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How To Work Effectively With A Doctor (GR)

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DRAFT: 07.28.17: NOT FOR CIRCULATION

In order to maximize your time with Dr. XXXXXXXXXXXXXXXX, experience indicates that the following ideas help patients work most effectively with a doctor during the usually limited amount of time patients have with doctors.

Following the guidelines is likely to take some time on your part. If you are not feeling up to it, or if you don't have the time, consider asking a family member or friend to do it for you - for instance, the person we recommend you take with you to the meeting. Divide up the pieces if necessary.

HOW TO PREPARE FOR THE UPCOMING MEETING        

  • Your health insurance policy requires the company's prior approval before meeting with a doctor. Grand Rounds has already obtained approval for the upcoming meeting.  
  • Start keeping track of your symptoms so you can report them accurately.   
    • The doctor needs to know:
      • A description of the symptom. For example, "pain"
      • When it started.
      • The severity of the symptom. For example, "the pain is a 6 on a scale of 1 to 10, with 10 being unbearable pain.
      • When you experience it. For example, "I have pain in the morning when I first wake up, and then again about mid afternoon"
      • How long the symptom lasts. For example, "I have the pain for about an hour at a time."
      • How often you experience it.
      • What, if anything, you tried to make it better - and whether it made it better or worse. For example, "I tried aspirin, 4 times a day, but it didn't help."
      • How it affects your daily and/or work life. For example, "The pain is so bad that when I have it, I can't think straight enough to be able to do my work."
    • In order to help you keep track of symptoms, we provide a Symptoms Diary. Before you see the doctor, the push of a button turns the information into a time saving, quick-to-read, graph which you can print for the doctor. 
      • The diary needs to be accessible via a mobile app for the patient's ease-of-use and to be able to show the doctor instead of a print-out and/or send electronically.
      • If a patient were linked to a specific symptoms diary, s/he could be automatically notified by the system if no symptoms are being noted.
  • Consider how your health condition has been affecting your ability to work.  Tell the doctor at each visit. Ask that the information be noted in your medical record. This information will make it easier if you ever decide to apply for a disability income, such as Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), or a disability income policy.
  • Consider what will be needed at the appointment. For instance:
    • Your information, which Dr. XXX's office will want to see upon your arrival:
      • Your insurance card or i.d. number.
      • Government issued identification such as a driver's license.
      • Contact information for your pharmacy in case a drug is prescribed or renewed.
      • Contact information for the person to be contacted in the event of an emergency.
      • Any documents you have which tell what you want to happen medically in case you become unable to speak for yourself. (For information about these documents which are known as Advance Directives, click here.)
    • Cash or a credit card to pay a co-pay in amount of $XXX. Dr. XXXXX's office accepts the following credit cards: YYY, YYY and YYY.
    • If you have hearing or seeing difficulties, take appropriate aides with you (e.g. eye glasses, hearing aid with new battery).
  • Information about medical history, including current list of prescription and over-the-counter drugs, herbs, vitamins, supplements and home remedies. Include name, dosage and number of times you take it a day. If Grand Rounds already collects this information, it would simplify life and assure accuracy if Grand Rounds put the information into a standardized history which could be sent electronically to each doctor's office, or at least a file for the patient to use to refresh memory and for accuracy.  Alternatively, consider content such as our following current content which would be revised if tGR does not have this information:
    • You can use a mobile app such as AARP's AARP Rx which allows you to take a picture of your prescription bottles with your smart phone. The app will automatically record the drug name, dosage, pharmacy and refill schedule. You don't have to type anything.  You can download the free app by typing the followingi aarp.org/rxapp  offsite linkinto your browser or on your smartphone by sending the text "aarprx" to 742864. 
    • In case it helps, we also provide a List Of Medications that you can print and take with you. 
    • If you don't have a list, consider taking a bag full of your prescriptions with you. 
  • Prepare a written list of your questions and concerns. Research indicates that patients who write down questions do better. 
    • Keep questions specific and brief. The doctor has limited time.
    • It doesn't matter whether the list is neatly typed or scrawled in handwriting. The more legible it is, the easier it will be for you to ask your questions quickly. You can also hand a list to the doctor. 
    • Include questions and concerns about the effect of your health condition and/or treatment on your work and daily life.
    • We provide a "Prioritizer"  that permits you to keep track of  your questions/concerns/thoughts as they occur to you. Before you go to your meeting, you can number them in order of your priority. At the push of a button, the Prioritizer automatically scrambles your questions/concerns/thoughts into the order you set.  You can print the reordered list and take it to the doctor. To see a Prioritizer, click here
      • The Prioritizer should be a mobile app.
      • Depending on the purpose of the meeting, we have a variety of lists of "Questions to ask" -which would be linked to depending on the patient's general situation. - or we could tell patients about the availability of the questions on their mobile device if needed during an appointment. E.g., Sample Questions To Ask A Doctor During A Visit Questions To Ask Before Agreeing To Chemotherapy
      • It would be ideal if the questions/concerns could be sent electronically ahead of time so the doctor can see the list at the start of the meeting. The doctor could either incorporate pertinent information into the general discussion and/or hold them until the end.  
  • It is up to you whether to do research about your condition and/or potential treatments. If you are going to ask the doctor about research you did or information you learned about, make a copy for the doctor or write down the citation where it can be found. 
    • Each document should indicate the source. For instance, if you have an article from the New England Journal Of Medicine, at least one page should show the Journal's name, the date of the issue, and page number. If not, hand write that information on the document or on a cover page.
    • Don't worry if the copy has your notes on it or isn't totally clean. The only question is whether it's easily readable.
    • If there is time, consider sending the doctor a copy of the documents ahead of time so the doctor has time to review the information before the meeting.
