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MAKING THE HEALTH CARE SYSTEM WORK FOR YOU

Getting The Most From Your visits to your Doctor

It was my first baby. It was excited and scared. I had so many questions to ask my doctor. It was my first appointment. My doctor was my husband's uncle so I expected him to share my excitement, calm my fears and answer all my questions. The nurse took my blood pressure, then gave me a paper gown. I looked around the room with instruments and rubber gloves. I felt the last vestiges of my personal power dissipate as I removed my clothing and covered my bare essentials with the skimpy crumply paper gown. I tied the plastic belt around the waste and attempted to pull the two sides together at the back.

Dr. Earn was a gray haired heavy set man who seldom smiled. He hardly ever spoke at family get togethers. He would be there but quietly. The family idolized him. All his brothers and sisters had contributed so that he could attend medical school. The son of immigrant parents, he was the first to graduate from college. He had graduated as a doctor with a specialty in obstetrics and gynecology. What a coup. The Earn family had a doctor. He was their "golden haired boy". He was the idol of the whole family. I was willing and prepared to join into the idolization. Of course, he was the idol so if anything went amiss, it must be my fault. He could do no wrong!
I had expected him to be friendlier in a one on one situation, than he was to me at family get togethers After all, our relationship would become intimate. He would see parts of me no one else had ever seen. He would share my secrets, my fears. He would be my teacher, my therapist, my father. All the magazines said that I should confide in my doctor. We would develop a very special relationship. Or so was my expectation.
Dr. Earn entered the room. There was a strictly business, no nonsense approach about him. "Put your feet in the stirrups and scoot down" said the no nonsense voice coming out of an expressionless face. He covered my knees with a paper drape so that I was prevented from seeing the part of my body that he was seeing. "How strange," I thought "that this is supposed to protect my modesty. From who?" "I'm the only one who can't see my private parts. He can see everything and there are only the two of us in the room. I considered this nonsense for a minute or two and decided to go along with it for now. I had many questions. I was very focused. I wasn't going to get unfocused on something that didn't seem too important. I started spouting my barrage of questions. "What can you see? What can you tell about my baby from what
you can see? Do you have a mirror so that I can see and you can explain what you are seeing to me?" " Scoot down a little more" said the not unkind but cold, no nonsense voice as he straightened the drape. The no response must mean he's concentrating. He must be going to answer my questions after the examination. No, maybe I had really turned him off with the part about the mirror. "What a stupid thing to have said" I told myself. A wave of embarrassment swept over me as I received the non verbal message that looking at your own private parts in a mirror is definitely perverted. The examination was finished. I felt like a child who's silly questions had been ignored because they were stupid. The Dr., family idol had decided that my questions were too stupid to answer. He must be right so I must be a stupid child with the curiosity of a pervert wanting to look at her private parts which were definitely the realm of only the godlike doctor. "Dr. Waters is on the phone for you, Dr." said the white capped head who had unceremoniously opened the door and peeked in." "Get dressed" said the Dr. as he left the room. I got dressed. "Here is your next appointment" said the nurse as she handed me a card and ushered me out the door of the examining room. "But my questions" I choked out, thinking, "I must have really offended him" as I flushed with embarrassment as I thought about my mirror question. "Doctor's very busy. He's with another patient. Your not his only patient you know," said the white cap. I tasted the frozen snowflakes mixed with the salt of my hot tears as headed to my car wondering in dismay what had just happened. How did I go from the feeling of excitement and elation to the feeling of being a humiliated, chastised child?

The most important thing to do in preparation for seeing your doctor is to examine your attitude and your expectations. A medical doctor has studied medicine and just medicine. S/He is a highly skilled technician. S/he is not your father or mother, not a therapist. S/he may even have poor communication skills, as did Dr. Earn. S/he may still be an excellent technician but if you don't expect more, you won't be disappointed. Your doctor is a human being, worth no more or less than you. Don't forget that 50% of all doctors graduated in the lower 50% or their class. By the same token, your doctor has no right to pass judgment on you for wanting to know all you can about your health. If you need emotional support, go to your mate, friends, family, or psychotherapist. Do not go to your Dr. for emotional support. It is unlikely that he or she has the time or the skills. The doctor does, however have the information that you want and need about your body. S/he has the responsibility to give it to you. You, as an intelligent person, must take responsibility for your own health and health care. In these days of managed care, with doctors too busy and stressed to even remember who you are, you must find a method of extracting the information you need in an efficient, organized manner. Reading this book and using the workbook will help you get the most out of the health care system.

