Making the Most of Health Evaluations
Nowadays, a patient has 15-minutes to be evaluated by the primary care physician in the office. Sure, a patient may request longer appointment time using the appointment type options. No matter how long your appointment is, you still have to make sure that you and your doctor can get everything he or she needs to figure out the cause of your presenting symptoms or signs. Here are the 10 cardinal rules of efficiency at every doctor office visit or urgent care visit within your control:
1. Get to the scheduled visit prepared to discuss your most important reason for the visit!
2. Know the major problem that prompted you to seek the evaluation as specifically as possible
3. Engage discussions during the visit focusing on the major problem while answering clarifying questions from the screener and/or the provider: be frank
4. If you are seeking the evaluation of a symptom, be prepared to provide what specific symptom it is; a good estimate of when you first felt the symptom; the location of the symptom; duration & frequency of the symptom; and what makes the symptom come on, go away, improve a little or what makes it get worse
5. If you are seeking the evaluation of a sign, be prepared to discuss when you first noticed the sign, how often you have been noticing the sign and why you are worried about the sign or signs
6. In a review of human body systems (ROHBS) that follows—characterized typically by pointed questions answered with “yes” or “no,” your provider is merely attempting to narrow the possible cause of the major problem: never misguide, just reflect what else you have felt or what else you have seen
7. Have an organized way of reflecting what medications—all medications (over-the counter & prescriptions) you are currently taking including the name of the medication; the dose (mg, g, ml, etc.); the route (by mouth, on your skin, etc.); and how often you take the medication (once, twice, 3-times, 4-time or just at sleep time): it is best to bring your medications to the visit, if you don’t already have a pre-made medication list
8. Provide any medication allergy you have ever had as well as the specific “allergic reaction”
9. Your past medical problems, family history and social history may be related to or have bearings on your current problem: always have these information handy
10. A well done steps 1-9 above puts your provider to work as you should, right away!
Make no mistake: giving medical history to your provider or obtaining the history of present illness (HPI) from you--the patient is never a game for either one of you. But only you know what symptom(s) or sign(s) made you seek this evaluation in the first place. Your provider is merely searching for the necessary clues to making the diagnosis before developing the treatment plan. And make the diagnosis, he or she will. It is a matter of how long it takes and how much costs will be involved. You would agree with me that the sooner your diagnosis is made, the better. Considering that in healthcare problem-solving, 80% of tasks necessary for reaching the medical diagnosis is in the effort spent acquiring the HPI and ROHBS. Another 10-15% effort is invested in physical examination and sieving through the differential diagnoses (potential diagnoses). The last proportion of the effort is spent in the most expensive and many times unnecessary part of making a new diagnosis: blood tests, imaging studies and the reviews. Lab tests and/or imaging studies may be inevitable in certain cases. But by and large, they are necessitated when the combination of HPI, ROHBS and the relevant physical exam could not enable a firm diagnosis of the presenting problem.