Patient Tips

 

10 Things to Know Before You See the Doctor in the Office

 

10 Do’s and Don’ts and Things to Understand in the Office Setting

 

10 Things to Know/Do/Understand in the Hospital Setting

 

10 Do’s and Don’ts and Things to Understand Regarding Surgery

                               

                              (Click Links For Quick Access)

 

10 Things to Know Before You See the Provider in the Office 

  • Be able to provide this information to the provider. It is helpful to have things written down in advance, so you do not forget them.​
  • We recommend you keep a health journal which includes your medications, allergies, past medial and surgical history, planning and visit or hospitalization notes.​
  • We recommend that you enlist the assistance of a helper to go over things with you and go to visits with you to listen and take notes.

1

YOUR AGENDA

This extends beyond listing your symptoms. 

  • What do you want to accomplish at the visit? – “I have a headache; make it go away” is a lot different than “I have a headache; reassure me that it is not a brain tumor.” 

  • Think in terms of,  “I am visiting the provider today because I want the provider to _________.” 

  • Perhaps you want the provider to explain why you feel this way, relieve your symptoms, reassure you, etc.

  • Who are you making an appointment with and who will be seeing you at your visit? The physician in charge of your care? A physician assistant (PA)? A Nurse practitioner (NP)?  They each have different levels of qualifications and responsibilities for your care. Think about who you want to schedule your appointment with.

2

YOUR SYMPTOMS

Be descriptive

  • Consider location, severity, frequency, duration, and timing in the morning, late at night, after eating, etc.

  •  What makes the symptoms worse or better – stress, movement, bowel movements, etc.

3

YOUR HISTORY OF PRESENT ILLNESS

  • When did the symptoms start?

  • Have the symptoms changed over time?

  • What treatments helped and what didn’t?

  • Why are you seeking medical attention now and not a week ago or a week from now?​

4

OTHER MEDICAL CONDITIONS (past medical history)

  • What other conditions have you been diagnosed with?

  • Are there other conditions for which you take medication unrelated to today's visit?

  • What surgeries have you had?

  • What is normal for you? Ex. weight, blood pressure, heart rate, blood type/counts 

5

YOUR MEDICATIONS

Always bring a list of medications to the office visit.

  • Name of the medication, dosage, and reason for taking it.

  • When was the medicine started, and what was the response?

  • Any adverse effects?

6

DRUG ALLERGIES AND INTOLERANCES

They are not the same – an upset stomach differs from itching or wheezing.

  • What is the reaction if you take the drug? – It is important to consider the type of reaction when deciding with your provider whether to try another medicine of the same class or a different one.

7

YOUR HEALTH INSURANCE

  • What is your deductible? Is It high?

  • Do you have prescription coverage?

  • This may influence what testing or medications you can get,  so it's important to discuss these things with your provider  

8

YOUR RESOURCES AND RESPONSIBILITIES

  • What is your support system?

  • Bring someone with you to the visit or plan for them to participate in the visit by phone (to listen and take notes).  

  • Is there someone at home to help you with the care plan after the visit?

  • Plan to raise limitations with your provider.  Ex. If you have to take care of a loved one 24/7 or can't take time off work, you might be unable to attend an elective hospital procedure or go to PT 3x/ week.  Brainstorm how to adapt.

9

PRIORITIES

It is important to know what matters most.

  • a conservative or less invasive approach or an aggressive, maybe quicker, or more invasive approach?

  • When choosing a medicine: whether it works well, is safe, or inexpensive?

  • Although all are important, what is the most important aspect?

  • If a less effective medicine were safer, would you prefer it?

  • Always plan to choose with your provider what is medically best for you.

10

THINK ABOUT YOUR POTENTIAL LIMITATIONS

  • Are there obstacles or circumstances that may hinder treatment? can’t attend PT because of transportation issues, can’t take injectable medicine, financial limitations, etc.

 

10 Do’s and Don’ts and Things to Understand in the Office Setting

1

YOUR ATTITUDE

Your attitude is important.

  • Be friendly, courteous, and smile.

  • Doctors, other healthcare providers, and support staff are people too, who are more likely to go above and beyond if you are friendly rather than rude or demanding.

2

YOUR AGENDA

Be ready with your agenda, knowing what you want to accomplish at the visit.

  • Present the reasons for your visit as a request rather than as a symptom – " I am here today because I want to ____________. 

  • Address your concerns at the beginning of the visit as clearly and concisely as possible. Do not wait until the end of a visit to raise an issue.

