An all too common occurence in the doctor’s office… #hcr #hcsm #pm #In


Graphic from thisisindexed.com…

A few months ago I had a blog post that dealt with the issue this graphic brings to light. Until health care reform enables more physicians to spend more time with their patients— or until Hello Health takes over health care … the following post should prove quite useful.

For those interested in my previous post on this topic, please refer to: http://hjluks.posterous.com/new-patients-are-you-prepared-for-your-visit

The unfortunate reality today is that most physicians; primary care and *specialists* alike are pressed for time. Many feel the need to put many (perhaps too many) patients on their schedule and few physicians are sympathetic to the plight of the patients in the waiting room.

Physicians were taught how to interview their patients… but somebody forgot to teach the patient how to communicate with their physician!!!

Because of these issues, it is critical that you are organized and ready for your visit. Not only do you need to dress appropriately, but you should have a few accouterments with you and your thoughts should be organized and well rehearsed. If you are organized you will not be as nervous and you will be able to properly discuss the pertinent issues with the physician—thus enabling the physician to help you.

As mentioned in my previous post, a pen and paper are a must. A smart phone with Evernote would be useful to snap pictures of the algorithms or diagrams the doc might draw for you on the chart or a whiteboard.

Physicians are taught to organize their thoughts in a certain manner. You should spend a few hours getting your thoughts together… do not wait until the morning of the visityou WILL forget something important. Issues for you to consider:

  • What are your symptoms?
  • When did your symptoms begin?
  • What were you doing when they began?
  • When your symptoms began, had you recently changed medicines, shoe-wear, exercise regimen, started taking herbs/supplements, etc, etc, etc ?
  • What precipitates your symptoms?
  • When are your symptoms worse? (Morning, evening, coughing, sitting, supine, prone, after eating, etc, etc,)
  • What relieves your symptoms?
  • Anyone in your family have similar medical problems?
  • Who have you seen for this problem?
  • What tests did they perform? (BRING COPIES WITH YOU)
  • What medications are you on? (BRING A LIST)
  • What other medical problems do you have?
  • What allergies do you have?
  • Have you had surgery previously?
  • Where, when, why?

For the exam, dress appropriately so the area that needs to be examined is accessible.

After the exam, your physician will review the pertinent studies which have been performed…. X-ray, blood tests, MRI, etc. Take notes!!!

After the physician has completed your history, physical exam and review of your studies they will likely arrive at a diagnosis, or a list of potential diagnoses. Take notes!!!

After the physician has discussed the diagnosis(es) with you, you will have the chance the ask questions… this is where most patients are too nervous to think quickly or clearly… and this is where it matters the most. If you have previously written down your questions, you will feel more confident and your thoughts will be more organized—thus allowing you to get the most out of your visit.

The questions you may want to address include (but are not limited to):

  • Are there other possible diagnoses?
  • Are there other experts I should consider seeing?
  • Do you feel comfortable treating patients with this?
  • Is further testing necessary (If the test will not change the plan of care, then it is possible that you do not require further tests)?
  • What are the non-surgical and surgical alternatives available to treat my condition?
  • What are the possible risks, side effects of the treatment?
  • What will happen if I choose not to have surgery?
  • What does the scientific literature or research recommend (many physicians still practice based on anecdotal experience [which might be appropriate, depending on the situation])
  • Ask for online content references. 

Hopefully this helps … as usual… Do not consider this medical advice.  

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About hjluks

A busy Academic Orthopedic Surgeon, Digital Strategist, Chief Medical Officer and father... intently and efficiently navigating the intersection of Social Media and Health Care.
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8 Responses to An all too common occurence in the doctor’s office… #hcr #hcsm #pm #In

  1. Blaine Warkentine MD says:

    think if all of this was on your website and was encouraged by your patients to read and fill out forms online before seeing you?

  2. Howard Luks says:

    Planning on it…. Good to hear from you Blaine!

  3. Deirdre Walsh says:

    Thank you – very, very helpful. I’ve always encouraged my friends/fam to think about how they want the doctor’s appointment to go and prepare, prepare. And to make it easy for the doctor to understand what is wrong and to fix what they can fix.

  4. sushilbansal says:

    Great idea Dr. Warkentine! Obviously the ‘online forms filling’ technology is a proven one; we just have to migrate it to the health care industry. So, let’s identify the issues and handle them one by one!Actually, I will like to see that patient’s demographic information and related medically history is even shared online amongst the Primary Care Physician and the Specialists and Labs…. the results, post-op care instructions and follow-ups perhaps conducted via e-mails and one-on-one secured video-chat. Once again, the technology exists, we just need medical pioneers… Calling Dr. Luks …

  5. TrishaTorrey says:

    Doctors and medical profs are educated and experienced – but no one ever teaches a patient to be a patient. I try! http://bit.ly/3x74fp

  6. Howard Luks says:

    Sushil… I have actually begun to work with a software outfit in Atlanta to help move this into the mainstream… if one exists 🙂 I would enjoy talking to you about this as well. The uses are in health care are nearly infinite.

  7. Amy Garrigues says:

    Dr. Luks–I am a physical therapist who spends a great deal of time educating patient’s regarding discussions with their physicians. My patient’s greatest complaint is that they’re never left any time to ask questions. I agree that after an oral history, physical exam, and discussion of diagnostic tests, the patient’s head is swimming. They’re asked if they have questions, but they’re unable to formulate them immediately. It’s hours later that they come up with a few that are quite important to them and then get angry that there was no time to ask these questions. I know, because often times this anger and frustration is directed at me — at least in the short term.You came up with a great list of questions — many of which I advise patient’s to ask at their follow-up appointments. My question is, if you know these are great questions that many patients want the answer to, why do you wait for them to ask? Why not just go through those questions with the patient? (and yes I have read the information vs confusion post, believe me, I know there is a balance.)I also agree with Dr. Warkentine and Sushil . . . wouldn’t it be great if many of these questions could be answered online. In my experience as a physical therapist treating patients along the spectrum of acute to chronic musculoskeletal pain, it seems many chronic conditions, fear avoidance behaviors, and general frustration and anger at the “system” could be assuaged with a quick email or conversation. Hello Health has an interesting thing going . . . however; my primary concern with online advice is what if I don’t know the whole story? Interested to hear more about your current venture–Amyhttp://amygarrigues.posterous.com/

  8. sushilbansal says:

    Amy,In the triangular engagement of patient, physician and physical therapist, you have pointed out three areas where I see potential of immediate relief:a. The ‘patient anger’, a feeling of despair, not enough time to ask questions.> Online discussion forum, emails will create an ‘engaged patient’ who will then have more time with the care providers. This should eliminate or at least minimize ‘anger’.b. PT is spending great deal of time with the patient. > Online tools will leave more time for the PT to treat the patient, provide comfort and answer new questions.c. PT and physicians are concerned about not knowing ‘the whole story’. > The current structure is also not the ‘whole story’ telling environment because unprepared patients are seen by doctors who are under pressure to see more patients. But, we can certainly improve the process with new tools and who knows one day we may approach 100% ideal world!My thinking is that keeping ‘patient’ in the center, three of us, the physician, physical therapist and technologist should create a framework which will partly address some of concerns you have raised. This will be the first step and after that, there’s always room for improvement.Sushil

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