Maximizing Your Visit with the Doctor

Staying Healthy Should Not Be This Hard… Source: Gary Larson, The Far Side

Why Do We Go to the Doctor? An acute complaint -- sore throat, knee pain, headache, etc. A chronic condition -- management of diabetes, hypertension, osteoporosis, etc. Preventative care -- cancer screening tests, vaccinations, advice on lifestyle changes, etc. All of the above Or, my personal favorite……

Why Do We Go to the Doctor? BECAUSE SOMEONE MADE ME COME TO THE DOCTOR! Maybe your physician called and said you were overdue for a visit, or your daughter said you should get that cough checked out, or your spouse said that if you did not get that snoring evaluated you would be sleeping on the couch We, as physicians, don’t mind how or why you came in. But we do want to make sure that the visit is a good experience for everyone.

The Power of Primary Care: A Physician In Your Corner Someone who knows you Someone who can help to coordinate your diagnoses, prescriptions and specialists Someone with whom you can discuss sometimes difficult topics, including age- appropriate screening tests, life stressors, and end of life decision making Someone who can be a resource for questions you might have about your general health

So, You’ve Made It to the Doctor’s Office…. Arrive early for your appointment Please be patient if the provider is running late -- We often are tending to someone who is in need of our attention, and would afford you the same additional time when necessary Bring a second set of ears, especially when discussing a new diagnosis Bring a copy of your insurance information, your most current list of medications (or the medicines themselves), and a written list of questions you might have

So, You’ve Made It to the Doctor’s Office…. Keeping a notebook or a pad with questions and responses is a great organizational tool, especially if you are seeing multiple physicians and/or have multiple medical issues – It provides a means for the patient to write down questions when they think of them, and not be frustrated that they can not do so on the spot in the physician office – It also is a means of recording the results of the visit for review later alone and/or with family/friends -- it helps to remember who said what and when

Understanding Your Visit: Different Perspectives The physician likely has several objectives he/she wants to accomplish – How is the patient feeling? – Are they compliant in taking their medications as prescribed? – Is the patient experiencing any side effects? – What are the next steps? The patient wants remedy for what ails them, and answers to questions they may have The perfect visit is when all this can be accomplished in an efficient manner

During the Visit: What to Expect For a focused problem -- brief history, exam and plan For a chronic problem -- history/exam, discussion and plan For a preventative visit -- expect a to-do list of tests/referrals and lifestyle changes that will be recommended based on the patient’s personal history, individual wishes, age and medical evidence

Types of Prevention Primary prevention aims to avert the development of disease – Immunizations, life style modifications (smoking cessation, promoting physical activity), and chemoprophylaxis (aspirin for primary prevention of heart disease) Secondary prevention focuses on early detection and treatment of asymptomatic disease – Screening for cancer, hearing or vision impairment, osteoporosis, hypertension, and abdominal aortic aneurysm (AAA)

So, Speaking of Age….. The profile of aging in the United States has changed dramatically over the last century – Average life expectancy at birth has increased from 47 years in 1900 to over 78 years in 2008 – By 2030, the percentage of the population over 65 years of age will exceed 20 percent, or over 70 million people 1 Decline in function and loss of independence are NOT an inevitable consequence of aging Given the high prevalence and impact of chronic health problems among older adults, evidence-based interventions to address these problems become increasingly important to maximize both the quantity and quality of life for the elderly

So, Speaking of Age….. Tell your clinician about all those things that might normally be a source of embarrassment in common conversation – Have you fallen recently? – Forgotten where you left your keys? – Had incontinence that has limited your social interactions? – Felt depressed or anxious due to the loss of a spouse? – No longer read because your vision is poor, but don’t tell anyone because you do not want to lose your independence?

So, Speaking of Age….. The relationship between doctor and patient should be comfortable enough to talk about all the above and much, much more It takes a provider who thinks to ask these questions, and is willing to listen -- Not everything has a quick fix, but identifying the problem is the first step It also takes a patient willing to discuss issues that are of particular concern without fear of embarrassment, and with understanding that the answers may not be simple

A Special Note on Medications Problems related to medication use are common in older adults. Adults over age 65 in the United States take an average of three to five medications 2 Notify your provider of all over-the-counter medications, prescription medications and herbal supplements you are taking It is especially important to review medications following hospitalizations or stays in rehabilitation facilities Drug interactions can be more frequent with increasing numbers of medications Side effects are more likely to occur at onset of medication use or during dosage changes, although with certain medication side effects can occur at any time

A Special Note on Medications The black box and web searches -- A word of warning

At the End of Your Visit… Feel empowered to ask questions If your provider has a electronic medical record, request a print out of your medication list, especially if changes have been made Understand what is being asked of you Know when and how you are to follow up with your provider (follow up appointment, phone call, , etc. ) Know the warning signs that warrant immediate attention

Questions

References 1 Centers for Disease Control and Prevention and The Merck Company Foundation. The State of Aging and Health in America The Merck Company Foundation, Whitehouse Station, NJ Using medications appropriately in older adults. Williams CM. Am Fam Physician. 2002;66(10):1917.