  • Having everything in writing before the visit will help you to remember everything you want to ask and help you get to your concerns quickly.

3

BE CLEAR AND TO THE POINT

  • Pick the 2 or 3 most important issues that you want to address.

  • Avoid a long laundry list of complaints.

  • Remember the provider may only have a limited amount of time to spend with you

4

UNDERSTAND AND CLARIFY

  • If  you don't understand, always ask questions and seek clarification until  you understand.

  • At visit conclusion, know and recap the plan by stating it aloud and asking your questions. Ex. You want me to see a specialist/consultant?  Will your office schedule the visit or do I need to do that? You want me to take Metformin and call if I have side effects.  Are you giving me a prescription or will you call it into my pharmacy? Is that the brand name or will the medication have a different name? (when you fill the prescription, double check it is correct).

  • Are there obstacles or circumstances that may hinder treatment? Ex. Can't attend PT because of transportation issues, can't take injectable medicine, financial limitations, etc.

5

YOUR GOALS

Rather than asking for a specific course of action, consider your goals in general. ​

  • Your goals are to get to the bottom of what really concerns you and receive effective treatment

  • If you are concerned about a brain tumor, it is okay to say so and ok to discuss how your provider is going to make sure you don't have a brain tumor.

  • If you are concerned a medication is causing a side effect, discuss other options for the same effective treatment.  But remember you may have to live with the side effects. Maybe a generic is just as good as a brand name, but maybe not.

  • Finally, remember that the insurance often won’t allow a specific diagnostic test or treatment.  Make sure that the recommendation being offered is what the provider thinks is best rather than what the insurer wants.  If not, ask the provider to fight the insurer to provide the care that they feel is most appropriate.

6

DON'T BE INTIMIDATED

  • Providers are there to help you, and doctors and other providers are not gods. You wouldn’t hesitate to raise an issue for a child or grandchild. Do the same for yourself.

  • You are the best advocate for yourself.

  • You can be assertive and nice at the same time.

7

YOUR PROVIDER'S TITLE

  • Are they a doctor, nurse practitioner, or physician assistant?

  • Each provider has different qualifications.

  • Depending on the severity of your problem, you may want to ask to see a doctor.

8

UNDERSTAND TREATMENT PLAN

  • Make sure you understand the rationale for and against a proposed test or treatment and the potential risks and benefits.

  • Make sure you understand alternatives to the proposed course of action–– the pros and cons of each option.

  • Is there an endpoint to treatment?

  • How will success or failure be determined?

  • Understand why your provider is making a recommendation and how it will benefit you.

  • YOU WANT TO KNOW AT THE CONCLUSION OF YOUR VISIT WHAT THE NEXT STEPS ARE

9

FOLLOW UP

  • Make sure you know what is expected of you after the visit – testing to be done, medication to be taken, or refraining from certain activities.

  • When should you follow up, and under what circumstances should you contact the doctor sooner?

  • Always follow up for test results and other concerns 

  • Do you need to schedule another appointment, with whom, or will your provider schedule it for you?

  • Use your patient portal appropriately.  Do you want to know your test result by looking or do you want to wait to hear it from your provider?  When sending messages/asking questions, be concise and focus on what is important (See #10 regarding portal functions) 

10

UNDERSTAND OFFICE PROCEDURES 

  • Make sure you understand office procedures and policies– hours of operation, phone calls and missed appointments.

  • Make sure you know how to request medication refills.

  • Ask support staff/front desk how to access the electronic patient portal and what can be viewed and requested via that system – Can you schedule appointments, view health history and medication list, request medicine refills, submit questions to your provider)?

  • Find out the best way to communicate with your provider.

10 Do’s and Don’ts and Things to Understand in the Office Setting

1

YOUR ATTITUDE

Your attitude is important.

  • Be friendly, courteous, and smile.

  • Doctors, other healthcare providers, and support staff are people too, who are more likely to go above and beyond if you are friendly rather than rude or demanding.

2

YOUR AGENDA

Be ready with your agenda, knowing what you want to accomplish at the visit.

  • Present the reasons for your visit as a request rather than as a symptom – " I am here today because I want to ____________. 

  • Address your concerns at the beginning of the visit as clearly and concisely as possible. Do not wait until the end of a visit to raise an issue.

  • Having everything in writing before the visit will help you to remember everything you want to ask and help you get to your concerns quickly.

3

BE CLEAR AND TO THE POINT

  • Pick the 2 or 3 most important issues that you want to address.

