By Mike DuBose and Blake DuBose with Dr. Surb Guram, MD
At your last doctor’s appointment, you likely spent about a fourth of the time actually speaking with your physician as you did sitting in the waiting room and filling out paperwork, according to a study by Harvard Medical School. Their research, which was published in 2015, found that “the average total visit time for a person seeking care for themselves, a child, or another adult was 121 minutes. That total includes 37 minutes of travel time and 84 minutes in the clinic. Of those 84 minutes, people spent only 20 minutes with physicians; they spent the rest of the time waiting, interacting with nonphysician staff, or completing paperwork or billing.”
The reasoning behind these rushed visits is simple: the more individuals that doctors see each day, the more money the practice makes. With the prospect of lowered profits due to changes in Medicare, Medicaid, and private insurance payments, many doctors are feeling pressure to move patients through even faster than they already do. In fact, according to a 2014 USA Today article by Roni Caryn Rabin, “Some physicians who work for hospitals say they've been asked to see patients every 11 minutes.”
Research indicates that patients can improve their medical outcomes, boost their quality of life, and lengthen their lifespans by playing a more active role in their own health—a choice that becomes even more important when one considers how little face-to-face time they have with their doctors. However, the National Patient Safety Foundation noted in a recent report that the majority of Americans “remain relatively uninformed and passive recipients of health care services and thus lack the confidence and skills needed to fully engage in their health care.” In fact, a 2010 review by the Center for Advancing Health found that 61% of Americans don’t keep a record of their own medical history!
Likewise, our research indicated that many people are too embarrassed or afraid of what their doctors may think to speak openly and honestly with them. However, hiding medical issues can do more harm than good. If individuals wait to consult with a physician until there is a major problem, it may be too late to treat the condition and could lead to a disability, shortened lifespan, or even death!
Going into your next doctor’s appointment prepared and ready to share important information can enhance your treatment and increase the likelihood of you receiving an accurate diagnosis. The following are our recommendations to help you get the most out of the precious minutes you spend with your medical practitioners.
Select the right medical practice. When it comes to healthcare needs, many individuals choose their provider based on convenience. They visit urgent care facilities, drugstore clinics, emergency rooms, or online doctors, seeing a different medical practitioner each time rather than consulting the same primary care doctor about most medical issues. However, consistently seeing one doctor who you trust and who knows all of your medical history goes a long way in accurately preventing, diagnosing, and treating medical problems and diseases. If you have built a relationship with a certain physician, he or she is also more likely to work you in faster for an appointment when a serious problem arises or to refer you to a specialist with the least wait time.
Finding the right primary care doctor for your needs requires some research. If you have private coverage, go to your insurance company’s website and search for a list of in-network, approved providers in your area (most insurance providers’ websites will let you search within a certain mile range of your home or zip code). Ask friends if they know of or have heard good things about anyone from the list. Some websites, such as www.healthgrades.com, allow you to search for a doctor and read reviews by patients who have seen them, so you may want to visit those as well.
We recommend that you choose an internist as your primary physician. Internists must undergo at least three years of special study in a program accredited by the American Council for Graduate Medical Education, meaning that they have received advanced training and education beyond most general practitioners. Your insurance company’s website should allow you to search specifically for internists in your area.
As you narrow your selection, there are several other considerations you should take into account. Hospital affiliations and admitting privileges can be very important, especially if you have a serious condition such as heart disease. Affiliations vary by doctor, so be sure to select one who is affiliated with the local hospital best suited to treat you. Another item you may want to look for is ABMS certification. Consumer Reports explained, “Being certified through the American Board of Medical Specialties means a doctor has earned a medical degree from a qualified medical school, completed three to seven years of accredited residency training, is licensed by a state medical board, and has passed one or more exams administered by a member of the ABMS.” A record of doctors who have obtained this certification is available at www.certificationmatters.org.
The most difficult factor to gauge before you meet—and one of the most important, according to a 2014 survey from The Associated Press and the NORC Center for Public Affairs Research—is the interpersonal relationship between you and the doctor. According to that survey, more than 50% of Americans base their choice of doctor on personality, and studies by the Cleveland Clinic have echoed these findings.
