Mohamadou Preveiw

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT



MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT MOHAMADOU M. DIENE

Text copyright © 2018 Mohamadou M. Diene. Cover art copyright © 2018 Mohamadou M. Diene. Cover photos used under license from DepositPhotos. All rights reserved. No part of this book may be reproduced in any form or by any means without permission in writing from the author. No part of this publication may be reproduced, or stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording, photocopy- ing, scanning or otherwise, without the expressed written permission of the author. Requests for authorization should be addressed to: [email protected] Cover design by Ivica Jandrijevic Interior layout and design by www.writingnights.org Book preparation by Chad Robertson ISBN: LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA: Names: Diene, Mohamadou M., author, physician Title: Making the Most of Your Doctor’s Appointment / Mohamadou M. Diene Description: Independently Published, 2019 Identifiers: ISBN (Perfect bound) | (eBook) Subjects: | Non-Fiction | Self-Help | Physicians | Doctor-Patient relationship | Medicine | Patient-care | Health Literacy | Socio-determinants of Health Classification: Pending LC record pending Independently Published Printed in the United States of America. Printed on acid-free paper. 24 23 22 21 20 19 18 17 8 7 6 5 4 3 2 1

DISCLAIMER The author and publisher of this book and the associated materials have used their best efforts in preparing this material. The information contained in this book is provided for general informational purposes. The materials are not a substitute for obtaining profes- sional advice from a qualified person, or licensed medical professional. The author is in no way acting as medical professional by setting out his thoughts in this book. None of the ideas and concepts embodied in this book should be taken by the reader as recommendations to take specific medical actions.



To all because we all become patients at some point during our sojourn on Earth.

Health is the greatest of human blessings. — Hippocrates

CONTENTS Disclaimer .......................................................................................... v Dedication......................................................................................... vii Epigraph .......................................................................................... viii Contents ............................................................................................ix Acknowledgements ...............................................................................xi Introduction........................................................................................ 1 CHAPTER 1 — COMMUNICATION IS KEY ........................................... 3 CHAPTER 2 — LEARN ABOUT DOCTORS YOU ARE CONSIDERING........ 8 CHAPTER 3 — KNOW YOUR BENEFITS .............................................15 CHAPTER 4 — DURING YOUR APPOINTMENT ...................................21 CHAPTER 5 — LEARN ABOUT MEDICAL TESTS...................................29 CHAPTER 6 — GET TO KNOW YOUR HEALTHCARE TEAM..................36 CHAPTER 7 — AFTER YOUR APPOINTMENT......................................40 CHAPTER 8 — WHAT SHOULD I DO IF I GET A SERIOUS DIAGNOSIS?....43 CHAPTER 9 — TALKING TO DOCTORS IN SPECIAL SITUATIONS ..........50 CHAPTER 10 — PATIENT BILL OF RIGHTS..........................................56 CHAPTER 11 — WHAT CAN I SAY? GIVING INFORMATION ..................66 CHAPTER 12 — MEN: STAY HEALTHY AT ANY AGE ............................76 CHAPTER 13 — WOMEN: STAY HEALTHY AT ANY AGE.......................85 CHAPTER 14 — THE DOCTOR–PATIENT RELATIONSHIP .....................92 CHAPTER 15 — ENGAGING HEALTHCARE USERS: A FRAMEWORK FOR HEALTHY INDIVIDUALS AND COMMUNITIES ............................99 CHAPTER 16 — THE CHANGING BALANCE OF POWER BETWEEN DOCTORS AND PATIENTS ...................... 104 CHAPTER 17 — SOME GOALS OF A SUCCESSFUL HEALTH INFORMATION ENCOUNTER........................................................ 112

x CHAPTER 18 — DIRECT- TO-CONSUMER PHARMACEUTICAL ADVERTISING .......................... 118 CHAPTER 19 — CULTURAL COMPETENCE ...................................... 124 CHAPTER 20 — DETERMINANTS OF HEALTH .................................. 130 CHAPTER 21 — HOW TO GET THE MOST OUT OF YOUR OB/GYN APPOINTMENT .............................. 136 CHAPTER 22 — GET THE MOST FROM YOUR PRENATAL CARE VISITS 142 CHAPTER 23 — GETTING THE MOST OUT OF YOUR CHILD’S CHECKUP ............................................................ 152 CHAPTER 24 — PREPARING FOR YOUR PSYCHIATRIC APPOINTMENT................................. 158 CHAPTER 25 — MAKING SURE YOUR HIV CARE IS THE BEST IT CAN BE .................................. 178 CHAPTER 26 — ORAL HEALTH ...................................................... 185 CHAPTER 27 — HEALTH INSURANCE IN THE UNITED STATES ........... 197 CHAPTER 28 — WHAT IS MEDICARE / MEDICAID? ........................... 208 CHAPTER 29 — THE AFFORDABLE CARE ACT.................................. 216 CHAPTER 30 — CONCLUSION ....................................................... 220 About the Author .............................................................................. 223

ACKNOWLEDGEMENTS I would like to take this opportunity to address my heartfelt gratitude to Chad Robertson from Writing Nights for his assistance in the materializa- tion of this book. Mohamadou M. Diene



INTRODUCTION The need to assist patients make the most of their doctor appointment has long been felt. This is now a reality with this book which will help patients to be prepared to navigate the complex health care system and build a strong relationship with their medical care provider. This book gives patients in- valuable tools on how to make appointment, what to do before the appoint- ment, during and after the appointment. It is now proven that patients who are engaged and actively participate in their own medical care are more sat- isfied with the quality of care they receive, with better health outcomes. It is hoped that my book will encourage patients to be more prepared to ac- tively participate in their care decision making process and form a robust partnership with their health care provider with improved quality of care and better health outcomes.