    • For tips about doing medical research, click here.
  • It is preferable to take a friend or other person with you to act as as a patient advocate 
    • A patient advocate can help ask questions you don't think of or may be too embarrased to ask. A patient advocate can also help you remember what was said.
    • If no one is available, consider contacting your local disease specific non-profit organization in case they have a volunteer who can go with you.  
    • Professional patient advocates are also available. 
    • For information about patient advocates, including their role, how to choose one, and what to talk about before going to a doctor, click here
    • If you and/or your patient advocate want information about what the various professionals you may meet in a doctor's office do, click here.
  • Consider taking a recorder to record the conversation if the doctor permits.  (When setting an appointment, GR could ask if the doctor permits recording. If no recording is permitted, the section could be revised to state that the doctor does not permit recording. The information is included so the patient can keep it mind for appointments with other doctors in the future.) If you have a smart phone, it likely has the ability to record. If not, basic recorders are not expensive. Today's inexpensive recorders even let you download content onto your computer for storage or for sharing with others via the internet. 
    • Following are some of the advantages of recording the conversation: 
      • You can focus on what the doctor is saying during your meeting rather than making notes. 
      • You can review at home what was said without stress or distraction. 
      • You can stop each time you hear a word you don't know so you can look up the meaning.
      • If you have a patient advocate with you, there will be a record to resolve any disagreements about what was said during the appointment.
      • Family and friends who were not with you can listen to the conversation rather than get one view of it.  
    • Check the batteries ahead of time to be sure they are okay.
  • Learn the medical terms for your diagnosis and symptoms. Knowing basic medical terms helps you understand what the doctor says, helps save time, and makes the conversation more precise.  
    • Consider whether Grand Rounds' doctors can provide key medical words for the health conditions GR encounters. In addition to the words, there could be a recording re how to pronounce the usually complex words and suggestions that the patient practice saying the words. Key words can be revisited periodically (Is it feasible to have the patient say the words, and an electronic system correct pronunciation?)
    • If the diganosis is one of those for which Grand Rounds has videos, recommend that the reader view the video for which a link would be provided. Likewise, we can integrate all other Grand Round services.
  • (If appropriate:) Since English is not your first language, we have arranged that a translator will be available for your meeting by telephone. (or:
  • If English is not your first language and you will need help communicating with the doctor, contact the doctor's office and find out if an interpreter is available. (Many health plans have a directory of doctors who accept their insurance. These directories will also tell you what languages the doctor speaks fluently.)
    • If the doctor's office does not have someone available who speaks your language, arrange for a friend or family member, or a member of your community, who can translate for you.
      • Be sure your interpreter understands your symptoms or condition before he or she conveys your information to the doctor.
      • If your language has more than one dialect, and your interpreter does not come from the same country or background as you, use universal terms to describe your symptoms.
      • During your session with the doctor, don't be afraid to let your interpreter know if you do not understand something that is said, even if you need to ask that it be repeated several times.
    • If a family member or friend are not available, there are professional services you can call from the doctor's office. The service will arrange for a translator to be on the phone to translate what is being said as it is happening. Such services should be arranged ahead of time. For instance, at Applied Language Solutions (www.AppliedLanguage.com offsite link), you register ahead of time. After registration, you get contact information and a PIN number. Then you call and arrange the appointment. Cost is per minute. 
  • Think about your relationship with Doctor XXXX and your other doctors.
    • An active patient thinks of a doctor as a medical advisor rather than a dictator. Alternatively, if you want to turn medical decisions over to your doctor, that is up to you. If you choose the advisory role, consider reading: How To Level The Playing Field With Your Doctor
    • To help avoid problems with a doctor, consider reading: How To Overcome Bumps In The Road  If you read it now, you'll have an idea how to handle any difficulties that come up in your meeting.
  • Think about what to take with you to keep you occupied in case there is a delay in the waiting room or exam room. If you are relaxed while you are waiting, you are likely to be more relaxed with the doctor. Our experience has been that the more relaxed we are, the better we hear and communicate. 
  • Don’t let the emotions that are likely to surface while waiting for the meeting unduly interfere with your life. To learn how, click here. To learn how to deal with fear of an upcoming appointment, click here.
  • Ask whether there is anything you can start doing even before the meeting to help your body deal with your health condition.  Dr. YYYY (the doctor who precipitated the meeting Grand Rounds is setting up) may have suggestions - such as to start losing weight or eat more nutritiously.  Following this advice will give you something to do while waiting for the meeting and help relieve anxiety and other emotions.
  • (include employer's specific procedure for time off so patient can follow it.)
  • Think about who you want to tell at work and/or in your personal life about your health condition, and what you want to say. There is no obligation to tell, but once you do, you cannot take it back. For tips about disclosing your health condition, click here.
  • Last but not least, be on time. In addition to the frustration a busy professional may feel by being made to wait for you, the office may even require that you reschedule your appointment. To help be on time:
    • If you need assistance getting to the appointment, start arranging it now. (If diagnosis is cancer, inform about ACS's transportation program.)
    • If you will be driving, take a few moments now to check an app such as WAZE to determine approximate drive time. Parking in or around Dr. XXXX's office is as follows: YYYYYYYYYYYYYYYYYYYYYY (readily obtainable from the doctor's office or frequently on line) or If you need help figuring out where to park, consider calling ahead to the doctor's office for their suggestions. Maybe there's even a parking spot where it's free or you get a discount.
    • If the expense of travel is difficult for you, see: How To Get Free Travel And Lodging For A Diagnosis Or For Treatment

