Patients often come to my office with a list of 30 things they want to talk about, but it's just not realistic to cover everything under the sun in one visit. And I'm guilty, too: I may want to cram in every vaccination, blood test and pearl of dietary advice I can, while my patient has something else entirely on her mind. Making a list in advance is always helpful, but be sure to prioritize. You might even make clear at the beginning of the visit: "There are two things I want to make sure we talk about today."
You might have read about the recent study showing that physicals don't yield head-over-heels benefitspatients who dutifully get them do not seem to be healthier or live longer. (They do, however, come out with more diagnoses and more possibly harmful testssee No. 3.) Still, I feel that touching base in an annual or biennial visit is probably the most important way that doctors can keep tabs on how you are doing. When your physician takes a complete medical history, this is her chance to pick up subtle clues about impending illnesslike changes in your sleep, energy levels or bowel habitseven if you may feel perfectly well.
So many patients come to my office and ask to have "everything done"more tests, more scans, more blood work. But too many tests can often do more harm than good. One of my patients recently went to an emergency room because she was experiencing abdominal pain. She was given a CT scan to figure out the cause. The scan found nothing in her stomach (it turned out she had gas pains), but did uncover an "incidental" nodule in the adrenal gland. Incidental nodules are benign 99 percent of the timeyet protocol requires three follow-up CT scans over the next two years to ensure the nodule isn't growing. It is estimated that radiation from unnecessary CT scans may cause up to 3 million cases of cancer in the United States over the next 20 to 30 years. Think about that! Now my patient has to undergo the risks of more radiationwhich could actually cause her to develop a diseaseeven though it's exceedingly unlikely that we'll find anything serious.
When a doctor and patient sit together in a room, they are not simply trading facts. How we think and process information is affected by emotions at every level. If you notice palpable feelings arising in yourself during a visitfrustration, fear, anger or sadnessit's a sign that something important is going on and needs to be addressed. You can stop the consultation and say something like, "I'm having very strong feelings about what we have just touched upon. Could we take a minute to talk about it?"
If you get a new diagnosis, medication or referral from your doctor, or have a test being ordered, make sure you understand the what, why and how before you walk out the door. You can take notes during the visit, have someone with you to do it or ask your doctor to jot details down for you. Often, a diagnosis is not clear. But the doctor should be able to explain the possibilities and what will happen next, even if it's just watching and waiting.
Of course, issues can arise after you leave the doctor's office. So ask before leaving the room: "What's the best way to get in touch if I have any further questions?" (My own preference is the telephone, to avoid some of the privacy issues encountered on the Internet.) Just remember, most doctors aren't allotted time in their day to handle phone calls and e-mails; they may work through their lunch hour or stay late to take care of them. So it's helpful to consolidate your questions into one call or e-mail, and to state whether the problem is urgent or not. Understand that it may take a few days for the doctor to get back in touch. If you have a lot of questions, then it's better to schedule another visit dedicated to discussing them. If your doctor isn't the type to answer follow-up queries at all, though, it's time to find a new one. Everyone is busy, but a good doctor should be able to offer an option for continuing the conversation.
Whenever a patient shares a story with a doctor, both of you become entwined in a relationship. Relationships may ebb and flow, but a good one is there for the long haul. Your medical needs will likely vary over time, and a good doctor-patient bond can adapt to this. Ms. Martinez and I often joke that we've outlasted most of our friends' marriages, not to mention presidential administrations, health care reforms, hurricanes and fashion trends. The political winds may shift every four years, but luckily for both of us, our relationship does not.