CHAPTER 1 COMMUNICATION IS KEY Communication is key to making the most of your doctor appoint- ment. However, communication involves strategies, method, and timeliness. A trip to the doctor’s office is often an uncomfortable experience usually because we are either unwell, in pain or just inconven- ienced. Furthermore navigating the medical system can be confusing. So it stands to reason that one would want to avoid follow-up appointments or multiple trips to the doctor in a calendar year. Asking the right questions can go a long way when trying to get the most of a trip to the doctor’s office. Prepare questions in advance. Write down any questions you have for the

4 MOHAMADOU M. DIENE doctor ahead of time because questions are the answer. You usually don’t go to the doctor unless you have to. Then from the time that you make the appointment until the time that you show up, you scare yourself into think- ing that maybe something terrible is wrong. You imagine that you came in normal but you will leave with a terminal illness. From experience I know that I would also forget every question I intended to ask. I also have dealt with the doctor reaching for the door as I was asking a question which makes me feeling rushed and not satisfied with the answer I got, and I leave even more worried than when I came. If you have health insurance you are probably offered preventive care to- tally or at a discount. Again in our busy lives we don’t always take time to go to the doctor unless we have to. If we did take the time for preventive care, the doctors would be able to detect almost any conditions or diseases. Maybe that is what we are afraid of. They will find something. However, no one knows your body like you and there are usually warning signs or symptoms if you pay attention. Doctors often spend only a few minutes with each patient they see for routine exams. However, there is often time out of the exam room that is spent reviewing the charts and records. The experience can be both confusing and frustrating when communication on one or both sides is lacking particularly if you are presented with new infor- mation to process or new instructions to follow. While a visit to the clinic can be intimidating to anyone, you can reduce the stress and worry associ- ated with doctor’s appointments by taking steps to be sure that you are pro- vided with all the information you need at the appointment. There are also ways you can improve the quality of your care by helping the doctor develop the best understanding possible of your symptoms and condition. First, you can get some advice over the phone. One can never emphasize enough the importance of the support staff when a patient wants to avoid multiple doc- tor’s appointments. Most doctors have clinicians that can help. They answer calls and can triage symptoms over the phone. Your provider’s ability to determine what is wrong and how to treat it depends almost entirely on communication. From scheduling an appointment to wrapping up your

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 5 visit, effective communication will help ensure that you get what you need. SELECTING A DOCTOR You are more likely to bring up all your health concerns to a doctor you feel comfortable with. Your primary care doctor should be most familiar with your medical history, and also is probably the perfect person to coordinate your care and refer you to specialists as necessary. What type of primary care doctor is right for you? Consider these options: • Family and general practitioners care for a wide range of health con- cerns. They may be able to treat family members of any age. • Internists treat adults and may have additional training in specialties such as cardiology. • OB/GYN (obstetrics/gynecology) practitioners specialize in women’s health, including pregnancy and childbirth. • Pediatricians provide care to children and adolescents. • Geriatricians specialize in the care of older adults. CHOOSING A DOCTOR YOU CAN TALK TO Finding a main doctor—often called your primary doctor or primary care provider—who you feel comfortable talking to is the first step in good com- munication. It is also a way to ensure your good health. This doctor gets to know you and what your health is normally like. He or she can help you make medical decisions that suit your values and daily habits and can keep in touch with the other medical specialists and healthcare providers you may need. If you don’t have a primary doctor or are not at ease with the one you currently see, now may be the time to find a new doctor. Whether you just moved to a new city, changed insurance provider, or had a bad experience with your doctor or medical staff, it is worthwhile to spend time finding a doctor you can trust. People sometimes hesitate to change doctors because

6 MOHAMADOU M. DIENE they worry about hurting their doctor’s feelings. But doctors understand that different people have different needs. They know that it is important for everyone to have a doctor with whom they are comfortable. Primary care doctors frequently are family practitioners, internists, or geriatricians. A geriatrician is a doctor who specializes in older people, but family practi- tioners and internists may also have a lot of experience with older patients. Here are some suggestions that can help you find a doctor who meets your needs. DECIDE WHAT YOU ARE LOOKING FOR IN A DOCTOR A good first step is to make a list of qualities that matter to you. Do you care if your doctor is a man or a woman? Is it important that your doctor has evening office hours, is associated with a specific hospital or medical center, or speaks your language? Do you prefer a doctor who has an indi- vidual practice or one who is part of a group so you can see one of your doctor’s partners if your doctor is not available? After you have made your list, go back over it and decide which qualities are most important and which are nice, but not essential. IDENTIFY SEVERAL POSSIBLE DOCTORS Once you have a general sense of what you are looking for, ask friends and relatives, medical specialists, and other health professionals for the names of doctors with whom they have had good experiences. Rather than just get- ting a name, ask about the person’s experiences. For example, say: “What do you like about Dr. Brown?” and “Does this doctor take time to answer ques- tions?” A doctor whose name comes up often may be a strong possibility. If you belong to a managed care plan—a health maintenance organization (HMO) or preferred provider organization (PPO)—you may be required to choose a doctor in the plan or else you may have to pay extra to see a

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 7 doctor outside the network. Most managed care plans will provide infor- mation on their doctors’ backgrounds and credentials. Some plans have websites with lists of participating doctors from which you can choose. It may be helpful to develop a list of a few names you can choose from. As you find out more about the doctors on this list, you may rule out some of them. In some cases, a doctor may not be taking new patients and you may have to make another choice. CONSULT REFERENCE SOURCES The American Medical Association’s Directory of Physicians in the United States and the Official American Board of Medical Specialties Directory of Board-Certified Medical Specialists are available at many libraries. These books don’t recommend individual doctors, but they do provide a list of doctors you may want to consider. MedlinePlus, a website from the Na- tional Library of Medicine at the National Institute of Health (NIH), has a comprehensive list of directories which may also be helpful. There are plenty of other online resources too—for example, you can find doctors through the American Medical Association or find a list of doctors who participate in Medicare. WebMD also lists doctors. Don’t forget to call your local or state medical society to check if com- plaints have been filed against any of the doctors you are considering. What does “Board Certified means? Doctors who are board certified have extra training after regular medical school. They also have passed an exam certi- fying their expertise in specialty areas. Examples of specialty areas are general internal medicine, family medicine, geriatrics, gynecology, and orthopedics. Board certification is one way to learn about a doctor’s medical expertise; it does not tell about the doctor’s communication skills.

