By Pamela D. Wilson, The Care Navigator, CSA, CG, MS, BS/BA
As we age, we typically experience one or more chronic diseases that benefit from medical oversight. If you’re not familiar with the term chronic disease it means a generally incurable illness or condition that we live with for many years that is usually managed by medication but in the early stages may be reversed by diet, exercise or other preventative measures. Common chronic diseases include: arthritis, asthma and related breathing difficulties, cancer, diabetes, heart disease and more recently memory loss.
The Centers for Disease Control indicate that 45% of Americans have at least one chronic disease. Research completed by the Robert Wood Johnson Foundation relative to chronic conditions reports that individuals with chronic diseases are the most frequent users of healthcare in the U.S accounting for 81% of hospital admissions, 91% of all prescriptions filled and 76% of all physician visits.
For persons diagnosed with a chronic disease, medical care and preventative steps are extremely important in supporting quality of life and the ability to continue to participate in daily activities of self-care and enjoyable activities. Many older adults rather than seeing health improve, find their health declining along with physical abilities. Uncertainty exists about how to reverse this trend.
The challenge in patient – physician relationships is that physicians typically treat and respond to disease. This occurs by way of ordering tests and writing prescriptions. In the United States, few physicians respond with proactive suggestions and solutions to reverse or stop disease; often because the physicians themselves have not set an example of health. Many physicians are overweight, unhealthy and diagnosed with their own chronic diseases. How likely is a patient to listen to a physician who exhibits similar issues and has not taken action to resolve them? Highly unlikely.
One of the most common concerns according to a physician’s office I visited with in Denver is that patients schedule and do not show up for scheduled appointments. Know that it is important to maintain a regular appointment schedule with your physician especially if you have a chronic disease diagnosis. Denver is not such a large city that a drive to your physician’s office should take more than 30 minutes.
Time allotted at a medical appointment, is 15 minutes at best. This brief amount of time isn’t sufficient to fully investigate reasons behind the diagnosis of a disease but is the time allowed by most insurance companies for an office visit. Most of us attend medical appointments unprepared, not realizing what information might be helpful for a physician or what questions might be important to ask. The most important questions are not asked. The most important facts are often those overlooked.
In order to have an effective appointment with a doctor, the responsibility today falls more on the patient than the physician. As with much of life, we don’t learn until too late what action we could have taken to achieve a different result.
Following are 10 tips to ensure an effective doctor appointment:
1) Make a list of ALL of your medications and over the counter supplements. Take the list to ALL of your medical appointments. Include the name, the dosage – for example 10 mg, and how often you take the medication – for example twice daily. This is extremely important information if you visit multiple physicians. Why? Because one physician may write a prescription for a medication that has a negative interaction with another medication or over the counter supplement you take. One of the leading causes of emergency room visits for adults is not taking medications according to direction or taking medications prescribed by multiple physicians that have negative interactions.
Many of us leave medical offices with a prescription in hand. We never fill it or if the prescription is filled it’s not taken according to instructions.
When you’re at the pharmacy, ask the pharmacist to take a look at your prescription list to see if he or she notices anything unusual. When the pharmacist asks if you have any questions about your medication, rather than responding “no”, respond, “what’s important that I should know?” I have personally known pharmacists in Denver and the Colorado Front Range to be particularly helpful in discussing medications and their interactions. If you don’t understand why you’re prescribed a particular medication it’s important to ask the doctor.
Never, ever share prescriptions medications with a friend. Your medical condition is likely not their medication condition. Prescription sharing causes harm rather than benefit. Dispose of old prescriptions at pharmacies that have medication disposal drop boxes. This will avoid confusion over use of a prescription that may have been discontinued.
2) Drink plenty of water and eat healthy foods. While this sounds like common sense it’s not. The number of individuals admitted to hospital emergency rooms because of dehydration and malnutrition is increasing. Both conditions present as dizziness and delirium with others viewing the person as “being out of their mind”. Denver and the Colorado Front Range is a particularly dry climate. If you’re not continually drinking it’s likely you are often dehydrated.
Many women taking diuretics because of leg or ankle swelling often withhold fluids due to worry about frequenting the bathroom. The purpose of diuretics is to flush fluids from the body if there is no fluid intake, fluids cannot be flushed from the body. Not drinking a sufficient amount of fluids also promotes urinary tract infections, yet another cause for visits to the emergency room. These issues, all preventable, result in visits to medical offices and hospital emergency rooms.
3) Write down all information and facts related to the reason you made your medical appointment If you have aches and pains, where, how often and how severe? If you feel tired, are you tired all the time? How many hours a night or day are you sleeping? If you have balance issues and are experiencing frequent falls, does this happen when standing up or during other activity? Details, details and more details are extremely important to help a physician diagnose a condition.
