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 "Could I Be a Better Patient?" (Washington Post 9/ 
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Post "Could I Be a Better Patient?" (Washington Post 9/
I read about this article on an MSA-related online discussion group today. Two organizations and their websites are mentioned:
Agency for Healthcare Research and Quality -->
American Academy of Family Physicians -->

Life's Big Questions
Could I Be a Better Patient?

By Jennifer Huget
Special to The Washington Post
Tuesday, September 25, 2007; Page HE06

You think you've got this being-a-patient thing down pat: You put on your paper gown (opening in the back), flip through a dog-eared People magazine, have your blood pressure taken, see the doctor for five minutes, answer his or her questions, pay your co-pay and get back to work.

But is there anything you can do to get more out of that doctor visit?

A lot, according to three experts: Richard Frankel, a geriatrics professor and senior research scientist at the Regenstrief Institute of the Indiana University School of Medicine; Carolyn Clancy, director of the federal Agency for Healthcare Research and Quality (AHRQ); and Richard Kellerman, president of the American Academy of Family Physicians (AAFP). And you'll help your doc do a better job, too.

1. Keep Lots of Lists, and Carry Them Around: Take time to write down your medical history, including any diagnoses and key lab tests you've had, any hospitalizations or surgeries, all the medications you take -- including any herbal remedies -- and your allergies and immunizations, Kellerman advises. And carry the list with you. "You never know when you go out of town whether you're going to end up in an emergency room somewhere," he notes.

2. Bag Your Meds: Before seeing your doctor, put all your medicine bottles -- again, including any herbals or over-the-counter drugs you use -- in a bag and take them along. Your doctor can sort through them with you, looking for potentially dangerous interactions, getting rid of drugs that have expired and simply confirming that "the blue pill that I'm talking about is the same blue pill the patient is thinking of," Kellerman says.

3. Make Another List -- of Questions: "Write down what you want to talk to the doctor about," Kellerman says, "and prioritize." Frankel suggests letting your doctor know from the get-go if you have more than one concern and indicating which one is your top priority. Clancy suggests checking the AHRQ Web site for its question-builder feature (click "Questions Are the Answer" under "Consumers & Patients").

4. And Don't Be Shy About Asking Them: Asking questions "sounds easy," Clancy says, "but people don't do it very often," citing a study showing that the average patient asks only 1.4 questions per office visit -- including inquiries about parking. "If the doctor has a stethoscope in his ears, it's not the best time," Kellerman says. "Otherwise, it's open season."

5. Put It on Record: "If you have made a list of questions or concerns, ask politely to make that list a part of your permanent record," advises Frankel. "That makes it more or less a legal document, leaving no question as to whether you and the doctor talked about that stuff or not. It's a parallel process to the doctor's making written notations," he notes.

6. Take Notes: Write down the things you and your doctor discuss, making sure you understand what the doctor said. Don't hesitate to ask the doctor to repeat something, Frankel says, or even to write it down for you. "We know that there are a lot of medical errors that result from the lack of checking patients' comprehension," Frankel adds. If the doctor doesn't check to make sure you've understood, you should.

7. Bring a Friend: A trusted friend or relative can serve as an extra pair of ears in the doctor's office, Kellerman notes. "Particularly when a patient is older or if you expect something complicated, or bad news, it's helpful to have a spouse, son or daughter -- someone you trust with confidential information" -- join you. "Oftentimes they come up with questions you don't think of in these stressful times," Kellerman adds.

8. Be Wary of Online Health Info: Not all health information on the Internet is reliable, Kellerman cautions. "Talk to your doctor about which Web sites they feel comfortable with. Some have their own Web sites with links to other sites they've checked themselves," he says. Start with the AAFP site.

9. Track Down Test Results: "If you have a test, procedure or operation, be sure you know what happens" during that procedure, Clancy says. "I've had patients who have had hysterectomies but don't know whether their ovaries were removed." That information has important implications for a woman's health, she says. Don't count on your doctor to give you the details, she cautions, as sometimes such communication slips through the cracks; be prepared to ask.

10. Keep a Symptom Diary: "If you've been having symptoms on and off, and that's part of why you've made the appointment, it helps to have some kind of diary or record" of when those symptoms occurred, Clancy says. And don't worry about looking like a hypochondriac, she says; the doctor will appreciate the data and can help you sift the worrisome symptoms from the less important ones.

11. Offer Feedback: "It is our responsibility as citizens to provide feedback" to our doctors, "even if it's a difficult situation," Frankel says. "Be prepared to say, 'Gee, this isn't what I expected; it hasn't gone well,' " if need be, he suggests. "If you have trouble buying an airline ticket, you don't hesitate a nanosecond before saying, 'Can I speak to your supervisor?' But that doesn't often happen in a medical situation." For the most part, Frankel says, "physicians are very open to feedback."

If you have questions you would like to see answered, e-mail and mark the subject line "Big Questions."

Wed Sep 26, 2007 6:06 pm
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