  • Avoid a long laundry list of complaints.

  • Remember the provider may only have a limited amount of time to spend with you.

4

UNDERSTAND AND CLARIFY

  • If you don't understand, always ask questions and seek clarification until you understand. 

  • At visit conclusion, know and recap the plan by stating it aloud and asking your questions. Ex. You want me to see a specialist/consultant? Will your office schedule the visit or do I need to do that? You want me to take Metformin and call if I have side effects. Are you giving me a prescription or will you call it into my pharmacy? Is that the brand name or will the medication have a different name? (When you fill the prescription, double check it is correct). 

  • Are there obstacles or circumstances that may hinder treatment? Ex. Can't attend PT because of transportation issues, can't take injectable medicine, financial limitations, etc.  

5

YOUR GOALS

Rather than asking for a specific course of action, consider your goals in general. ​

  • Your goals are to get to the bottom of what really concerns you and receive effective treatment

  • If you are concerned about cancer, it is okay to say so and ok to discuss how your provider is going to make sure you don't have cancer.

  • If you are concerned a medication is causing a side effect, discuss other options for the same effective treatment.  But remember you may have to live with the side effects. Maybe a generic is just as good as a brand name, but maybe not.

  • Your insurance may not allow a specific diagnostic test or treatment.  Make sure that the recommendation being offered is what the provider thinks is best, rather than what the insurer wants.  If not, ask the provider to fight the insurer to provide the care that they feel is most appropriate.

6

DON'T BE INTIMIDATED

  • Providers are there to help you, and doctors and other providers are not gods. You wouldn’t hesitate to raise an issue for a child or grandchild. Do the same for yourself.

  • You are the best advocate for yourself.

  • You can be assertive and nice at the same time.

7

KNOW YOUR PROVIDERS

  • Are they a doctor (or resident or fellow doctors in training), nurse practitioner, physician assistant (PA), medical assistant?

  • Are they an opthalmologist (a medical doctor) or an optometrist?

  • Are they a nurse (RN or LPN)? RN's have training in patient advocacy

  • student, aide, clerk, receptionist

  • Each provider has different qualifications.

  • Depending on the severity of your problem, you may want to ask to see a doctor.

8

UNDERSTAND TREATMENT PLAN

  • Make sure you understand the rationale for and against a proposed test or treatment and the potential risks and benefits.

  • Make sure you understand alternatives to the proposed course of action–– the pros and cons of each option.

  • Is there an endpoint to treatment?

  • How will success or failure be determined?

  • Understand why your provider is making a recommendation and how it will benefit you.

  • YOU WANT TO KNOW AT THE CONCLUSION OF YOUR VISIT WHAT THE NEXT STEPS ARE

9

FOLLOW UP

  • Make sure you know what is expected of you after the visit – testing to be done, medication to be taken, or refraining from certain activities.

  • When should you follow up, and under what circumstances should you contact the doctor sooner?

  • Always follow up for test results and other concerns 

  • Do you need to schedule another appointment, with whom, or will your provider schedule it for you?

  • Use your patient portal appropriately.  Do you want to know your test result by looking or do you want to wait to hear it from your provider?  When sending messages/asking questions, be concise and focus on what is important (See #10 regarding portal functions) 

10

UNDERSTAND OFFICE PROCEDURES 

  • Make sure you understand office procedures and policies– hours of operation, phone calls and missed appointments.

  • Make sure you know how to request medication refills.

  • Ask support staff/front desk how to access the electronic patient portal and what can be viewed and requested via that system – Can you schedule appointments, view health history and medication list, request medicine refills, submit questions to your provider)?

  • Find out the best way to communicate with your provider.

  • Who are you seeing at your visit, who is making decisions at your visit and who is ultimately responsible for your care? Physician, Physician Assistant, Nurse Practitioner. See 10 Things to Know before you see the Provider in the Office #1 Agenda. 

 

10 Things to Know/Do/Understand in the Hospital Setting

1

KNOW WHO IS IN CHARGE OF YOUR CARE

Ask who is your attending physician.  

  • The attending is the person in charge of your care and is ultimately responsible for your care.

  • Your attending may be a private physician, group of physicians or physicians that work for the hospital (hospitalists).

  • Attending may bring in consultants or specialists and others to help with your care – other physicians, resident physicians (who are doctors in training and report to the attending), physician assistants, or nurse practitioners. 

2

WHO IS CURRENTLY TENDING TO YOU

  • Make sure you know who is tending to you in the moment and their role in your care––nurse, nurse practitioner, resident, respiratory therapist, consulting physician, etc.