Identifying a competent medical doctor with an excellent bedside manner, however, can be difficult. Consumer Reports recommends, “Use your first visit as a litmus test. Some factors to consider: Does the doctor listen to you without interrupting? Does she fully answer your questions? Does she explain your diagnosis and treatment, and specify a date for a follow-up visit?”
Sometimes, the doctor you need may not be the doctor you like, especially when dealing with specialized procedures. The best surgeon for your condition may be an arrogant jerk or have the personality of a plant. It’s all a matter of weighing the pros and cons of working with each individual! However, when building a long-term doctor-patient relationship, you want to seek out a doctor whose communication style and personality are compatible with yours.
Once your list is tapered down to a few desired physicians, call each office to verify that the doctor currently accepts your insurance. While their practices may be listed as approved within the insurance network, that information may be dated or incorrect. During our research, we also learned that while some doctors within a practice may accept your insurance, others may not. When you find an in-network doctor who meets all of your criteria, make sure that they are accepting new patients. Then, you are ready to make an appointment!
How often should you see your physician? Experts have differing opinions on how often you should see your doctor, especially when you are well and have no symptoms. Most private insurance companies and Medicare will pay for one wellness exam annually. We recommend that you see your primary physician (for an annual physical with blood analysis); a dermatologist (for a full body scan for skin cancers); and an ophthalmologist (for a complete dilated eye exam) each year. Individuals over 40 should also consider a seeing a gastroenterologist for an annual colonoscopy.
When should you seek out a specialist? If you experience a serious condition or have a family history of a disorder, build relationships with specialists before a serious problem surfaces (for heart disease, for example, visit a cardiologist). You can ask your primary physician to make a referral, and some specialists even accept self-referrals. It may also be wise to obtain a second opinion if your regular physician cannot solve your problem within a reasonable amount of time. However, always check with your insurance carrier to make sure you are covered before proceeding to specialists or other doctors.
When you call for your appointment, give a brief summary of your issue. According to a study of 2.5 million individuals by online doctor-booking resource ZocDoc, Tuesdays are the busiest times for medical practices. Some research indicates that most appointment cancellations happen on Monday, so that may be a good time to call if you need to get an earlier appointment. You don’t have to go into too much detail, but provide the receptionist with a solid idea of the reason for your visit. Make sure to alert him or her if the problem is urgent. For some issues, staff will know immediately if bloodwork or other tests are required, which allows them to plan accordingly and may save time on unnecessary additional visits.
You may face a longer-than-usual wait for your first appointment with a new medical provider. The best strategy is to tell the appointment rep your desired dates and times, but then say that if they are not available, you are flexible. Once you are in the practice’s system, your chances of being bumped up to an earlier appointment increase. If you don’t receive a good date or time, ask to be placed on the waiting list in case someone else cancels, or call every few days in the morning to see if there’s any chance they could work you in. Many doctor’s offices are now channeling patients with minor or intermediate problems to their nurse practitioners and physician’s assistants, and you may be able to get an appointment faster with one of these professionals (if your issue is not too severe).
If you have minor or short-term problem like the flu, many doctor’s offices will take walk-ins on the same day you call. However, expect your time in the waiting room to be longer if you don’t have an appointment. Most experts recommend using the same doctor’s office for all medical events (even if you don’t see the main physician) so that they have documentation of your treatment history on hand and are more likely to notice patterns of issues. Therefore, unless your illness is so urgent that you can’t wait, try your best to see your primary care doctor for all health problems (at least initially; they may refer you to specialists later).