CHAPTER 2 LEARN ABOUT DOCTORS YOU ARE CONSIDERING Once you have narrowed your list to two or three doctors, call their offices. The office staff is a good source of information about the doctor’s education and qualifications, office policies, and pay- ment procedures. Pay attention to the office staff—you will have to deal with them often. You may want to set up an appointment to meet and talk with a doctor you are considering. He or she is likely to charge you for such a visit. Your first meeting is a good time to talk with the doctor and the office staff about some communication basics. First name or last name—When you see the doctor and office staff, intro- duce yourself and let them know by what name you like to be called. For

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 9 example: “Hello, my name is Mrs. Jones,” or “Good morning, my name is Bob Jennings. Please call me Bob.” Ask how the office runs—Learn what days are busiest and what times are best to call. Ask what to do if there is an emergency, or if you need a doctor when the office is closed. Share your medical history—Tell the doctor about your illnesses, opera- tions, medical conditions, and other doctors you see. You may want to ask the doctor to send you a copy of the medical history form before your visit so you can fill it out at home where you have the time and information you need to complete it. If you have problems understanding how to fill out any of the forms, ask for help. Some community organizations provide this kind of help. Share former doctors’ names—Give the new doctor all of your former doc- tors’ names and addresses, especially if they are in a different city. This is to help your new doctor get copies of your medical records. Your doctor will ask you to sign a medical release form giving him or her permission to re- quest your records. After the appointment, ask yourself if this doctor is a person with whom you could work well. If you are not satisfied, schedule a visit with one of your other candidates. WHEN LEARNING ABOUT A DOCTOR, CONSIDER ASKING QUESTIONS LIKE • Do you have many patients my age or older? • How do you feel about involving my family in care decisions? • Can I call or email you or your staff when I have questions? Do you charge for telephone or email time?

10 MOHAMADOU M. DIENE • What are your thoughts about complementary or alternative treat- ments? WHEN MAKING A DECISION ABOUT WHICH DOCTOR TO CHOOSE, YOU MIGHT WANT TO ASK YOURSELF QUESTIONS LIKE: • Did the doctor give me a chance to ask questions? • Was the doctor really listening to me? • Could I understand what the doctor was saying? Was I comforta- ble asking him or her to say it again? MAKE A CHOICE Once you’ve chosen a doctor, make your first actual care appointment. This visit may include a medical history and a physical exam. Be sure to bring your medical records, or have your former doctor send them. Bring a list of your current medicines or put the medicines in a bag and take them with you. If you haven’t already met the doctor, ask for extra time during this visit to ask any questions you have about the doctor or the practice. WHAT DO YOU NEED TO KNOW ABOUT A DOCTOR? Basics • Is the doctor taking new patients? • Is the doctor covered by my insurance plan? • Does the doctor accept Medicaid/ Medicare?

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 11 Qualifications and Characteristics • Is the doctor board certified? In what field? • Is the age, sex, race, or religion of the doctor important? • Will language be an obstacle to communication? Is there someone in the office who speaks my language? • Do I prefer a group practice or an individual doctor? • Does it matter which hospital the doctor admits patients to? Logistics • Is the location of the doctor’s office important? How far am I will- ing to travel to see the doctor? • Is there parking? What does it cost? Is the office on a bus or sub- way line? • Does the building have an elevator? What about ramps for a wheelchair or walker? Office Policies • What days/hours does the doctor see patients? • Are there times set aside for the doctor to take phone calls? Does the doctor accept emailed questions? Is there a charge for this ser- vice? • Does the doctor ever make house calls? • How far in advance do I have to make appointments? • What’s the process for urgent care? How do I reach the doctor in an emergency? • Who takes care of patients after hours or when the doctor is away?

12 MOHAMADOU M. DIENE KNOW HOW TO MAKE APPOINTMENTS The communication during this step is crucial. When making an appoint- ment with your physician, nurse practitioner, or integrative provider, ex- plain the reason for the appointment, so the receptionist knows how much time you’ll need. Be as clear as possible but remember that you don’t need to give a full health history or disclose any private information. Here are some good examples: “My right knee has been bothering me for several months and I would like to schedule an appointment within the next week or two to have it evaluated.” “I’ve had a cold for a week and now I feel worse with a high fever and pain. I would like an appointment today.” Feel unsure about whether or not you actually need to see a healthcare pro- vider? Then speak to a nurse or to someone who can help evaluate your concern and determine when you should schedule an appointment. In other words, ask for what you need on the front end, and your time with your provider will be more useful. You should have the following information ready when calling to sched- ule your appointment: • Patient’s full name (including middle initial) • Date of birth • Current address and phone number • Current insurance information • Physician’s name whom you wish to schedule appointment with if you know it Purpose of the appointment It is important to let the scheduler know about all of the concerns you would like addressed so that the doctor’s office can schedule the appropriate

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 13 amount of time to care for your needs. Cancellations Ideally, all cancellations must be made at least 24 hours prior to your sched- uled appointment time. This will allow the staff to give another patient the opportunity to be seen. To expedite registration, you may have in some cases to download the patient registration form or ask your appointment scheduler to mail any forms to your home prior to your visit. Insurance To find out more about your doctor’s participating health plans, please visit the contracted health plans web page in the billing and insurance section. It is recommended that you call your health insurance company to find out which services are covered by your health plan. REQUEST AN INTERPRETER IF YOU KNOW YOU’LL NEED ONE If the doctor you selected or were referred to doesn’t speak your language, ask your doctor’s office to provide an interpreter. Even though some Eng- lish-speaking doctors know basic medical terms in Spanish or other lan- guages, you may feel more comfortable speaking in your own language, es- pecially when it comes to sensitive subjects, such as sexuality or depression. Call the doctor’s office ahead of time as they may need to plan for an inter- preter to be available. Always let the doctor, your interpreter, or the staff know if you do not understand your diagnosis or the instructions the doctor gives you. Don’t let language barriers stop you from asking questions or voicing your concerns.