  • Make sure you know who is making the decisions regarding your care, both in general and for specific care.

  • You have the right to be involved in the decisions regarding your care.

  • Don't be afraid to ask to speak to the person who is responsible for your care and to ask questions.

3

UNDERSTAND YOUR DIAGNOSIS AND TREATMENT PLANS

Make sure you understand the diagnosis and treatment plans:

  • What are they?

  • Why?

  • What to expect both short-term and long-term.

  • Once you know your treatment plan, ask when it will happen and follow up to make sure you are receiving the planned treatment, including medications. 

  • For example:

    • Today, you will have a heart catheterization to see if there is a blockage in your heart vessels. The results will dictate whether you need heart surgery. You will need to lie flat for several hours after the procedure. I will be back later this afternoon to discuss the results and next steps. 

    • Knee surgery is scheduled for later today. We will get you up and walking with assistance this afternoon, and if all goes well, you will be discharged tomorrow. You will need PT for several weeks after you get home. No stairs for 2 weeks. No driving for 4 weeks. I expect you will be able to resume normal activities in 2 months.​​

    • Today you will have a chest x-ray to make sure your lungs are clear. We will be making decisions about your treatment after we get the results. 

4

REALISTIC EXPECTATIONS

Unrealistic expectations lead to dissatisfaction. 

  • Discuss your expectations with your provider to help you understand if they are realist.

  • For example:
    • After my surgery, can I expect the pain to go away completely, or is the surgery designed to make the pain more tolerable without eliminating it completely?
    • Will I eventually be able to resume normal activities after the treatment?

5

MEDICATIONS

  • Make sure you know what medications you are being given in the hospital and why you should take them. 

  • Make sure you understand potential side effects.​​ 

  • Ask the person giving you the medicine to make sure it is your medicine (confirm that it's your medicine. You want to make sure that you don't accidentally receive another person's medicine).

  • Understand why you are taking the medications.

6

TIME FRAME

  • When will I receive the test results? 

  • When does the medicine usually start working? 

  • When will I be able to get out of bed, return to work or drive, etc.?

7

ASK QUESTIONS

  • Always ask questions if you do not understand something. This is perhaps the most important thing! 

  • Always repeat and clarify your understanding. 

8

YOUR CONCERNS

  • If you have any concerns about your care ask to speak directly to your attending physician.

  • If you have a concern with nursing care, speak directly to your nurse or nursing supervisor.

  • You can also speak to the patient representative or advocate in the hospital.

  • Always be nice; don't be critical; be firm but not demanding; and focus on what will be done for you in the future to make things better for you.

9

DISCHARGE

  • Make sure you are very clear on discharge instructions regarding what you need to do and what to expect after discharge.

  • Discharge instructions may be given by a nurse or social worker.

  • Ask for instructions as soon as you learn you are going to be discharged so you can make your own preparations before the time you leave the hospital.

  • See 10 Things to Understand in the Office Setting,  #9 Follow Up for more details. 

10

UNDERSTAND HOW TO FOLLOW UP AFTER DISCHARGE  

  • Make sure you understand what your follow up is and how you will do it––whether it be a phone call, office visit, or visits, and with whom.

  • Have correct phone numbers and know how you can communicate directly with your provider for any serious concerns that you need an immediate response to after your discharge. 

  • Patient portal system

  • See  #10 from office setting list above for more details on office procedures.

 

10 Do’s and Don’ts and Things to Understand Regarding Surgery

1

ASK QUESTIONS

  • Ask as many questions as you need to make sure you understand everything.

2

CONSENT TO SURGERY

  • Surgery is never a risk-free proposition. There needs to be a formal informed consent process before every surgery where the physician explains the surgery, including why surgery is being recommended and the alternatives to surgery.

  • The surgeon should explain the rationale for and against, the pros and cons, and the risks and benefits of the proposed surgery. They are not all exactly the same. Make sure you understand all of these issues.

  • Consent Form. For the surgery to be performed, you will be required to sign a form saying that the surgery has been explained to you, that you understand everything, and that you agree to the surgery. Do not sign the form unless all your questions have been answered and you do, in fact, understand everything, you know who is going to be performing your surgery and you do agree to the surgery. Make sure you read and understand what you are consenting to when you sign the consent form.

3

CONSENT TO ANESTHESIA

  • Make sure you understand what will happen with regard to anesthesia. The anesthesiologist, not the surgeon, should explain this to you before surgery.