Going to your doctor requires preparation, Just as preparing for a business meeting requires preparation. Only in this case the business meeting is about your body.
Your workbook is also a record of your health and the interventions you have tried for your symptoms so write down your blood pressure, you temperature, if it is taken, and whatever the doctor may say about you or your condition. It is often difficult to remember what has been said.

At the end of your appointment, request a copy of your chart notes, lab reports or anything else that is being kept in your file. File these in chronological order in a 3 ring binder. This is important for several reasons. If, at some time your insurance changes and you must change doctors, you will know what has been said about you by the previous doctor. Another important reason is that if you are ever in a car accident, your medical records can be subpoenaed by the opposing attorney. If there is anything you have said to your doctor "off the record" or anything you do not want brought out in a court of law and used against you, you should call your doctor and have it removed at the time. Also if there are errors in the records. I found that my insurance was raised when my doctor diagnosed my as missing my left breast. Last I looked, my left breast was there, but the doctor had dictated someone else's notes into my chart and my insurance rate was raised. If you have signs of depression, or headaches, this will go against you, if you claim headaches or whiplash in a car accident. Medical records are not private. It is your responsibility to see that they are accurate and to protect yourself in the way that they may be used. This is a hard fact to swallow. We would all like to believe that our relationship with our doctors is a supportive, private, matter, but with few exceptions, it is can become public and you doctor can do nothing to protect you. It is important that you know what is on file about you. Also, if you attempt to get your records at some later time, you may be charged for the copies. If you get them as you go, you will not generally be charged. If you are, change doctors.

Work Book

1. Name _______________________________ Date _____________
At times you may want to hand this work sheet into a
doctor or hospital so it is important to have your name on it. The date is very important. It helps you keep a record of your personal health care record.

2. Symptoms

Entering your information in the chart. Enter the symptoms in the symptom column. To the best of your recollection enter the duration of time which you have been experiencing that symptom. In the intensity column, assess the intensity of the symptom or pain on a scale from 1 being the lowest to 10 being the most severe. A #10intensity symptom would be a pain or symptom so intense or severe that it would interfere with normal functioning.

One of the important things that you will ever do before seeing your doctor is to make a list of your symptoms. If the doctor attempts to leave before you are finished, you can say, "Please help me with the rest of my list". Your doctor has to listen to people talk about their symptoms all day long. Some people whine, they just want someone to sympathize. Those people would be better seeing a psychotherapist. But the doctor often listens patiently anyway. Some people really want to get well but they don't know how to focus on the problem and really get the help they need. Can you imagine how impressed and willing to work with you, the doctor will be when he sees a well organized person
presenting their symptoms in a manner that the doctor can quickly analyze? Presumably, Your doctor is in medicine because s/he want to be successful in healing. When you can present something that can be worked with, your doctor has an incentive to help you. It is an opportunity for you to work together as a team and together be successful in finding a solution.

3. Blood Pressure ________________ Temperature ___________
Record your vital signs for your personal medical record.

4. Medications (including herbs) presently using
It is very important for the doctor to know what medications you are already using before s/he prescribes any more. This way you can be fairly certain that you do not get incompatible medications. Herbs can also be very powerful and incompatible with certain medications so it is important to mention them. When a medication is prescribed, be sure to find out what is not compatible with that medication. For example, grapefruit juice is incompatible with certain medications. If you are taking certain antibiotics, you may develop a negative reaction to the sun. Ask these questions of your doctor. Then ask the same questions again of your pharmacist If they don't agree, then someone doesn't know what they are talking about, and you need to do further research and possibly fire somebody from your health care team.

Using the Chart
Enter the name of the medication in the first column. In the second column enter the number of milligrams in each pill, capsule or dosage of liquid. In the third column enter how many times a day, week or month, you take the medication or herb. In the fourth column, enter the purpose of the medication. If you don't know the purpose, you have not been taking responsibility for your own health care. If you don't know the purpose, find out the purpose or stop taking the medication.

List any chronic conditions or recently diagnosed or underlying conditions:

Your doctor needs to know where to begin. and what to look for. There may be times, however, especially when you think you have been given a wrong diagnosis, when you don't want to mention the previous diagnosis. This way , you can get a completely separate opinion which is not contaminated by previous, possibly erroneous diagnosis.

6. Medications and interventions attempted for these symptoms, if any and the results.

7. Any reactions and especially adverse or allergic reactions you may have had to a medication.

8. Doctor's Recommendations: During your visit, make notes on your doctor's recommendations. This will help you remember and carry out the treatment that your doctor may recommends. Notice I say doctor's recommendations, not doctor's orders. This is part of equalizing your power in the relationship. NO one, including a doctor can order you to do anything. They can only recommend and you can make a choice whether to follow the recommendation or decline.