14 MOHAMADOU M. DIENE Using an Interpreter • Consider telling your interpreter what you want to talk about with your doctor before the appointment. • If your language is Spanish and your interpreter does not come from the same country or background as you, use universal Span- ish terms to describe your symptoms and communicate your con- cerns. • Make sure your interpreter understands your symptoms or condi- tion so that he or she can correctly translate your message to the doctor. You don’t want the doctor to prescribe the wrong medica- tion. • Don’t be afraid to let your interpreter know if you did not under- stand something that was said, even if you need to ask that it be repeated several times. Resources in Spanish If you are looking for written information in Spanish, there are an increas- ing number of resources that can help. For example, the National Institute on Aging has translated many of its AgePages to Spanish. AgePages (called Vivir Mejor la Tercera Edad) are short, easy-to-read fact sheets on a wide variety of health and aging topics. To get copies of these free publications you can call 1-800-222-2225 or order them online at www.nia.nih.gov/health or www.nia.nih.gov/espanol

CHAPTER 3 KNOW YOUR BENEFITS Health insurance has the effect of insulating patients from the full cost of health care. Patients’ behavior that leads to a higher utili- zation of health care services when the services are covered by in- surance is referred to as moral hazard. It is very important to understand that even though you are expecting your health insurance company to pay for all or part of your medical treatment, you are responsible for your bill. It is wise to familiarize yourself with your insurance benefits. Your health plan mandates that you are financially responsible for payment of all co- pays, deductibles, and non-covered services, and your doctor’s office is con- tractually obligated to collect them.

16 MOHAMADOU M. DIENE BEFORE YOUR APPOINTMENT Gathering your health information and getting organized before your ap- pointment are the key steps to ensure a productive meeting with your doc- tor. This is especially important if you see multiple doctors or are meeting with a new physician for the first time. Get your tests results Make sure that the doctor you’re seeing has the copies of your latest X-ray, MRI, or any other test or lab results, including reports from other doctors that you’ve seen. In most cases, you will need to do the legwork yourself, which may only require a phone call to your previous doctor’s administra- tive staff, asking for them to be sent, or you may need to go pick them up and bring them to the new office yourself. List your medications Make a list of all the medications you’re taking (prescription drugs, over- the-counter medications, vitamins, minerals and herbal supplements) along with the dosages, and take it with you to your appointment. Or just gather up all your pill bottles in a bag and bring them with you. List of allergies: mention any allergy you have. Allergy happens when your immune system reacts to something that is usually harmless. Those triggers called allergens can include pollen, mold, and animal dander, cer- tain foods or things that irritate your skin. Bring your immunization records (include questions about possible new vaccinations, such as shingles, pneumonia, flu). Gather your health history Your doctor also needs to know about any previous hospitalizations, as well as any current or past medical problems, even if they are not the reason you are going to the doctor this time. Genetics matter too, so having your family health history can be helpful.

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 17 GET TO KNOW YOUR FAMILY MEDICAL HISTORY • You doctor will want to know about major illnesses in your family tree. • A family history of heart disease, diabetes, cancer, asthma, or other conditions will help your doctor know how to best care for you. Family members share genes, behaviors, lifestyles, and environments that may influence their health and their risk of chronic disease. Most people have a family health history of some chronic diseases (e.g., cancer, coronary heart disease, and diabetes) and health conditions (e.g., high blood pressure and high blood level of cholesterol). People who have a close family member with a chronic disease may have a higher risk of developing that disease than those without such a family member. A chronic disease is any condition that requires ongoing adjustments by the affected person and interactions with the health care system. Family health history is a written or graphic record of the diseases and health conditions present in your family. A useful family health history shows three generations of your biological relatives, the age at diagnosis, and the age and cause of death of deceased family members. Family health his- tory is a useful tool for understanding health risks and preventing disease in individuals and their close relatives. Some people may know a lot about their family health history or only a little. It is helpful to talk with family members about your health history, write this information down, and up- date it from time to time. This way family members will have organized and accurate information ready to share with their health care provider. Family health history information may help health care providers deter- mine which tests and screenings are recommended to help family members know their health risk. To help individuals collect and organize their family history information, the Center for Diseases Control’s Office of Public Health Genomics collaborated with the U.S. Surgeon General and other federal

18 MOHAMADOU M. DIENE agencies to develop a web-based tool called “My Family Health Portrait.” Each year since 2004, the Surgeon General has declared Thanksgiving to be National Family History Day. Over the holiday or at other times when families gather, the Surgeon General encourages Americans to talk about, and to write down the health problems that seem to run in their family. Learning about their family’s health history may help ensure a longer, healthier future together. PREPARE A LIST OF QUESTIONS Make a written list of the top three or four issues you want to discuss with your doctor. Since most appointments last between 10 to 15 minutes, this can help you stay on track and ensure you address your most pressing con- cerns first. If you’re in for a diagnostic visit, you should prepare a detailed description of your symptoms. Write down any questions you want to ask. If you write it down, ask it. Never assume that it is a stupid question, because when it comes to your health, there is no stupid questions. If you have two questions or twenty, ask them all, but be mindful of the timing. Make sure your doctor listens to you. Health care is not cheap and you pay the doctor for his time. He can listen to you. It is important to your health, and if necessary, to your treatment. Tell the doctor when he or she first comes into your room that you have some questions that you need to ask. That way, he or she will know that you will be asking them. Consider any differences in your health since your last visit. Watch for changes in eating, sleeping, sudden aches or pain, skin changes or growths, and note your overall sense of well-being. Don’t forget to take this list along to your appointment. You can make sure you get the best possible care by being an active member of your health care team. Being involved means being prepared and asking questions. Ask- ing questions about your diagnoses, treatments, and medicines can improve the quality, safety, and effectiveness of your health care. Taking steps before your medical appointments will help you make the most of your time with

