Wednesday, June 22, 2011

Yes! Take notes at the doctor's office.

As a recently minted physician, I am often on the receiving end of the gripes and grouses about the medical profession. Often I get complaints of office visits that are too short, doctors who seem too preoccupied to hear their patients' complaints, medical bills that are too high and medications that do nothing but cause adverse effects. On the other hand, I can't count the number of times I have left the exam room, convinced I have gotten the most complete and accurate information from the patient only to be confronted by the attending on something I had 'missed'. Really?!?!? I just asked her that and she denied having chest pain one week ago! The truth is, patients are often intimidated and confused by the whole medical experience and in this state are even more likely to forget the details of their medical history, thus creating a less than ideal environment for optimizing health.  Something needs to be done to improve the doctor's visit, both for patients and for physicians.

Posts from by the Gold Foundation and  by Dr. Melanie Lane on KevinMD today reminded me that this is a topic I've wanted to write about for some time. These articles provide solid advice for having a successful visit. I'll add my $0.02 and say that one easy solution to many misunderstandings and misinterpretations at a doctor's visit is to have a Little Black Book of Health. In these times it seems so natural to document our every thought and action why not do the same for our health?

Your LBBH can be either a written or digital record of your health journey and is especially handy for those with multiple illnesses. Just as making notes during lecture solidifies learning, so too can this habit of taking notes facilitate understanding your goals of care and provide a timeline of your health progression. Here's how to use your LBBH:
  1. Document your symptoms - What are the symptoms? When did they begin? What were you doing when these symptoms began? Have the symptoms improved or worsened since the beginning? What medications have you taken to relieve the symptoms? Have you used any alternative therapies also? These are questions your doctor will ask you so you might as well be thinking about them before you arrive , writing them down will save you from forgetting important details.
  2. Document your doctor's name and specialty - This is especially true if you have multiple doctors. Most patients know their PCP but often times when I ask about the specialist s/he went to see the patient either does not know what that specialty is or s/he does not remember the name of the doctor. Knowing these details saves some time sleuthing around on Google trying to match names of doctors phonetically. It also makes for easy communication with that specialist if need be. 
  3. Take notes at your visit - If you don't understand something, ask your doctor to repeat it to you. Know the name of your condition, know what the doctor recommends that you do. Ask her to spell the names of medications she is prescribing. Take note of each medication prescribed, the dosage and at what time of day it should be taken, with meals or without. I can't tell of the number of times patients mix-up medications and dosages just because they didn't fully understand what their physician directed them to do at the last visit.
  4. Keep a medication list - As mentioned before, you want to record the names and dosages of your medications. Equally important is recording when you began taking a particular medication, when your doctor discontinued the medication or changed the dosage or the drug altogether. Note side-effects also.This can help both you and your doctor by reducing polypharmacy and medication list comes in handy if you ever, God forbid, end up in an emergency room. 
  5. Keep your LBBH with you! - In your pocket, your handbag, and take it on every doctor's visit/hospital stay it will make your (medical) life so much easier!
The idea of the LBBH is not unique, think to pediatrics. Parents know to walk with the little yellow card that documents the timeline of a child's immunizations. The LBBH can do the same for adults with more complex comorbidities.

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