For some medical concerns, you will need your blood drawn and tested in advance so you and your doctor can review the results during your appointment. Most physicians will order blood tests a week before you see each other, including the standard chemistry panel and complete blood count (CBC), which measures about 40 different variables. Depending on your age, existing diagnoses, and health concerns, you may want to ask for additional tests (such as detailed lipids, which studies different cholesterol levels, shapes, and sizes; A1c, to measure diabetes control; prostate-specific antigen (PSA) test for prostate cancer; c-reactive protein, to assess inflammation levels within the blood; and Vitamin D tests). Confirm that the provider who draws and analyzes the blood is covered within your insurance network, since many doctor’s offices use third parties for this task. (If they are not covered, some blood labs will provide a heavily discounted cash price, so be sure to ask.)
Fill out paperwork in advance, especially if it’s your first visit. Many practices will send you the necessary paperwork by mail or e-mail prior to your visit. If they don’t, call and request that the forms be sent to you, or ask if the documents can be found on their website. You don’t want time spent filling out forms to spill over into your appointment! When calling, have your private insurance or Medicare cards ready, and give the receptionist any information (insurance policy number, birthdate, etc.) that is possible over the telephone to help expedite the check-in process. (Bring a form of identification and your insurance card to the appointment as well—most check-in staff will make copies of them to place in your file.)
Have your other doctors send relevant medical records over prior to your visit. This will give the medical office’s staff a chance to review your records before seeing you. The physician won’t have to spend time asking questions that are already answered in the chart or need to request information from the other doctor (which may result in another appointment for you). Ask for any important test results and immunization records to be sent over as well. It is helpful to maintain a file of all your important medical procedures, blood results, tests, immunizations, etc. (ideally, listing all relevant data in electronic form to help save time). For assurance that the documentation will arrive by your appointment and will not get misplaced, pick it up and deliver it personally. Some practices also have online portals where you can review and print your information yourself.
Write down your questions in advance. Medical office employees are often very busy, and it can take a while to receive a call back about your concerns. It’s much easier to ask your doctor in person and hear their answers right away. Bring a list of questions arranged in order of importance. That way, if you only have time to talk about a few, you’ll get the most urgent queries covered first. Be sure to write down your goals for the visit so that you don’t lose track during your appointment.
Come prepared to discuss medical and family histories. Before your appointment, jot down a record of your major medical issues, such as surgeries, hospitalizations, and important diagnoses, as well as those that have affected your relatives. In a 2011 US News and World Report article, Angela Haupt recommends breaking the document down into several sections: “one for past and present illnesses, and the treatment you received, another for hospitalizations, a third for allergies, and a section for family history—including how old relatives were when they were diagnosed.”
Referring to this list during your appointment will decrease your likelihood of leaving out something important, and it gives your doctor a quick way to learn the underlying issues that may affect your treatment. For example, scientists have proven that family genetics play a major role in the development of high cholesterol, certain mental illnesses, some cancers (like breast cancer), and the number one killer of Americans: heart disease. Your doctor needs to know of any diseases that affected your immediate family (parents and siblings), as well as your grandparents, to have a full understanding of factors contributing to your health.
Bring a list of your current medications. Develop an electronic chart with the names of your medications, their dosage, how often you take them, and who prescribed them. Save it to your computer so you can simply print out a copy before you attend each appointment and hand over the printout to the nurse who is checking you in. This is much more convenient than dragging in a bag of pill bottles, especially if you are taking a lot of medications! Be sure to include any supplements, vitamins, and herbs you may be taking on your chart since they can interfere with the absorption of certain prescriptions, alter their effectiveness, or inflate their potency. Some interactions can even be deadly! (Visit www.mikedubose.com/supplements for our article about the dangers of supplements, written with the help of Dr. Surb Guram.)
Record a list of symptoms, including when and how frequently they occur. This information allows your doctor to immediately narrow down potential diagnoses without expensive, time-consuming tests. Pay particular attention to any patterns that seem to be appearing in your symptoms. Dr. Orly Avitzur, MD, a medical advisor with Consumer Reports, recommends that patients keep a “symptom diary” to help identify triggers. This record should note how you feel (especially the severity of the pain) and what is happening when the issue occurs (e.g. you just mowed the grass; you recently changed laundry detergents; you ate a meal containing certain ingredients; the weather changed; etc.). Other items to not overlook are: recent surgeries or medical procedures; prescription side effects; quitting or adjusting your meds; changes in exercise levels; loss of appetite or overeating; sexual problems; unusual stressors (like losing your job or going through a divorce); blood in your stool; and changes in your bathroom habits. This information is very helpful in finding the true cause of your problems, versus the physician merely treating the symptoms.