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 19 your doctor and health care team. So be prepared. Let your doctor know about your symptoms and concerns upfront in case more appointments are needed. By doing so, the most important issues may be addressed first. Al- ways remember to bring these items to your appointment: • Your up-to-date insurance information and a form of identification. • Method of payment to cover your co-pay or deductible. • A list of all the medications you are currently taking, including how many times per day and the dose strength. Include both prescription and over the counter (such as aspirin, vitamins, and herbal supplements). It may be easier to bring in your medication bottles or packages for the doctor to check. • Your list of questions and concerns for the doctor. Find a friend or relative to accompany you to your visit. A lot of infor- mation may be presented at a doctor’s visit; it may be helpful to bring a friend or relative to help you write things down, share medical information, and talk with the health care team. However an example of where other people present in a doctor-patient encounter may influence their communication is one or more parents pre- sent at a minor‘s visit to a doctor. These may provide psychological support for the patient, but in some cases it may compromise the doctor-patient confidentiality and inhibit the patient from disclosing uncomfortable or in- timate subjects. When visiting a health provider about sexual issues, having both partners of a couple present is often necessary, and is typically a good thing, but may also prevent the disclosure of certain subjects, and according to one report, increases the stress level. Time is limited during doctor visits. Prepare your appointment by think- ing about what you want to do during your next visit.

20 MOHAMADOU M. DIENE Do you want to: Talk about a health problem? Get or change a medicine? Get medical tests? Talk about surgery or treatment options? The answers can help you make better decisions, get good care, and feel better about your health care. Patients who ask questions and take an active role are happier with their care and see more improvement in their health than patients who do not.

CHAPTER 4 DURING YOUR APPOINTMENT Be punctual. Arrive 15–20 minutes early for your appointment. Doing so will give you plenty of time to check in and have your vitals (height, weight, blood pressure) taken before your appointment time. It also will help you get as much time with your doctor as possible. RELAX It’s natural to be nervous or anxious when visiting a doctor but remember that your doctor is here to help you. Try to relax as much as possible. Some patients even suffer from white-coat hypertension, which means their blood pressure rises higher than normal when they are in the doctor’s office. When you arrive, take a few deep breaths and remember that your doctor is on your get-well and stay-well team.

22 MOHAMADOU M. DIENE In today’s managed care environment, the time you spend face-to-face with your physician is limited. To get the most from your health care pro- viders (HCPs) and an accurate diagnosis, preparation is the key. Good prep- aration will also go a long way to alleviate any anxiety you may be feeling about the appointment. You increase the likelihood of an accurate diagnosis if you come prepared with the details and history of your problem, antici- pate questions, know your medications and bring your medical records. The best advice when you meet with your doctor is to speak up. Don’t wait to be asked. Be direct, honest, and as specific as possible when recount- ing your symptoms or expressing your concerns. Many patients are reluc- tant or embarrassed to talk about their symptoms, which makes the doctor’s job a lot harder to do. Again it is a good idea to bring along a family member or friend to your appointment. They can help you ask questions, listen to what the doctor is telling you and give you support. BRING YOUR HEALTHCARE RECORDS If you are seeing a new provider, bring a copy of your healthcare records and the results of any previous tests or procedures. Remember to keep cop- ies of these records for yourself, just in case you are asked to leave the doc- uments you bring to your appointment. It is important to remember that your healthcare records belong to you. You have a right to your own medi- cal information and may request it from any provider or hospital. This is particularly helpful when people are seeing multiple providers for complex health issues. Consider putting together a notebook or filing system to maintain all of your records in an orderly fashion. Even better, create an online personal health record. You should begin tracking your health infor- mation in whatever format works best for you, even if the choice is paper. However, if you plan to share your personal health information with various health care providers, using digital media or a software format is recom- mended. It will be easier to format your information quickly, accurately and

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 23 securely regardless of which or how many healthcare providers need to ac- cess it. Personal Health Record information should always be stored in a secure manner just as you would store other confidential personal infor- mation such as financial information. Once you’ve gathered your health information, there are a few different ways you can maintain it: • Simply place it in a file folder • Transfer the information to a USB drive • Subscribe to a web-based service that allows you to access and en- ter your health information anytime into their online tools from your computer. Policy to look for include privacy and security, your ability, or those you authorize, to access the information, control over accessibility by others. Your doctor may use electronic health records, and offer a web portal or patient gateway that allows you to view and track some of your health in- formation via the internet. You may also be able to e-mail your doctor, schedule appointments, or get a prescription refilled through the internet. This is a great start to giving you access to your information, but it is not your complete personal health record. You’ll still need to be proactive to collect the information you need. ARRIVE PREPARED TO TELL YOUR STORY Since the average doctor’s appointment is about fifteen minutes, it is helpful to prepare for your visit. Write a list of your concerns and use it to jog your memory. Include the following information: • What symptoms am I experiencing? • When did they begin? • What makes the condition better or worse?

