Managing your life is a lot like managing a company. You sit in the corner office as CEO and manage your team of employees who may include (but are by no means limited to) your accountant, personal trainer, lawyer, hair stylist, and, most relevantly, your physician. We often forget this relationship due to the dynamics of our interactions with these "employees" but at the end of the day, they really do work for you. That being said, you have an obligation to "manage" these individuals, informing them of your needs and expectations, so that they can do the best work possible on your behalf and subsequently allowing you to enjoy the fruits of their labor. The question then becomes, "How do you manage your doctor?"
Step 1: Hire the Right One
The first and most critical step is to find the right doctor for you. You want a physician that is personable and who you feel comfortable trusting with your health. You also want to make sure that your physician can provide you with the face time you deserve and need. Many doctors now have to rely on a larger volume of patients to compensate for the decreasing reimbursements they receive from insurers (i.e. they crank through 40+ patients per day and look a lot like this guy flying from exam room to exam room). So make sure that your doctor is willing to spend enough time with you each visit to address all of your medical needs. Another key is to make sure you're seeing the right type of doctor. Primary care doctors come in many forms (internists, family physicians, geriatricians, etc.) so make sure that the doctor you hire is the right one for you. How do you know what's right for you? Ask them about the types of patients in their practice. If 90% of their patients are 65+ and you're 24 years old, you may want to find another doctor with more experience with a younger population. If you're a female and don't feel comfortable with a male physician, you should probably find a female (females, by the way, have now surpassed men and become the majority in medical schools in America). The takeaway: Find someone that you can relate to and that you feel comfortable with.
Step 2: Schedule Your Meeting
Just as in business, there are good times and bad times to schedule appointments with your physician to maximize the attention you receive and prevent yourself from waiting for hours in a crowded waiting room (like the one we are all too familiar with seen here). Imagine the energy and enthusiasm you would bring to a board meeting at 4:30pm on a Friday afternoon. It would be a sad showing to say the least. A Monday morning seems like a more logical choice. So let's begin with when NOT to schedule an appointment:
Right Before Lunch: Doctors often have lunch meetings that they have to attend. If the doctor is running behind (which they almost always are) you may be bumped to the first appointment of the afternoon meaning an extra hour in the waiting room. Those magazines can only keep you entertained for so long.
At the End of the Day: We would bet a small fortune that the doctor will be behind by the time the 4:00pm appointments start to arrive. The few minutes behind that he has been with each patient will have snowballed into at least 30 minutes by now translating into more waiting for you. In addition, it's hard to keep everything straight in your head by the end of the day. With 30+ patients already floating around in your doctor's mind, you will certainly not be getting the attention you need at this time in the day.
With all this in mind, the first or second appointment in the morning seems to be the best time to see your doctor. They will be on time (we hope) and with a clear mind that can be entirely focused on your needs.
Scheduling your appointment is the next step. Behind every famous Senator has a wonderful assistant who holds the key to face time with that elected official. The same goes for doctors. Schedulers are the gatekeepers of the doctor's office. Find out who your doctor's scheduler is and shower that individual with love and kindness. If you do, they can make miracles happen. If you are rude to the, they can make your life miserable. Once you're on their good side they can squeeze you in at the last minute, give you a call if someone cancels and help you secure that perfect time first thing in the morning. You may have a longer wait time if you try to get an appointment the same day but the scheduler is the only one that can get you on the books. They're like wizards.
Step 3: Lead the Meeting
The most important part of this step is to BE ON TIME. How would it look if you showed up 15 minutes late to a board meeting you were running? Think of your appointment the same way. Your physician, unfortunately, may not be on time but if you're late and the doctor is on schedule, you run the risk of losing your appointment and having to start the process all over again. Also, you will undeniably have to do paperwork when you get there. We're not entirely sure where all this paperwork comes from or what it is used for (we doctors don't see the majority of those forms) but you will, without a doubt, have to fill out some new form and sign a document or two before the doctor sees you. It's as predictable as the weather in Seattle, so plan for it. Also, bring a book or a magazine to keep you entertained for the few minutes until your appointment but make sure you're there on time.
In addition, be prepared. Bring your personal medical records with you including any imaging and lab studies you've had performed (we'll cover what to include in your record in a minute). Many physicians will request to see these studied before they make any treatment decisions so save yourself an extra visit by having these tests performed in a timely manner and bringing the results with you. You only need to bring your full medical record to your first visit with a new doctor but always bring your most recent labs and imaging for the doctor's reference.
Now it's time to run the meeting. The key to any successful meeting is a clear agenda. As soon as the doctor walks in, set this agenda with him, outlining all of the issues you'd like to address as well as the questions you would like answered before you leave (remember that, on average, the doctor only has 15 minutes to spend with you each visit). It's amazing how many times patients, when asked why they have come to the doctor, reply, "I don't know. I thought you would know." Our advice: Know why. You've called the meeting for a reason and we can't help you unless we understand what you need so be sure to let us know why you have made the appointment as well as all of your specific questions and concerns. Many people also forget the questions they wanted to ask (we call it "White Coat Anxiety") so the best strategy is to write them down and bring them with you to your appointment.
The next key step is to recap and plan your treatment. Physicians are required to complete the note they write in your chart with an "Assessment & Plan." Your job is to make sure you understand both of these inside and out. It sounds simple but you'd be amazed how many people don't leave with this understanding. The number of patients who don't know why they're taking a certain medicine is astounding. Before you begin any treatment plan, you should ask these questions:
What is my diagnosis and how did you confirm it?
