelihealth.com
the National Institutes of Health's www.nih.gov reputable
resources.

GET A SECOND OPINION. Studies show 10 percent of all first
opinions are overturned by a second one. And the treatment
options recommended by the remaining 90 percent are
overturned 20 percent of the time. And the good news is,
medical insurance will often pay for it. Be sure to bring
copies of whatever test results (X-rays, MRIs, etc.) you've
had done so the second specialist can be completely
informed about your condition.

FIND THE RIGHT SPECIALIST. When going for a second
opinion, choose a physician with a slightly different
specialty than the first. For example, a cardiac surgeon is
likely to recommend surgery to treat many heart ailments.
Get a second opinion from a cardiologist with a more varied
experience in treating heart problems.

ASK, "WHY THIS HOSPITAL?" If a specialist says you'll need
to be treated in a specific hospital, ask why. Is it
because it's the best place to have the treatment he's
suggesting, or simply because it's where he prefers to
practice? Most doctors have privileges at more than one
hospital, so make sure you're being treated at the best. To
do so, check the Web site of the Joint Commission on
Accreditation of Healthcare Organizations (www.jcaho.org),
which lists quality indicators for most U.S. hospitals.
These include everything from how well patients with heart
attacks are treated to how often surgical patients develop
infections.

ASK HOW MANY TIMES THE SPECIALIST HAS DONE A PROCEDURE.
The more, the better, although "enough" depends on how
commonplace the procedure. "If it's surgery for colon
cancer, I want someone who has done 100 or 200 procedures,"
says Michelle Ingram, a registered nurse and the quality
director for the University Health System in San Antonio,
Texas. "If it's Lasik surgery, I want a couple of
thousand." The physician should be willing to give you the
answer.

If not, contact the hospital's Medical Staff Department
(sometimes called Professional Staff Services). They're
required to keep such statistics and should provide you
with the information you need.

ENLIST AN ADVOCATE. Even more so than in the doctor's
office, at the hospital you'll need someone - a trusted
friend or family member - to act on your behalf with
doctors, nurses, even other family members. If necessary,
this person may be able to help facilitate your care -
helping you to the bathroom, for example, if the nursing
staff is busy and can't get to you quickly enough. Although
most hospitals post visiting hours, they cannot bar someone
from being with you in your room, as long as that person
doesn't impede the staff's activities.

PAY ATTENTION. In a typical 400-bed hospital, 60 errors
are made each hour, according to Charles Inlander,
president of the People's Medical Society, a nonprofit
patients' rights advocacy organization.  "So if you've been
given one green pill a day and suddenly the nurse hands you
a yellow one, ask why," he says. "Maybe your doctor changed
your medication orders, or maybe the nurse grabbed the
wrong pill." Also, make sure someone explains every
procedure or treatment you're getting in advance, and don't
let anyone do anything to you until you fully understand
the reasons.

 Patients who miss appointments have variety of reasons
 It's the flip side of not having enough time with the
 doctor: Patients who don't show up for their scheduled
 visits.

 Some hate the long wait. Others can't find a ride. But
 more than a few patients, it seems, skip doctors'
 appointments for deeper emotional reasons such as
 anxiety, anger or outright fear.

 "Come in with a headache, and they say you've got a big
 brain tumor up there," one patient recently told
 researchers.

 A recent study conducted at a community clinic in Omaha,
 Neb., and published in the Annals of Family Medicine
 concludes that patients often miss appointments because
 they dread exam procedures or bad news. Some do not show
 because they had felt "disrespected" in earlier dealings
 with a doctor's staff.

 "They may feel no reason to respect the system in
 return," said researcher Naomi Lacy, an assistant
 professor of family medicine at the University of
 Nebraska.

 Physicians and their staffs have long grumbled about
 patient no-shows. Missed appointments cause confusion
 and must be rescheduled. Doctors lose fees. Most
 important, a patient who skips a visit may risk
 aggravating a serious medical condition.

 No-show rates of 15 percent to 30 percent in general
 medicine and city health centers are not uncommon,
 according to published research. Rates of 50 percent
 have been recorded at some primary care clinics.
 Postcards or phone reminders are deemed somewhat
 effective in addressing the problem, but their
 one-size-fits-all approach doesn't address the wide
 range of patient circumstances, experts say.

 Dr. Allen Hixon, an assistant professor of family
 medicine at the University of Connecticut, said
 reminders are less needed for reliable patients in some
 categories - those who are older, suffer from chronic
 conditions or have pressing medical needs.
 It is other categories of patients - young adults, those
 coming for a "well visit," or first-time appointments -
 who are more likely to miss, Hixon said.
 The equation gets more complex with poverty. The poor
 often face problems with transportation, child care and
 other issues, research has found.