24 MOHAMADOU M. DIENE • What are my questions or concerns? • What medications am I taking, including prescriptions or over- the-counter medications, vitamins, herbs, or nutritional supplements? Be sure to note the name of the medications, the dose, and how often you take them. • Don’t forget about your emotional health; it influences your physical health. It is important to have the chance to discuss your health while you are comfortable in your street clothes prior to disrobing and having an exami- nation. Even if you feel worried, anxious, or embarrassed about your health concern, don’t wait until the end of the visit to bring up your real reason for the appointment or the provider won’t have time to deal with it. For example, a woman went to the doctor for treatment of cold symptoms, but during the last two minutes of the appointment informed the doctor that she was going through a painful divorce, was highly anxious, and couldn’t sleep. This was the real reason that she wanted to see the doctor, but since she didn’t bring it up until the end of the visit there wasn’t enough time for the doctor to explore the issue with her. Remember, your provider is legally bound to confidentiality and privacy. And most likely, he or she has “seen it all,” and won’t be surprised by any of your story. AGAIN HONESTY IS THE BEST POLICY Using acupuncture for pain management? Tell your physical therapist. Thinking about trying valerian to help your insomnia? Share it with your general practitioner. Healthcare practitioners can often tell you how your therapies might complement one another or offer you vital information about how certain treatment combinations might be less healthy or even dan- gerous. Whatever treatment you are using or planning to try, whether it is integrative or conventional, always let everyone involved with your health care know about everyone and everything you are accessing to address your needs.

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 25 CONSIDER BRINGING A FRIEND OR FAMILY MEMBER Whether you bring someone with you to your appointment is up to you. For a routine visit, it may not be necessary to bring a friend or family mem- ber with you. On the other hand, if you are feeling anxious or concerned, have a language barrier, are facing a challenging diagnosis, or anticipate dis- cussing treatment options, it may be helpful to have someone with you. Choose someone who is a good listener and who won’t interrupt, dominate the visit or ask too many of his or her own questions. The person who ac- companies you on your visit can be another set of ears. This will help you remember after the appointment what was said. It is often helpful to have this person write information down so that you have a written record of what was discussed or done. Let your family member or friend know in advance what you want from your visit. Your companion can remind you what you planned to discuss with the doctor if you forget. DON’T LEAVE UNTIL YOU UNDERSTAND WHAT TO DO NEXT Even with routine examinations or check-ups, be sure you understand the results before you leave. What was the result of the exam? Was any problem identified or diagno- sis made? • If laboratory or other tests were done, when and how will I get the results? Will I also receive an interpretation of the result—in other words, how will I know if they are normal? • Are there screening or diagnosis tests that should be scheduled? If so, when or how often? • If a diagnosis was made, what are my treatment options? • What recommendations does the healthcare provider have for helping me maintain or improve my health or prevent disease?

26 MOHAMADOU M. DIENE If you have been given a prescription or other type of medication, know the following: • What is being prescribed and why? What symptoms does it treat? • How and when should the medication be taken? What is the dose and frequency? Should I take it with food or water? • Are there side effects? For example, drowsiness, nausea, or dry mouth? • How will I know if the medication is working? When will I notice, or how long before I can expect a change? • Will the medication interfere with any other prescriptions or substances I’m taking? • What should I do if I forget to take a dose? Take another? Skip it? • How much does it cost? Will my insurance cover it? Is there a generic substitute? • Are there alternative medications to consider? Are there other medications that might have fewer side effects, or are less expensive? It is also crucial to regularly review all of the information in your provider and insurance company records to make sure it is accurate. Here are some simple things you can do to verify the accuracy of the records: • Make sure that your name appears on all of the forms, reports, and correspondence. • Verify that you have had the conditions and/or procedures listed, and that the diagnoses are correct. • Read the report of each office visit and the results of each procedure. Make sure to ask the questions you prepared before your appointment. Start by asking the ones that are most important to you. To get the most

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 27 from your visit, tell the nurse or person at the front desk that you have questions for your doctor. If your doctor does not ask if you have questions, ask him or her when the best time would be to ask them. Asking questions is important but so is making sure you hear, and un- derstand the answers you get. Take note or have the person you bring to your appointment help you understand and remember what you heard. If you don’t understand or are confused, ask your doctor to explain the answer again. It is very important to understand the plan or next steps that your doctor recommends. Ask questions to make sure you understand what your doctor wants you to do. The questions you may want to ask depend on whether your doctor gives you a diagnosis, recommends a treatment, med- ical test, or surgery, or gives you a prescription for medicine. Questions could include: • What is my diagnosis? • What are my treatment options? What are the benefits of each option? What are the side effects? • Will I need a test? What is the test for? What will the results tell me? • What will the medicine you are prescribing do? How do I take it? Are there any side effects? • Why do I need surgery? Are there other ways to treat my condition? How often do you perform this surgery? • Do I need to change my daily routine? MAKING GOOD USE OF YOUR TIME Be honest—It is tempting to say what you think the doctor wants to hear, for example, that you smoke less or eat a more balanced diet than you really do. While this is natural, it’s not in your best interest. Your doctor can sug- gest the best treatment only if you say what is really going on. For instance,

28 MOHAMADOU M. DIENE you might say: “I have been trying to quit smoking, as you recommended, but I am not making much progress.” Decide what questions are most important—Pick three or four questions or concerns that you most want to talk about with the doctor. You can tell him or her what they are at the beginning of the appointment, and then discuss each in turn. If you have time, you can then go on to other ques- tions. Stick to the point—Although your doctor might like to talk with you at length, each patient is given a limited amount of time. To make the best use of your time, stick to the point. For instance, give the doctor a brief description of the symptom, when it started, how often it happens, and if it is getting worse or better. Share your point of view about the visit—Tell the doctor if you feel rushed, worried, or uncomfortable. If necessary, you can offer to return for a second visit to discuss your concerns. Try to voice your feelings in a positive way. For example, you could say something like: “I know you have many patients to see, but I’m really worried about this. I’d feel much better if we could talk about it a little more.” Remember, the doctor may not be able to answer all your questions— Even the best doctor may be unable to answer some questions. Most doctors will tell you when they don’t have answers. They also may help you find the information you need or refer you to a specialist. But if a doctor regularly brushes off your questions or symptoms as simply a part of aging, think about looking for another doctor.