WHAT TO DO THE DAY OF THE MEETING

Be sure you have with you the following which were noted above:

  • Insurance card
  • Personal ID
  • Pharmacy information
  • Name of person to contact in event of emergency
  • Copy of any advance directives you have
  • Payment for co-pay in amount of $XXXX
  • Eyeglasses/heariang aid
  • Medical history including current list of medications
  • Symptoms history
  • Questions and concerns
  • Copies of any research
  • Patient advocate
  • Recording device
  • Activities for the waiting room

A reminder: it is important to be on time.

WHAT TO DO WHILE IN THE WAITING ROOM

Rather than just "waiting" in a doctor's waiting room, consider the following tips:

  • If you haven't kept a list of symptoms, now is a good time to think about them.  The doctor will want to know.   
    • When your symptoms began, how long they occurred, how often they occurred, what makes them worse, what makes them better. 
    • If you used our tool to help keep track of symptoms, review the print out. (or check that it is readily availabe on your mobile device.) For information about the symptoms tracking tool, click here.
  • If you haven't compiled your questions, write a list of your questions and concerns. If you can access our prioritizer to make notes, you can reorder your list to your priority with the click of a button.
  • If you don't have a list of your medications with you, consider listing all medications you are currently taking. Include in the list drugs you stopped taking since your last visit with this doctor, over the counter medicines, supplements, herbs etc. 
  • If you have a patient advocate with you, consider reminding the person of what role each of you will take during the meeting. 
  • Check that the office has your correct, up-to-date insurance and personal information.

