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Monday, September 14, 2009

Visiting the doctor for a new, undiagnosed medical problem can be daunting. Patients often struggle to try to get their symptoms across to the doctor in an effective manner, and the physician needs to gather the information they need from a patient without overlooking anything important. All this must be done during a medical interview which, on average, will be shorter than 10 minutes. Here's how you can maximize the appointment by giving the doctor the information they are looking for in the same format they learned in medical school.

Bring an up-to-date cumulative patient profile with you to the interview. You can create one by summarizing your medical history on a page. Include dates of, and reasons for hospitalizations and surgery. You may not end up needing to refer to it, but if questions about your medical history come up, having one will maximize the time you can spend discussing your current medical issue(s). Bring your current medication bottles, which list the name & dose information, including herbal supplements if applicable.Describe your basic reasons for the visit in one or two sentences. Most doctors will start with the interview with something like, "What brings you here today?". Preparing an answer to this question in advance will facilitate the visit. Some common symptoms include:Pain, weakness, Nausea, vomiting, diarrhea, constipation, fever, confusion, breathing problems, or headache. Recall the onset and timing of your symptoms. Include starts, stops and frequency. ("I get bad pain right in between my menstrual periods that lasts about three days.") Be prepared with dates and times, if possible. ("The first time I remember feeling this way was on the 15th. It tends to get worse in the late evenings, but occasionally I feel it in the early mornings, too.") Explain what makes the pain better or worse. Make note of any movement that sharpens the pain ("My finger feels fine unless I bend it towards my palm, and then I feel a sharp pain.") or lessens it ("It seems to go away when I lie down on my side."). If any foods, drinks, positions, activities, or medications worsen or alleviate the symptoms, make it clear. ("The fever got better with Tylenol but then came back in two hours.")

Use adjectives to describe your symptoms more fully. Not all pain is the same. It can be sharp, dull, right on the surface of the body, deep inside, etc. Example: "When I get dizzy, it isn't just that I feel like I'm going to faint; it feels more like the world is constantly spinning to the left!". Without getting overly poetic, try to point out what makes this sensation different than other types of pain you have felt before. Point to the location of your symptoms. Include details if the pain moves about. ("The pain was right around my bellybutton but now, it seems to have moved over here near my right hip.") Rate the severity of your symptoms. Use a scale of one to ten, with one being almost nothing and ten being the worst possible symptom you can imagine. Be honest, and don't minimize or exaggerate. "Ten out of ten" pain (in the eyes of medical professionals) would render a person almost incapable of speech or any other act such as eating or reading. ("I was sitting eating lunch and then I suddenly got the worst headache of my life out of nowhere. It was so bad that it nearly knocked me unconscious. Definitely a nine or ten.") Describe the setting and your condition when the symptoms occurred. Where were you? What were you doing? How different was the setting and activity than what you normally do? What had you been doing right before the symptoms arose, and earlier that day? List other things that happen at the same time as your symptoms. ("During the three weeks I've been having these fainting spells, my wife also said that I've been looking very pale and I've also had these dark colored bowel movements and I've lost ten pounds even though I'm eating exactly the same.") Expect the doctor to examine you and potentially order some tests or a trial of treatment.

Know your own health. It is very frustrating for both the patient and the doctor to meet face-to-face and then begin piecing together the story. Actively performing these steps may not be necessary if the doctor already seems to be asking questions in a logical flow, and is hitting all the points. A well trained professional should actually be able to get all the points without even thinking through the steps. Bring written notes about what you want to ask. Many people when faced with a doctor go blank! A pen to write down what the doctor says is handy, too. Many patients often remember things they want to ask the physician after the visit has concluded and are then embarrassed to call back about it. Consider bringing a friend or family member for the visit if you are not sure how to explain your physical problem correctly, if you are forgetful or fluster easily.

Look the part. If you are complaining of the worst pain of your life, don't be drinking coffee, reading a magazine and answering your cell phone. If you are complaining of a sore toe, don't have the doctor enter the room to find you laying on the exam table in a medical gown. Honesty is key. Physicians are bound by a duty of confidentiality. If your continued health is at stake, you may as well tell them every detail. Make a list of questions you have for your doctor. Most of the time, due to time constrains, You will forget what you were supposed to ask! Think about the symptoms and their nature before you get to the doctor to save both your and the doctors time as well as making it diagnostically clearer to the doctor. Do not wait till the end of the meeting to say "...and, by the way, I have this other pain". This is terribly inconvenient to doctors since something that you think is minor might change their whole treatment plan. Tell them all of your symptoms up front before they start working on a diagnosis.

Start talking to the doctor about your symptoms, not what you think your diagnosis is (unless you are absolutely sure). Responding with something like, "I think I have multiple sclerosis" may seem like a big time-saver for you but in practice, will tend to set most doctors on edge and derail the interview. Instead, open the discussion with something like, "My arms and legs are getting really weak lately and now I can barely walk."This framework is most helpful when dealing with someone who has never met you before, and in particular when the medical problem is new. It doesn't add much if you are reviewing a chronic problem with your own family doctor. If a medical interview doesn't seem to be getting you satisfactory answers, it is more effective to continue to express concern and worry and much less useful to become upset or angry. You do not want to be labeled as a "Problem Patient" or a potential lawsuit-in-waiting (something that may carry over to future appointments or even be leaked to the doctor's colleagues). In these cases, it may be easier to try again at a different time, or seek a second opinion.


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