Don’t forget to include emotional or mental issues that are troubling you. Science has proven that there is a strong connection between emotional wellbeing and health. Stress, for example, can trigger panic attacks, the symptoms of which (racing heartbeat, chest pain, and breathing problems, to name a few) mimic those of a heart attack! Mental health issues like anxiety and depression can also translate into physical problems such as fatigue, headaches, irritability, and stomach or joint pain.
Many people are embarrassed to tell their doctor that they have depression or anxiety, but these are important pieces of the puzzle. If you keep your doctor in the dark about your emotional and mental issues, they can’t make an informed diagnosis and prescribe the correct treatment to improve your condition. Doctors can also guide you to a good professional counselor or psychiatrist, which can help you work through anxiety, depression, and excessive stress. (We recommend Dr. Fredrick Mau as a counselor and Dr. Josh Fowler, MD for psychiatric services.)
Weigh yourself before coming in to save time. The best time to weigh yourself is when you first wake up, after you empty your bladder but before you eat breakfast. Using an accurate scale (Weight Watchers makes a good one), weigh yourself with no clothes on and record the result. Then, report your weight to the nurse when you are called back for your appointment so you can skip that step in the process.
Practice good waiting room etiquette. When you arrive, check in with the receptionist and then take a seat. Remember: be polite! Front desk staff members are human beings, and they often have little control over matters like appointment availability or schedules running behind. If you have been waiting for more than 30 minutes after your scheduled start time, politely inform the receptionist and inquire when the appointment might occur. If you need to reschedule, you’re much likely to get a good appointment time if you’ve been pleasant!
Come prepared with plenty of reading or work materials to keep yourself busy while you wait. Place your cellphone on silent or vibrate so that it does not disturb others if you receive a call, text, or e-mail, and take any phone calls that you absolutely must answer outside. It’s amazing how many people think it is appropriate to have loud, personal conversations in a crowded waiting room! Turn your cellphone off once your name is called to go see the doctor.
Be prepared for a screening by a nurse. Before you see your doctor, his or her nurse will normally inquire about your reasons for coming in, record some basic data like your current medications and blood pressure, and ask if you need any prescriptions renewed. Once you have been prescreened, you will be placed into a queue of patients waiting to be seen by the doctor. Bring your reading or work materials back with you to keep yourself occupied.
Speak openly and honestly. You have a limited amount of time with the doctor, so it’s important to be as direct as possible about your issues and concerns.Catherine Winters recommended in a 2016 Parade article, “To get the most from your visit, your doctor wants to know why you’re there, ASAP.” Be friendly, but zero in on the issues quickly: the more time you chit-chat, the less time is left to talk about your medical condition. Above all, tell the truth, even if it’s embarrassing! Doctors “need to know the gory details,” according to Winters, and they’ve likely heard much worse over the course of their schooling and careers. Although a study by the Cleveland Clinic and Parade of 1,000 people found that many had lied about exercise (13%), diet (8%), drinking excessively (6%), and consuming (or not consuming) medications (5%), you’re only hurting yourself if you give your doctor an inaccurate image of your health practices.
Research potential disorders and their treatment options so you are prepared to discuss them with your doctor. There are many reputable websites (such as the Mayo Clinic Symptom Checker and WebMD) where you can enter your symptoms and receive some possible answers about what may be causing your medical problems. You should certainly take an active role in your health and bring up any ideas you have with your physician; however, take most of what you read on the Internet with a grain of salt. Don’t insist on a certain cause, diagnosis, medication, or treatment because you’ve read all about it online—leave that up to the professional with whom you’re meeting with face to face. Once you have been diagnosed and have jointly created a plan of action, you can conduct further research based on what you have learned at the appointment.
