Several readers have suggested that I devote a column to this topic, so here it is.
The fact that I have been asked to write about this issue suggests that at least some of the time interactions with the health care system leave something to be desired.
In fact, multiple studies in multiple health care settings suggest that information flow between the provider (doctor, nurse practitioner, physician’s assistant, etc.) and the patient is frequently limited and ineffective.
Research also suggests that we aging amateurs often fail to even get our major concerns on the table. In adult primary care (family and internal medicine, and geriatrics, too), about half the time the caregiver and patient do not agree about what the main complaint or concern is for the visit.
You have probably seen the statistic that doctors interrupt the patient’s attempt to describe the problem after 18 seconds. Most doctors (65 percent in one study) underestimate how much information patients want about their problem or planned treatment.
How can you help yourself to get more benefit from your interactions with your caregiver?
First, have a plan and write down what your concerns are before your visit. Writing things down helps you to clarify what you are feeling, what your questions are and what you expect from the visit.
Know how much time you have. Ask the length of the appointment when you make it. If you don’t think the time offered is adequate, ask for another appointment when more time is available.
In a 15-20 minute visit, usually 1 to 3 problems can be addressed, depending on their complexity. Let your caregiver know your prioritized concerns early in the visit, even if you are interrupted after only one. Sometimes the problem you consider least important demands quicker attention than you think it does.
Bring all your medications or at least a list of them (with how much and how often you take them), including over the counter meds and supplements, especially those that have been given by another prescriber.
Don’t expect to remember everything your doctor says, especially if you are in pain, anxious or just not feeling well. Take notes on what you are told about your illness and how to take care of it, or record what is said, or have a friend or family member accompany you to take notes.
If you don’t understand what you have been told, ask questions. It often helps to tell your caregiver what you have heard him/her say regarding your diagnosis and treatment to clear up any misunderstandings.
Be sure you know how soon you can expect your symptoms to improve and what to do if things don’t get better after your visit. If your practitioner doesn’t tell you when to return, ask if you need a follow-up visit.
Take advantage of your care team. If you have been encouraged to lose weight or change your diet because of a specific illness, ask if the office has a nurse educator or dietitian to work with you. If you are concerned about being able to afford your medications, ask your nurse to help find the best price for your medication or to ask the practitioner if there is a less expensive alternative.
Now, for the most important part of the visit: follow through. Keep the list of concerns you had and the notes you took during the visit so you can refer to them later.
Whether you get a lot or just a few treatment suggestions, having a copy of the list close by can make staying on track easier. Add notes on how you feel when you follow your treatment plan and when you don’t. Use these notes on your next visit. Your caregiver needs to have feedback on what worked and what didn’t.
Expect to get quality time with your provider. If you find that most of your time in the office is spent with your caregiver’s back to you while he enters data into a computer, if your concerns are routinely left unaddressed or not even heard, then you may need to consider looking for another caregiver. This is certainly a difficult decision and one not to be taken lightly.
If you have had a long relationship with your practitioner, consider a note, call or visit to express your concerns and try to work out a solution.
But your health is what is potentially at stake. Will it be better in another office? Online ratings are often unreliable, particularly when there are few reviewers. So, friends, family or other practitioners may be your best resources.
It’s your health, take good care of it.