Work in Partnership With Your Doctor

You, the individual, can do more for your health and well-being than any doctor, any
hospital, any drug, and any exotic medical device.

Joseph Califano

The Wise Medical Consumer

The quality and the cost of medical care depend more on you than on your doctor.

To become a wise medical consumer, start with three basic principles:

• Work in partnership with your doctor and health care team.
• Share in every medical decision.
• Become skilled at obtaining medical care.

By following these three principles, you will gain more control over the quality and cost of your health care than you have ever had before.

Work in Partnership With Your Doctor

Good partnerships are based on a common goal, shared effort, and good communication. If you and your doctor can make these things happen, you will both gain from the partnership. You will get better care and your doctor will practice good medicine.

Five Ways to Be a Good Partner

1. Take good care of yourself. Both you and your doctor would prefer that you don't get sick in the first place. And if problems arise, you both want a return to good health as soon as possible.

2. At the first sign of a health problem, observe and record your symptoms. Your record of symptoms will help both you and your doctor make an accurate diagnosis. And the better job you do recording early symptoms, the better you and your doctor can manage the problem later.

Keep written notes on the symptoms. Record when, how long, how painful, etc., for each symptom.

• Note anything unusual that might be related to the problem.
• Measure and record vital signs.
• Add regular updates and watch your progress. Are your symptoms getting better or worse?

3. Practice medical self-care at home. As the front-line partner, you can manage a lot of minor health problems on your own. Use this book, your own experience, and help from others to create a self-care plan.

• Learn all you can about the problem.
• Keep notes on your self-care plan and what you do.
• Note whether home treatment seems to help.
• Set a time to call a health professional if the problem continues.

4. Prepare for office visits. Most medical appointments are scheduled for only 10 to 15 minutes. The better organized you are, the more value you can get from the visit.

• Prepare an Ask-the-Doctor Checklist (right).
• Update and bring your list of symptoms and your self-care plan.
• Write down your main concern (chief complaint) and practice
• describing it. Your doctor will want to hear that first.
• Write down your hunches or fears about what is wrong. These are often helpful to your doctor.
• Write down the three questions you want answered the most.(There may not be time to ask a long list of questions.)
• Bring along a list of the medications you are taking.

5. Play an active role in the medical visit.

• State your main concern, describe your symptoms, and share your hunches and fears.
• Be honest and straightforward. Don't hold anything back because of embarrassment. If you don't intend to fill a prescription, say so. If you are getting alternative treatment such as acupuncture or chiropractic treatments, let your doctor know. To be a good partner, your doctor has to know what is going on.
• If your doctor prescribes a drug, test, or treatment, get more information.
• Take notes. Write down the diagnosis, the treatment and follow-up plan, and what you can do at home. Then read it back to the doctor to be sure you have it right.

Finding the Right Doctor

If you don't have a family doctor (primary care physician), now is the time to get one. Everyone needs a regular doctor. A host of specialists working on separate health problems may not see the whole picture. In choosing a doctor there are lots of questions to ask, but these three matter the most:

• Is this doctor well-trained and experienced?


• Is this doctor available when needed?


• Will this doctor work in partnership with me?

Training and Experience

For most people, a good choice for a family doctor is a board-certified family practice doctor or internist. For children and teens, a pediatrician is a good choice. These doctors have broad knowledge about medical problems.

Availability

Because health problems rarely develop when it's convenient, it helps to have a doctor who can see you when needed. Call or visit the office. Tell the clinic receptionist that you are looking for a new doctor. Ask these questions:

• What are the office hours?


• If I called right now for a routine visit, how soon could I be seen?


• How much time is allowed for a routine visit?


• Will the doctor discuss health problems over the phone?


• Does this doctor work with nurse practitioners or physician assistants? These primary care providers have special training for managing minor and routine medical problems. For many health problems, these professionals can often see you sooner, spend more time with you, and help you just as well as a doctor can.
  
  Also ask if the doctor is eligible for maximum payments under your health plan.

Partner Potential

During your first visit, tell your doctor that you would like to share in making treatment decisions.

Pay attention to how you feel during the visit.

• Does the doctor listen well?


• Do you think you could build a good working partnership with this doctor?

If the answers are "no," consider looking for another doctor.

But I Want a Take-Charge Doctor

Not everyone wants to be a partner with his or her doctor. Maybe you don't like to ask your doctor questions and you don't want to share in any decisions. Would you rather just let your doctor tell you what is best for you? If that's what you prefer, tell your doctor. Most doctors have a lot of patients who don't want to be a partner. Let the doctor know what you expect.

Is It Time for a Change?

If you are unhappy with how your doctor treats you, it may be time for a change. Before you start looking for a new doctor, tell your current doctor how you would like to be treated. Your doctor would probably be pleased to work with you as a partner--if only you would tell him or her that that's what you want. Otherwise, your doctor may think that you, like many patients, want him or her to do all the work.

Notes:

Ask-the-Doctor Checklist

Before the visit:

* Complete the Healthwise Approach and take it with you.

* Take a list of medications and record of last visit for similar problems

During the visit:

* State your main problem first

* Describe your symptoms

* Describe past experiences with the same problem

Write down:

* Temperature

* Blood pressure

* The diagnosis (what's wrong)

* The prognosis (what might happen next)

* Your self-care plan (what you can do at home)

For drugs, tests, and treatments, ask:

* What's its name?

* Why is it needed?

* What are the costs and risks?

* Are there alternatives?

* What if I do nothing?

* (For drugs) How do I take this?

* (For tests) How do I prepare?

At the end of the visit, ask:

* Am I to return for another visit?

* Am I to phone in for test results?

* What danger signals should I look for?

* When do I need to report back?

* What else do I need to know?

The Healthwise Approach

Step 1. Observe the problem.

* When did it start? What are the symptoms?

* Where is the pain? Dull ache or stabbing pain?

* Measure your vital signs:

• Temperature


• Blood pressure


• Pulse


• Breaths

* Think back

• Have you had this problem before?


• What did you do for it?


• Any changes in your life (stress, medications, food, exercise, etc.)?


• Does anyone else at home or work have these symptoms?

Step 2. Learn more about it.

* Read the Healthwise Handbook

* Other books or articles in Internet

* Advice from others (lay or professional)

Step 3. Make an action plan.

* Your tentative diagnosis

* Home care plan

* When to call your doctor

Step 4. Evaluate your progress.

* Are your actions working?