8. Dr.'s Prognosis
Ask the doctor what s/he thinks the outcome of the condition and the treatment is likely to be. Write it down during your visit for your records.

9. Prescriptions to be written:
If you know before your visit what prescriptions you need written, l write them down before you go as part of your plan. If as the doctor is examining you or discussing your condition and mentions a medication that s/he recommends, write it down. By the time it comes to writing down the prescription, s/he may have forgotten. That may be exactly the medication that may have helped you.

10. Samples to Ask For:
Very often, drug companies give doctors samples. If your doctor prescribes a medication, ask him if he has any samples. If you are taking a certain medication on a regular basis, ask your doctor if s/he has samples of that. I take Previcid or Acifex regularly for reflux and I haven't bought a pill in years.

11. Goals for This visit
Carefully think out and write down your goals for this visit. If you write down your goals, you can achieve them. You may or may not want to share your goals with your doctor, but just have in them clearly thought out in your mind and written where you can refer to them, will help you achieve them, just as it would in a business meeting.

12. Expectations of your Doctor:
Clarify what you expect from your doctor. Then ask yourself if these are realistic expectations considering who your doctor is, who you are and the time constraints that you are both under. If your expectations are realistic, you will be less likely to be disappointed. You need not share your expectations with your doctor unless it becomes relevant. But have them firmly in your mind. You may say "I am or was expecting .......".

13. Narrative history
Suppose you have been referred to a specialist for a condition that your primary care doctor is unable to resolve or you have a long-standing condition and you are seeing a doctor for the first time. Collect all your medical records from each doctor. Put them in a three-ring binder divided by subject categories such as dermatology, neurology. Or you may prefer to put them under history, lab reports, chart notes. Put them in chronological order. Make it as easy as possible for the doctor to look at them. Then go through the notes and write a summary of your history. Your symptoms, interventions, medications, results and especially the chronology of these events. Make an exact copy of the binder for you to keep and one to leave with the doctor. This will help your process. The doctor does not have time and will not get the continuity of scattered notes, but will be better able to use his/her technical abilities if you make it easy.

USING This Work Book

I recommend that you get a three ring binder and keep these worksheets in the binder, the most recent worksheet on top.

1. Name _______________________________ Date _____________
2. Symptoms

3. Blood Pressure ________________ Temperature ___________

4. Medications (including herbs) presently using

5. List any chronic conditions or recently diagnosed or underlying conditions:

6. Medications and interventions attempted for these symptoms, if any.

7. Doctor's Recommendations:

8. Dr.'s Prognosis

9. Prescriptions to be written:10. Samples to Ask For:

11. Goals for This visit

12. Expectations of your Doctor:

Trust Your Intuition

Aviva, my 30 year old daughter had been to the doctor 3 times in a week. She had a fever, a sore throat and she was itchy all over. The doctor sent her home on all three occasions, telling her to take lots of fluids and go to bed. Aviva called me in the morning to say that her skin had big blue blotches. I felt a cold chill run through me. My intuitive power told me that this was serious. I thought of flesh eating bacteria. I thought of the little girl in south bay who had her arms and legs amputated in order to save her life. I had an appointment that afternoon with the dermatologist so I requested that she see her too. I told her it was an emergency and she agreed to see Aviva. Aviva was diagnosed with scarlet fever.

I remember when people with scarlet fever were quarantined. The put a sign on the door saying "Quarantine! Anyone touching this sign will be prosecuted" We would stand and stare at the sign. Once in awhile one of us would touch the sign and try to figure out how they would know who touched the sign to prosecute us.

The dermatologist gave her an antibiotic and she recovered after a lengthy illness and recovery period. Scarlet fever is an unusually rare disease these days. Many doctors don't even know of its existence. The doctor Aviva had been seeing was a fill in doctor while our doctor was on vacation. The Fill in doctor had no knowledge of this serious disease. My daughter could have died if I had not intervened.

Professionals are not always right. It is your responsibility to use your brain to research at the library, on the internet, read magazine and newspaper articles and keep your eyes and ears open for TV and radio spots that may pertain to yours or your children's condition. But when all of that is said and done, the most important thing you can learn is to trust your intuition. If you think that things are not right, unless your are a constant neurotic worrier, chances are they are not right. You must keep searching until you get them right. If you think the professionals are overacting to a situation that you don't feel is as serious as they are making it out to be, chances are they are overacting. You know your body and the bodies of your children better than anybody on earth. If you must err, err on the side of your intuition. That is the most important piece of advice that I can give you.