CHAPTER 5 LEARN ABOUT MEDICAL TESTS It’s important to ask your doctor questions when you don’t understand something, such as about medical tests they recommend or details about your diagnosis. Sometimes doctors need to do blood tests, x- rays, or other procedures to find out what is wrong or to learn more about your medical condition. Some tests, such as Pap tests, mammograms, glau- coma tests, and screenings for prostate and colorectal cancer, are done reg- ularly to check for hidden medical problems. Before having a medical test, ask your doctor to explain why it is im- portant, what it will show, and what it will cost. Ask what kind of things you need to do to prepare for the test. For example, you may need to have an empty stomach, or you may have to provide a urine sample. Ask how you will be notified of the test results and how long they will take to come in.

30 MOHAMADOU M. DIENE QUESTIONS TO ASK ABOUT MEDICAL TESTS • Why is the test being done? • What steps does the test involve? How should I get ready? • Are there any dangers or side effects? • How will I find out the results? How long will it take to get the results? • What will we know after the test? When the results are ready, make sure the doctor tells you what they are and explains what they mean. You may want to ask your doctor for a written copy of the test results. If the test is done by a specialist, ask to have the results sent to your primary doctor. Follow up if you don’t hear about your test results. You can’t assume that no news is good news. Some busy offices sometimes misplace or forget to call about positive tests results. Can I Find Information About Medical Tests Online? Yes—there is a lot of information online about medical tests. The National Library of Medicine’s MedlinePlus website provides links to many trust- worthy resources. You can get information on preparing for lab tests, expla- nations of different tests, and tips on interpreting lab test results. DISCUSS YOUR DIAGNOSIS AND WHAT TO EXPECT A diagnosis identifies your disease or physical problem. The doctor makes a diagnosis based on the symptoms you are experiencing and the results of the physical exam, laboratory work, and other tests. If you understand your medical condition, you can help make better de- cisions about treatment. If you know what to expect, it may be easier for

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 31 you to deal with the condition. Ask the doctor to tell you the name of the condition and why he or she thinks you have it. Ask how it may affect you and how long it might last. Some medical problems never go away com- pletely. They can’t be cured, but they can be treated or managed. QUESTIONS TO ASK ABOUT YOUR DIAGNOSIS • What may have caused this condition? Will it be permanent? • How is this condition treated or managed? What will be the long- term effects on my life? • How can I learn more about my condition? FIND OUT ABOUT YOUR MEDICATIONS If your doctor prescribes you new medication, ask questions about why you need it and if there are special instructions or possible side effects. Your doctor may prescribe a drug for your condition. Make sure you know the name of the drug and understand why it has been prescribed for you. Ask the doctor to write down how often and for how long you should take it. Make notes about any other special instructions. There may be foods or drinks you should avoid while you are taking the medicine. Or you may have to take the medicine with food or a whole glass of water. If you are taking other medications, make sure your doctor knows, so he or she can prevent harmful drug interactions. Sometimes medicines affect older people differently than younger people. Let the doctor know if your medicine doesn’t seem to be working or if it is causing problems. It is best not to stop taking the medicine on your own. If you want to stop taking your medicine, check with your doctor first. If another doctor—a specialist for example— prescribes a medication for you, call your primary doctor’s office and leave a message letting him or her know. Also call to check with your doctor’s

32 MOHAMADOU M. DIENE office before taking any over-the-counter medications. You may find it helpful to keep a chart of all the medicines you take and when you take them. The pharmacist is also a good source of information about your medi- cines. In addition to answering questions and helping you select over-the- counter medications, the pharmacist keeps records of all the prescriptions you get filled at that pharmacy. Because your pharmacist keeps these rec- ords, it is helpful to use the same store regularly. At your request, the phar- macist can fill your prescriptions in easy-to-open containers and may be able to provide large-print prescription labels. WHAT ARE SIDE EFFECTS? “My headache prescription always makes me sleepy.” “Aunt Betty’s cough syrup caused a rash.” Unwanted or unexpected symptoms or feelings that happen when you take a medicine are called side effects. Some side effects happen just when you start taking a medicine. Some happen only once in a while and you learn how to manage them. But other side effects may make you want to stop taking the medicine. Tell your doc- tor if this happens. He or she may be able to prescribe a different medicine or help you deal with these side effects in other ways. Once again the following are questions to ask about medications: • What are the common side effects? What should I pay attention to? • When will the medicine begin to work? • What should I do if I miss a dose? • Should I take it at meals or between meals? Do I need to drink a

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 33 whole glass of water with it? • Are there foods, drugs, or activities I should avoid while taking this medicine? • Will I need a refill? How do I arrange that? UNDERSTAND YOUR PRESCRIPTIONS When the doctor writes a prescription, it is important that you are able to read and understand the directions for taking the medication. If you have questions about your prescription or how you should take the medicine, ask your doctor or pharmacist. If you do not understand the directions, make sure you ask someone to explain them. It is important to take the medicine as directed by your doctor. Keeping a record of all the medications you take with instructions for how to take them may be useful. Helping You Remember No matter what your age, it’s easy to forget a lot of what your doctor says. Even if you are comfortable talking with your doctor, you may not always understand what he or she says. So, as your doctor gives you information, it’s a good idea to check that you are following along. Ask about anything that does not seem clear. For instance, you might say: “I want to make sure I understand. Could you explain that a little more?” or “I did not understand that word. What does it mean?” Another way to check is to repeat what you think the doctor means in your own words and ask, “Is this correct?” Here are some other ideas to help make sure you have all the information you need. Take notes—Take along a notepad and pen and write down the main points, or ask the doctor to write them down for you. If you can’t write while the doctor is talking to you, make notes in the waiting room after the