What treatment am I being given and why?
How does that treatment work?
Are there any alternative treatments? If so, why is this treatment the best choice?
With this knowledge, you'll be able to make better decisions about your treatment and will understand why the treatment is necessary. Your health care is a team effort and there's no "I" in "team." You are the CEO of the company called "You" and are as accountable for your care (the doctor is your hired consultant, remember?). While we're talking about accountability, let's discuss your medical records.
Step 4: Manage your Records
Until the government and private industry resolve the battle over the ultimate solution to electronic medical records in America, you are responsible for keeping your thorough medical record. It is scary how many patients can't remember the name of their medications. The most common response to "What medications are you taking?" is "A little white pill for my blood pressure." Not a good answer (and a scary one at that) given the ridiculous number of blood pressure medications on the market and the catastrophic effects of medication interactions. Have we convinced you to keep your personal medical record yet? If not, we're happy to fill you in on all the gory details of medical mishaps from poor record-keeping.
What should you keep track of?
The medical profession is highly regimented. We are trained to follow a very specific (and thorough) format when recording a medical history. Below, is an outline of all the medical information your physician will need to know to provide you with the best care possible.
History of the Present Illness: This is the full story of your current medical problem. Write it all down so you don't forget any important details when you finally get face time with your doctor.
Past Medical History:
Hospitalizations: Have you ever been admitted to the hospital? If so, keep copies of your "Discharge Summary" from each admission. These are not routinely given to patients so be sure to specifically ask for a copy or track one down via medical records.
Surgeries: Have you ever had surgery? If so, keep copies of your "Operative Reports" so the doctor knows exactly what was done and when.
Medical Conditions: The doctor will want to know about all of your medical problems. This includes any history of cancer, heart disease, hypertension, diabetes, STD's, etc. If you've had something, keep track of it.
Medications: Do you take any prescription medications? It is very important to keep detailed records about the medications you take, how often you take them and what dosage you take. Also, keep track of any side effects you've had with medications in the past. Many classes of drugs are related and tracking your side effects may be helpful in finding the right medication for you in the future.
Allergies: Do you have any allergies to food, medications or things in the environment? Allergic reactions are horrifying and are often more severe each time you are exposed to the allergen. Definitely worth keeping track of!
Trauma: Have you even been in a major accident? A history of trauma of any sort is very important for a physician to know.
Vaccinations: The government currently gives you a small card to keep track of your vaccinations...not the easiest thing to keep track of. Add your vaccination history to your medical record so you can be sure to stay up to date with any boosters you may need.
Family History: Many of the diseases that plague our society have a genetic component passed down from one generation to the next. Keep a detailed history of any major medical problems that have affected your parents, aunts & uncles, siblings, and children.
Imaging: X-Rays, CT Scans, Ultrasounds and MRI's are extremely expensive. These test are repeated too often because physicians cannot track down copies of the most recent imaging studies performed (the cost of which comes back to you as a patient). If they can't find it, they'll just do it again. Request a copy of every imaging study you have performed as well as the report from the radiologist who examined the study. This is a huge time and cost saver for you.
Lab Results: Same idea as the imaging studies. Keep a copy of all lab studies you've had including blood work and biopsies. For biopsies, you will want to keep a copy of the "Pathology Report" which contains a description of what the specialist saw when they examined the biopsied tissue. Nobody wants to have two biopsies done if they don't have to (they are not as much fun as they sound)!
How do you keep track of your personal medical record?
There are a number of ways you can manage your personal medical record depending on your personal preference and predilection for technology. There are thousands of additional options, but these should get you started.
Google Health: Google Health, a free record keeping system, allows you to manually input your medical record or import it from a number of medical provider networks' electronic record systems. They also have partnerships with a number of record-keeping companies that will track down and upload your personal records for a fee. Google Health is an efficient paperless way to track your records. At the same time, many people fear the repercussions of inputting their health record into an online database. We feel you. If you are more of a Microsoft fan, Microsoft has created a similar program called HealthVault with similar functionality.
Word Document: If you're worried about the hackers of the world finding out about your vaccine history, a password-protected Word Document may be the solution for you. This method requires the same amount of manual data entry as Google but requires you to format the record yourself. Luckily, you have our nifty outline above to follow...your doctor will be seriously impressed. Be sure to back up the file on a CD or external hard drive in case your computer crashes. You don't want to have to start all over again if you spill coffee on your hard drive.
A Good Old Fashioned Folder: If technology isn't your thing or you don't want to have to retype everything into a document, keep copies of all of your doctor's notes, operative reports, imaging, lab reports, etc. in a big folder. Oh yeah, and put the folder somewhere safe (ideally fireproof) that you will remember. We know how hard it is to keep track of paperwork...don't lose this stuff!
Now that you've compiled your extensive medical record, take a copy with you each time you see a new physician. This document will save you a ton of time in the office with them (which you can use for your personal questions) and ensure that you receive the best care possible.
Armed with these strategies, you'll be able to make the most out of each meeting you have with your doctor. Remember, the most crucial step is finding the right doctor for you; someone you can trust, who spends time listening to your concerns and who leaves you feeling well cared for. Your health is a team effort and you are the team captain. Assume the helm and lead "You" to a happier, healthier life, beginning with more meaningful visits with your doctor.
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By Joshua Goldman, MD/MBA 2010
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