Keep a written log of how you feel and what symptoms you experience at least one week, if not more, before you see your doctor. Take the written log to your medical appointment. This information will be valuable in supporting an accurate diagnosis. Rather than being a victim of circumstance, be proactive in providing information about your health concerns in order to have a positive outcome from your visit.
4) Prioritize. Plan your appointment. We all know appointment time is limited. Prioritize the reasons you are seeing your doctor to 3 or fewer issues. Write down specific questions related to each issue and hand the list to your doctor in order to be time efficient. If your list is longer than 3 items, ask the receptionist if you can schedule 2 back to back appointments so there is sufficient time to have all your concerns addressed.
5) If you are able, complete research prior to your doctor appointment. While the internet can be a dangerous place for the average consumer because it offers information about medical conditions that may be confusing or contradictory, information that supports questions is beneficial. The internet has unlimited information about medical conditions and symptoms. The information you find may allow you to write down specific questions related to the symptoms you are experiencing.
For example, if you suspect you have high blood pressure, the internet may provide an “average” reading of 110/70. If you have a home blood pressure machine write down readings and take the list to your next medical appointment for your doctor to review.
6) Know your numbers. As in the prior example relative to blood pressure, know your numbers: blood pressure, oxygen level, weight, cholesterol, triglycerides, thyroid, blood sugar etc. You can request copies of bloodwork to keep in your own permanent record so that you are aware of whether your numbers are within standard guidelines and can compare results on an ongoing basis.
If you have x-rays, CT scans or other tests, ask enough questions to make sure you understand the diagnosis and the prognosis – what you can expect in the future. This is an area where some patients would rather remain ignorant. However having this information and knowing what to expect laces you in the driver’s seat relative to action you can take now to avoid even greater health issues in the future.
Rather than accepting a prescription as a solution to a diagnosis, ask your doctor what might be done to change the condition if you are so motivated. Be proactive and consider changing longstanding habits in order to improve your health.
7) Make sure your immunizations and regular tests are up to date. After high school and college we lose track of immunizations. Do you receive an annual flu shot? When was the last time you had a pneumonia vaccine? Tetanus? Shingles? When was the last time you had a mammogram or other preventative care care? If male, a prostate check?
Again it’s up to you, not your doctor, to make sure you are receiving the best preventative care possible. If you don’t ask, you may not receive.
8) Would you benefit from seeing a specialist? Many individuals err on the side of continuing to see a physician who they’ve seen for years or who they may not be satisfied because changing physicians is intimidating and takes investigative work. Denver and the Colorado Front Range have an abundant number of specialists able to treat any condition you might experience.
If you’re 55 or older you would likely benefit from seeing a geriatrician or at least an internal medicine physician. If you have arthritis – a rheumatologist, thyroid issues – an endocrinologist, a heart condition – a cardiologist. The idea is not to see every physician of every background, but to be proactive and make sure the condition you have is appropriately addressed. Specialists can quickly arrive at solutions that may not be in the expertise of a general practitioner.
9) Ask questions or bring someone to your appointment who will ask questions. Many adults see their physicians as “godlike” and are fearful of asking questions that might be insulting to the physician. We are beyond the good old days when physicians know best.
Physicians and medical personnel often talk in “big words” or relate terms that they assume you understand. If you don’t understand, there’s no shame in asking. If you don’t ask the right question you may miss something important. It’s also okay to disagree with recommendations or say that you’d like to think about a recommendation. Make sure you understand the advantages and risks of accepting or not accepting medical advice. Many times when we’re the patient we’re too overwhelmed to advocate for ourselves.
Today, unless we ask questions and take responsibility for our own care, health issues are commonly missed or not diagnosed. Support groups exist for many conditions where information can be shared among individuals in different stages of the disease. Care advocates, like the staff of The Care Navigator, attend medical appointments and advocate with medical professionals on behalf of clients. We ask the questions you might not think to ask and can recommend ancillary services of which physicians may not be aware.
10) Physicians diagnose and treat, not advise. As mentioned earlier, physicians diagnose and treat disease. They’re not experts in many of the areas of life that become helpful as we age that include: powers of attorney related to healthcare and financial, types of care communities, options for home care, support programs, planning ahead for a person diagnosed with memory loss, community services etc.
The challenge with the healthcare system is that we don’t know what we don’t know. This leaves us at a clear disadvantage and is where advocates are beneficial. The challenges and uncertainty of managing our day to day lives becomes equally as important as managing our health as we age and experience multiple health concerns.
If remaining independent is important to you and you feel you’d benefit from working with an advocate, contact The Care Navigator. We serve the entire Denver metro area and the Colorado Front Range.
©2014 Pamela D. Wilson, All Rights Reserved.Return to the Caregiver Library of Articles