34 MOHAMADOU M. DIENE visit. Or, bring an audio recorder along and with the doctor’s permission, record what is said. Recording is especially helpful if you want to share the details of the visit with others. Get written or recorded materials—Ask if your doctor has any brochures, DVDs, CDs, cassettes, or videotapes about your health conditions or treat- ments. For example, if your doctor says that your blood pressure is high, he or she may give you brochures explaining what causes high blood pressure and what you can do about it. Ask the doctor to recommend other sources, such as websites, public libraries, nonprofit organizations, and government agencies that may have written or recorded information you can use. Talk to other members of the healthcare team—Sometimes the doctor may want you to talk with other health professionals who can help you un- derstand and carry out the decisions about how to manage your condition. Nurses, physician assistants, pharmacists, and occupational or physical ther- apists may be able to spend more time with you than the doctor. Call or email the doctor—If you are uncertain about the doctor’s instruc- tions after you get home, call the office. A nurse or other staff member can check with the doctor and call you back. You could ask whether the doctor, or other health professional you have talked to, has an email address you can use to send questions. Find out what you are to do next. Your doctor is there to listen to you and help you and your family. Your well-being depends on being comfort- able in sharing your thoughts, concerns, and needs. Feel free to ask ques- tions or repeat any information you did not fully understand. Open com- munication is the key to a successful visit to your doctor. Take an active role in your care by asking about recommended important exams, screenings, and vaccinations:

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 35 • Breast and cervical cancer screening • Cholesterol screening. • Colorectal Cancer Screening • High Blood Pressure • Immunization Schedules • Oral Health for adults • Prostate Cancer Screening • Skin cancer • HIV testing • Viral Hepatitis screening Regular exams offer many benefits, from improving your quality of life to detecting early signs of diseases. Your doctor will base your particular exam on your age, gender, and health status. In a routine exam, your doctor may check your skin for changes, listen to your heart and lungs, and take your blood pressure and pulse. Your doctor may request a blood analysis to check for sugar, cholesterol, liver and kidney function, anemia and any other disorders. A urine sample and a stool sample may also be tested. Talk to your doctor. A physical exam combined with an open discussion will help your doctor determine the best care for you.

CHAPTER 6 GET TO KNOW YOUR HEALTHCARE TEAM While you might expect to receive care from your doctor only, it may be a nurse/nurse practitioner, a physician assistant or pharmacist providing your care. Keep in mind that some- times it takes a team of people to help you manage a health condition. Know the key players in your healthcare team, and understand what they do. After all, your health is important and you can’t manage it alone. When you are in your doctor’s office, you may have noticed that you may have seen your doctor but for a short time at the end of your visit. As a matter of fact, a study showed that doctors spend only a few minutes per patient, including post-visit case work outside the examination room. Healthcare today is much more complex. It takes a team approach to provide the best care. When caring for patients, primary care practitioners of- ten coordinate treatment across a range of specialists, providers, and facilities.

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 37 Although led by a physician, the healthcare team is multidisciplinary—this means that it includes a range of supportive and licensed providers who are involved not only in providing care services but also in ensuring access, co- ordination, and continuity of care to all patients. You may have also noticed that while you are in the doctor’s office, you actually see a number of different people before and after you see your doc- tor. Your doctor can’t do it all by him or herself, and there may be many other healthcare providers who have specific roles in helping you take care of your health. These professionals are there to help make sure that you not only get the information you need, but also the best care possible. You just need to know who they are and what they do. THE DOCTOR Ideally doctors act in the best interest of their patients to maintain their patient’s physical and mental health. These professionals oversee your care by applying their medical knowledge and skills to diagnose, help prevent, and manage diseases and injuries. They also develop a plan of care with you. Doctors may also refer you to a wide range of other healthcare professionals. For example, if you have a chronic condition or a specific disease, you may need to see one or more specialists. If you have diabetes you may need to see an endocrinologist, a specialist in the endocrine or hormonal system. If you have rheumatoid arthritis, you may need to see a rheumatologist. Cancer patients see oncologists – these are professionals who specialize in treating cancer. In some instances, your doctor may also refer you to allied health professionals such as physical therapists to help you recover from an injury or a disease. THE NURSE PRACTITIONER AND THE PHYSICIAN ASSISTANT Because of the time constraints that most doctors face, the role of “physician extenders” has become more prevalent. You may see more and more physician assistants and nurse practitioners in doctors’ offices, outpatient clinics, and hospitals. Physician assistants and nurse practitioners typically work under

38 MOHAMADOU M. DIENE the supervision of a licensed physician to provide patient care. They can examine, diagnose and treat patients, prescribe medications, order and in- terpret laboratory tests and other diagnostic procedures within the scope of their practice and license. THE NURSE Nurses provide and coordinate patient care by working with a wide array of healthcare professionals. Nurses can perform physical exams, administer medications, gather vital signs, capture any symptoms you may be experi- encing, interpret patient information and conduct research. Nurses play a vital role because they can also help you understand your condition and manage your health, as well as be an advocate for your care. They support the overall efficiency and quality of care provided to patients. Be sure to communicate your symptoms and concerns with your nurse. THE PHARMACIST Your pharmacist is also an important member of your healthcare team. Learn how to work with your pharmacist in managing your medications, especially if you have multiple prescriptions. Pharmacists can provide rec- ommendations on over the counter medicines and can also provide advice if you need to escalate your concerns to your doctor. The pharmacist can be another resource for medical information that you may need regarding your prescriptions or general questions about medications. In addition to consulting patients on medications, certain pharmacists are trained to pro- vide services such as quitting smoking and blood pressure, diabetes, and cholesterol management. Please don’t be shy about engaging your local pharmacist with your medical questions or concerns. YOU All of these healthcare professionals and others work together to coordinate the delivery of your health care, but the most important member of your healthcare team is you. They are expert in the medical field, but you are