Communicating with your Physician

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Communicating with your Physician

• Dr. Evan W. Kligman
• Arizona Center on Aging
• agewell100_at_aol.com
• www.aging.arizona.edu

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Aim for a Partnership Let your PCP know what you
want Do your own research Ask why Ask about
alternatives Consider watchful waiting State
your preferences Compare expectations Accept
responsibility
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Partnership

• Five ways to be a good partner
• 1. Take good care of yourself
• 2. At the first sign of a health problem,
  observe and record your symptoms
• 3. Practice medical self-care at home
• 4. Prepare for office visits
• 5. Play an active role in the medical visit

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Problems in Communication

• Misinterpretation
• SOB
• Surgical
• Big words
• Frightened, anxious people misinterpret
  information
• ASK Questions.

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Check list for Office Visits

• Make a list-
• What are the top 3 things you want to address?
• Make a list of all medications.
• Write down your questions.
• Be prepared to take notes.
• Review your progress with your provider.

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Be Prepared!

• Old medical records
• Current medication and OTC list, including
  herbals and vitamin supplements
• Names of current physicians
• Bring notes about items you want to bring up
• Emergency contacts allergy lists

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Be Prepared - 2

• Insurance card (make sure your coverage is
  active for particular physician BEFORE making
  appointment)
• Symptoms when first appeared, how long,
  severity, where, same symptoms as before,
  self-care (what are you doing?), what makes
  symptoms better or worse

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Be Prepared - 3

• Advance Directives
• Hidden Agenda Dont wait until the end
• begin with these issues

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Present Emotional Problems as Well as Physical
Problems

• Over 50 of Common Symptoms Result from
  Overactive Arousal System (Stress)

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Common Stress Related Complaints

• Neck, back, and shoulder pains
• Myalgias and arthralgias
• Headache
• Crying
• Poor sleep
• Appetite changes
• Poor concentration

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Stress Related Symptoms - 2

• Skin tension and rashes
• Frequent urination
• Diarrhea and constipation
• Shortness of breath
• Chest pain
• Fast heart rate
• Poor immune function

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Request Adequate Visit Length

• Ask for greater than 15 minute visit if you think
  you need more time when scheduling

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Take Notes during Visit

• Dont leave until you have clear understanding of
  diagnosis, treatment, and your role in recovering
  health
• Your role - what you need to do to be a partner
  in care
• If you cant write, have an advocate or tape
  recorder

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If you are Hard of Hearing

• Consider owning a pocket-talker if hearing aids
  dont work sufficiently

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Feel Free To Inquire About Options to
Conventional Tx

• Many common conditions, if not very serious, can
  first be treated with nonpharmacologic agents
  (drugs)
• Exercise, good nutrition, and stress reduction
• Herbs, supplements, and vitamins
• Mind-body therapies

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Common Problems Best Treated Initially Without
Medications

• Glucose intolerance, early type II diabetes
• Mild hypertension
• Mild osteoarthritis
• Tinnitus
• Anxiety and depression
• Viral upper respiratory infections

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If cost of medications a concern, ask about
generic efficacy and safety and other options

• Indications
• Contraindications
• With, without food
• Impact on trace vitamins and minerals, and other
  prescriptive medications
• How long to take medicine
• What to do if not feeling better
• May ask pharmacist

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Appreciate Your Providers Limitations

• Most are not accessible 24/7/52
• Inquire about back-up and whether or not
  hospitalists are used for inpatient care
• When is best time to make routine, non-urgent
  phone calls (Rx refills, schedule appointments,
  etc.)
• Time and reimbursement issues (over 60 of
  revenue for overhead expenses) panel size

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Know Providers Office Policies

• Walk-ins seen?
• If urgent care needed, can be seen within 24
  hours?
• If need routine care, can be seen in 3 days of a
  week?
• Penalty fee for no show to visits or
  cancellations less than 24 hours?

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Know When to Use Primary Physician Vs. Specialist

• Know policy of your insurance coverage and
  whether second opinions are covered

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3 big questions

• Is this PCP well trained and experienced?
• Is this PCP available when needed?
• Is this PCP going to work in partnership with me?

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Training and experience

• Board certified Internist or Family Practice
• Adult or Geriatric Nurse Practitioner
• Geriatrician- board certified in care of older
  people
• Specialists

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Availability

• Questions
• What are the office hours?
• If I called right now, how soon could I be seen?
• How much time is allowed for a routine visit?
• Will the PCP discuss health problems over the
  phone?

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Money- Cost

• Ways to cut your health care costs
• Keep your immunizations current
• Dont put off needed services
• Reduce your medical test cost
• Reduce your medication cost
• Avoid surgery when the risks outweigh the
  benefits
• Substitute home care for an office visit when
  appropriate
• See your PCP in his or her office instead of
  going to urgent care or the emergency room