February 1, 2009 - As a practicing physician for 23 years, I was always interested in what created the most successful outcome for a patient.
There are at least two components for this success. The obvious objective is to diagnose and cure or control an illness. The equally important but less obvious goal has to do with psychological comfort. Physicians know we cannot always cure, but we can always comfort.
The relationship between patient and physician is subtle and complex. Understanding this relationship will help us all toward the common goal of a productive, satisfying experience—and that will lead to better health.
Let me start with a couple of facts and then offer seven suggestions toward that common goal.
- The average medical office visit lasts less than fifteen minutes.
- The average patient asks two or fewer questions.
- Most patients don't know what medications they are taking.
- Most patients don't bring their medical history with them.
There are two major issues here for patients:
(1) Making better use of the time they have.
(2) Overcoming a reluctance to ask questions.
Given the current state of the economy and the evolution of health care reform, I would not expect patients and physicians to have more time during an office appointment or hospital interaction. This is just reality. So without more time, we have to be smarter with the time we have together.
Patients are sometimes afraid or embarrassed to ask questions. This reticence may stem from the long-held belief that the physician dwells in an elevated position, and that asking questions would be somehow disrespectful. But that's an antiquated viewpoint and it doesn't help the patient or the physician.
So here are my seven suggestions based on personal experience and supported by a quick review of recent literature on the subject of being a better patient.
1. Start a log and keep it up to date. Patients often have “recall shutdown” when time-stressed during a physician visit (meaning an inability to remember in detail when you are pressured.) To avoid this problem, keep written or digital logs of your medical history including symptoms, diagnosis, treatments, lab/X-ray results, and most importantly, current and past medications. This medication list should include herbals too. With most everyone going digital, consider having this medical log as part of your own profile under your name or as a separate file on your digital device. That way, your medical log is portable, easy to update and always available, even in an emergency.
2. Bring your medications to your visit. Nothing is more frustrating than wasting time trying to identify that “little white pill” your other doctor just started you on for a current problem. Make it easy: Bring the pill bottles with the pills inside. The bottles are clearly labeled and make it seamless to obtain an accurate medication list. Again, don't forget the herbals as they can interact with the prescription medications.
3. Write down or type out your questions. You don't want to go home and say, “Gee, I meant to ask …” Also write down your questions in order of priority as the most important questions and answers may address other issues.
4. Take notes. Auditory shutdown is another common phenomenon. It's easily avoided by taking notes during the visit. Why so? Because taking notes helps you with prompts as you recall the advice you were given during the office or hospital visit. You don't have to be a stenographer. Just write down key phrases or thoughts so that soon after the visit, when you have time and recall is best, you can expand to a more comprehensive narrative. This expanded version will be helpful later as you prepare your questions for the next encounter.
5. Bring a friend. Having an independent but interested person alongside you is comforting psychologically. It also helps with the transfer of information. A trusted friend or relative may even ask a question which you overlooked.
6. Be informed. Life is an open book test and you should understand your illnesses and treatments. The Internet has broken down the information disparity between patients and caregivers. Basically any motivated person has access to the latest research and detailed explanations of any disease or treatment. Granted, some of the information on the Internet is bogus, but staying on reputable sites will help you be better informed and a better patient. From a physician's point of view having an informed patient generally makes for a more compliant patient and better, safer care. But just because you have been downloading information, don't think you're an expert. Each patient's situation is unique. That's why you need someone with experience to help you navigate through the healthcare sea.
7. Be an active participant. Being a good patient is not a spectator sport. Notice that the ideas above all have the common theme of active participation. Being “on the case” as a patient will produce tangible results for you and help your physician care for you. Being passive, lying back, and not being informed will result in worse care and more dissatisfaction. In general, the more you put into the visit, the better the visit will go for all involved.
These are all common sense recommendations. Sadly, the majority of patients don't follow all of them. They're not even universally recommended by physicians.
But if you do decide to follow what could be called “The Seven Habits of Highly Effective Patients,” you'll be on your way to a wonderful patient/physician experience.