If you have extra time, consider:

NOTE: Do not assume that whatever is happening to the sickest people in the room is what will happen to you.  Even if that person has the exact same condition as you, no two people are alike. What happens to him or her is not likely to be a predictor about what will happen to you.

WHAT TO DO WHILE WITH THE DOCTOR  (If you click on a link, click the back button on your browser to return to this article.)

WHAT TO DO AFTER THE MEETING

After an appointment with a doctor, it is advisable to think back over what was said during the appointment. If you didn't ask all your questions, contact the doctor. If the doctor prefers, set another appointment. (It will be covered by your insurance.)

Review:

  • The discussion about your condition.
  • Your overall health.
  • Anything you agreed to do. For instance, the drugs you agreed to take, exercise you agreed to do, and nutrition habits you agreed to change. Also think about what you agreed not to do.
  • Were all your questions and concerns addressed?
  • Was your doctor thorough?
  • Did your doctor listen to you?
  • Is there anything about the relationship you want to change?
  • If a new treatment was recommended and you haven't decided, 
  • If you have questions, or aren't sure about the doctor's instructions, call or email the doctor's office. Possibly a nurse or other staff member can answer your question. If not, he or she can check with the doctor and get back to you. (If you do call or send an email, see How To Work The System). (If GR has it, include Dr. XXX's  phone number and/or email.)

Update all your doctors about what went on if there were changes in your condition or if any drug changes were made (Is this something GR can do automatically?)

  • When you have more than one doctor: at the end of each appointment, ask the doctor to summarize what happened during the appointment so you can use it to keep your other doctors to date. 
  • Fax or email a copy of the summary to each of your doctors. This keeps them to date. It also gives them an opportunity to weigh in if they see a problem. For example, Ron M. had two serious health conditions, each of which was treated by a different specialist. When one specialist changed Ron's drugs, the other specialist wasn't informed. While the new drugs were compatible with the ones Ron was taking under the other specialist's direction, they worked against what the doctor was trying to accomplish. Ron ended up in the hospital -- a stay that could have been avoided if he'd kept all the doctors up to date with every change.
  • A method for keeping your doctors to date is located in A System for Keeping Your Doctors To Date.

If there were tests, get and review test results: Make a note in your calender for the date the results should be back. If you do not hear from the doctor or his/her staff to confirm receipt of the results before the date you noted, initiate the contact yourself. Do not assume that silence means anything.

If the result of the meeting is that you receive a new, serious diagnosis, or substantial change in your health condition, or a new major treatment, consider asking your doctor about a second opinion. (or even a third or fourth opinion.) They will be covered by your health insurance.  

  • There is no reason for a doctor to be upset about the request for a second set of eyes. In fact, many doctors welcome a second opinion. 
  • For non-medical assistance concerning deciding between various treatments, see our Treatment Evaluator. (While the evaluator does not get into medical issues, it can be revised or eliminated per GR doctors)

If you want to switch doctors, first see if there is any way to get past whatever problems you experienced with your current doctor. See How To Overcome Bumps In The Road. If you still want to switch, see: How To Change Doctors. If necessary, see What to Do If You Have Been Wronged By A Doctor.  (Include mention of what to do re the person's specific health insurance policy.)

If you owe money to your doctor:

  • From your point of view, it is preferable to pay it off over time instead of charging it. It is better to ask the doctor to allow you to pay what you owe in small monthly installments than to put the bill on your credit card. Credit cards have very high rates of interest which quickly adds up. In addiiton, debt on a credit card decresaes the amount of credit available to you on that card. You may need that credit for future medical or other expenses. For information about dealing with a financial crunch, click here.  
  • NOTE: If necessary, doctors ' bills are negotiable. To learn how, click here

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