  • You will need to sign a consent to anesthesia. Before signing, make sure you understand the type of anesthesia you will be receiving, if there are any risks involved with this type of anesthesia and if there are less risky options for you, and who will be giving you the anesthesia and monitoring you during the surgery. 

  • Ask questions, assess the plan and alert them to any potential issues regarding anesthesia, such as previous complications.

4

SECOND OPINIONS OR NOT

  • Depending on the nature of the proposed surgery, the physician, and the facility, consider a second opinion.

  • If you want a second opinion, do not worry about hurting the feelings of the first physician.

  • Know how urgent the surgery is. You may not have time to get a second opinion if you need an urgent procedure.

  • When scheduling the surgery, make sure you know how long you can wait for the surgery and push to have it sooner if you can't wait for the next available surgery date. 

5

KNOW WHO WILL BE TAKING CARE OF YOU

  • Make sure you know who will perform the surgery and who will give the anesthesia. Will it be the attending physician? A resident? A non-physician provider? Training levels and experience may vary significantly.

  • Understand that the physicians may delegate different parts of the surgery to other providers, for example, the surgeon may let a resident physician perform parts of the surgery under their supervision; a nurse anesthetist may be giving and monitoring your anesthesia during the surgery. 

  • Make sure that whoever will be doing the surgery and giving the anesthesia are both acceptable to you. 

6

EXPECTATIONS 

  • Make sure you understand what to expect with surgery, both pre-op and post-op. Some examples: 

  • “After the surgery, you can expect to be in the ICU for 2-3 days, after which we will transfer you to a regular room.”​

  • “You will be on a liquid diet for 2 days, after which we will advance you to solid food.” 

  • “You can expect to have significant pain and swelling in your knee for the first week.”

  • Make sure you communicate directly with the physician if you have any concerns in the pre-op area or post-op area, e.g. blood pressure very high, oxygen low, blood sugar low. 

  • Make sure you are stable before surgery and at the time of discharge and speak up if you don't agree with the plan for you. 

  • Always ask questions to make sure you understand everything and follow up with your provider right away if things are not going as expected. If you have an important concern, don't wait because it's a night or weekend or you don't want to bother someone. There should always be someone "on call" to help you. 

7

POST-OP INSTRUCTIONS 

  • READ AND UNDERSTAND the post-op instruction form before signing it. Ask questions about anything that is not clear.

  • Follow post-op instructions with regard to activity, diet, wound care, etc. Take medicines exactly as prescribed. 

  • Ask questions to clarify and make sure you understand, including: 

  • If you are being given the medicine you need to take or if you will have to get a prescription filled by the pharmacy right away (what if the pain starts before I get the pain medicine?) ​

  • Who do I call and what number if I have an urgent concern or problem?

  • Do I need someone to stay with me and for how long? How often should they check on me? 

  • What adverse reactions should I watch out for (ex. With these medicines, could I have a problem breathing?) 

  • When will my home health equipment arrive and what do I do before it arrives? 

  • Will I receive visits from a home health nurse or therapists? When should I expect to hear from them and who do I call if I don't hear from them? 

8

RESTRICTIONS AND LIMITATIONS AFTER SURGERY

  • Make sure you understand your restrictions and limitations after surgery regarding driving, activity, eating, lifting, return to work, etc.

  • Make sure you have written instructions about your limitations and the time frame for when the limitations will change. 

  • If you don't feel that you have made enough progress to have the limitation come off, be sure to discuss your concerns with your provider before you resume normal activities. 

9

FOLLOW UP

  • Know when, where and with whom your follow up appointment is scheduled or if you have to schedule it. 

  • Know under what circumstances you should contact the physician sooner than the follow-up appointment and what is the best way to get in contact.

  • Keep your follow-up appointments.

10

ATTITUDE AND APPRECIATION  

  • If you are pleased with your care and results, let the people taking care of you know. Kind words are always welcome and may prompt them to go out of their way for you.

  • If you are not pleased with any important aspects of your care, nicely communicate in what ways things were not as expected. 

  • If it could be an ongoing issue, ask how things could be made easier or better for you and will the person you are speaking with please make a note about it in your record. 

  • If it doesn't get better with the next person, again raise the concern nicely and try to get what you want in the moment it is happening. Ask again if it is documented in your record and if not please ask for it to be documented for the next person taking care of you. 

  • ALWAYS THANK PEOPLE FOR THEIR ASSISTANCE 

With thanks to Mark Lopatin, MD, author Rheum for Improvement.