Be aware that it is acceptable to share any concerns you may have about your diagnosis or discuss alternative treatment strategies with your doctor. For example, if you are overweight and your cholesterol is high, you can suggest that you try to lose weight and exercise more instead of taking medications for a few months. Then, schedule a follow-up appointment to see how you are progressing and if your efforts paid off. You and your physician can analyze the results and decide how to proceed from there.
Consider bringing a friend or relative. Take a small pad of paper and a pen with you to your appointment to document the important points. If you think you may become overwhelmed with the amount of information discussed, ask a trusted person who is a good listener and has excellent hearing to come with you. He or she may ask questions you didn’t think of beforehand, and can help you recall points that you forget later.
At the end of the appointment, verbally summarize what you have talked about with the doctor. This should include any action items that you or the medical staff will be responsible for (e.g., taking medication for a certain amount of time, future tests, follow-up telephone calls or appointments, researching specific treatments, etc.). Ensure that you completely understand your treatment plan and have asked any questions that are on your mind before you leave the office. If something confuses you, discuss it with your physician until you are both on the same page.
If your doctor wants to order any tests, it’s acceptable to ask why (and to ask for an alternative to any tests that generate high radiation dosages, such as CT scans). You should receive the results of follow-up tests within 7-10 days; if not, be sure to call for the results. Above all, if the doctor feels like you need to take a test because of a serious problem, do it! Mike’s life was saved due to an additional heart test that was suggested by his internist.
If you do not think you can afford a test (even after confirming that the hospital or facility that will perform it is in-network with your insurance), ask your physician if he or she is aware of any cash discounts or payment plans. If your doctor provides you with an expensive prescription or one that your insurance may not cover, ask about generic options, or see if the doctor has any discount coupons. (Surprisingly, many prescription drug companies offer discount coupons that can be obtained online.)
Make follow-up appointments and arrange any other visits that are necessary. Arranging future appointments immediately upon leaving (rather than calling back later) will make it less likely you will forget, and more likely that you will obtain a preferred appointment time. If you have a smartphone, plug the appointment into it, but also ask for an appointment reminder card. Post it in a visible location so your spouse can also see it and remind you.
If your doctor has ordered any tests or images taken, start a file with copies of the results. Take notes on any health or mood changes due to medications or other treatments your doctor has prescribed, and add them to the file. Bring this information to your follow-up appointment, and you will have a “jump start” on making the most of your visit the next time around!
The bottom line: Many doctors are feeling pressure to maximize profit by seeing the most people possible. However, this can mean that patients leave their offices with more questions than when they arrived…and possibly even a misdiagnosis! By taking a few simple steps to prepare, however, you can optimize the precious minutes you spend speaking directly to your physician. You’ll be free to discuss how you can solve the problem and live your healthiest life!
For more health articles written with Dr. Surb Guram, MD, including a series on how to improve your chances of living to 100 years old, visit our nonprofit website www.mikedubose.com.
About the Authors: Our corporate and personal purpose is to “create opportunities to improve lives” by sharing our knowledge, research, experiences, successes, and mistakes. You can e-mail us at firstname.lastname@example.org.
Mike DuBose received his graduate degree from the University of South Carolina and is the author of The Art of Building a Great Business. He has been in business since 1981 and is the owner of Research Associates, The Evaluation Group, Columbia Conference Center, and DuBose Fitness Center. Visit his nonprofit website www.mikedubose.com for a free copy of his book and additional business, travel, health, and personal published articles.
Blake DuBose graduated from Newberry College’s Schools of Business and Psychology and is president of DuBose Web Group (www.duboseweb.com).
Katie Beck serves as Director of Communications for the DuBose family of companies. She graduated from the USC School of Journalism and Honors College.
Dr. Surb Guram, MD is a board-certified internist and a graduate of the University of South Carolina School of Medicine. He is a partner with the SC Internal Medicine Associates in Irmo, SC and has practiced internal medicine in the Midlands for the past 30 years. See www.scinternalmedicine.com for more information on Dr. Guram and his practice.
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