Acute Health Care Visits

     Many health care providers are rushed because of significant time limitations on visits.  In order to make a medical practice financially feasible, most office visits are only set up for 10-15 minutes.  In these 10-15 minutes your health care provider needs to review the chart, take a patient history, examine the patient, explain his or her findings to the patient and write a progress note and prescription.

     To assure that your agenda is covered, it is essential that as a health care consumer you are prepared for the appointment. If you are not an active partner with your health care provider you are guaranteed to get sub-optimal care.  Being prepared for your appointment assures that the fifteen minutes you have are utilized to optimize your health.  

Steps to preparing and organizing for your doctor visit

Helpful tips when visiting you health care provider

• Be on time.  Being late to an appointment compromises the amount of time you have to spend with the health care provider or may make you cancel your appointment.  The health care provider has a busy practice and being on time shows him or her that you not only value his or her time but you also value your health. 
• Get to know your doctor.  Having a personal relationship with your doctor can have a positive impact on the care that you receive. 
• Give a good history.  Spend some time before the appointment preparing for the visit by taking notes so you can provide the doctor with an accurate description of your problem or concerns.  An accurate history is the most valuable tool a doctor uses in making a correct diagnosis.
• Use the forms in the appendix or a tape recorder to capture comments made by the doctor.
• Bring someone with you to be an extra set of eyes and ears.
• Talk openly about alcohol, tobacco and lifestyle changes.
• Ask the health care provider to slow down or speak-up if needed.
• Ask the doctor to explain things in plain English.
• Bring in one page of organized questions in order of importance with a copy for your health care provider.
• Bring in your personal health care record.
• Ask the health care provider for copies of tests and lab work.
• Assure that you understand what the doctor is saying to you.  Repeat the important information back to him in your own words to assure you understand what he/she is saying. 

Question your Doctor

     Assure you are not pushed out the door with a diagnosis and a prescription.  Before leaving the office make sure that you understand what the doctor thinks is causing your problem and what the treatment plan is.  Table 3 suggests some questions to ask when you are presenting with a new problem or diagnosis.   

     Asking questions about medical testing and treatments helps assure you are a partner in your medical care.  Medical testing is done so routinely in health care that it is often never questioned.  Medical testing and treatments involve risk and it is important to discuss this in detail with your health care provider.  More testing is not necessarily better; sometimes waiting out symptoms may be a better option than testing or treatment.  When a new test is ordered ask the questions listed in Table 4.

     It is important to have a full understanding about the treatments that the doctor orders for you.  Table 5 provides a list of questions to ask your doctor when a new treatment is ordered. 

Table 2: When presenting with a new problem or a new diagnosis

Table 3: When a new test is ordered

Table 4: When a new treatment is ordered

Different types of health care encounters     

     Step number two in preparing for your doctor visit involves giving a concise history of your current concern.  This section of the chapter provides a framework for you to organize and communicate your concerns under the three types of office visits: acute problems, follow ups, and maintenance visits. 

       The most important part of an office visit is being prepared.  Take 15-20 minutes before each appointment to prepare.  Use the steps below to optimize your appointment time. 

• Bring your personal health record to each appointment.
• Accurately describe signs and symptoms.  Use the form in the appendix that best describes the type of office visit you are having - to help you relay this information. 
• Prepare a list of questions (Use question form in appendix) in order of importance with a copy for you and your doctor. 
• Keep it short and sweet.  Stay focused on your problem. 

Communicating with your health care providers in different situations

Acute visit

     Acute visits are appointments with the health care provider that revolve around a specific complaint.  Common examples of acute visits are cold symptoms, fever, stomach pain, diarrhea, constipation and weight loss.  Use this visit to focus on the current problem and not to discuss multiple other problems.  Acute visits are usually set up for short periods of time, often only 10 minutes.  There is limited time, so use that time wisely. 

     Come to the appointment prepared.  Filling out the acute visit form before the appointment assures proper information is transmitted to your health care provider.  When acutely ill, a prepared history can significantly enhance the doctor’s ability to accurately diagnosis and treat the problem.   Diagnosis can be made the majority of the time with only a history if the right questions are answered.  The problem is that the right questions are not always asked.  Solution: answer the questions before they are asked. 

     The next part of the acute visit is the physical exam that is preformed to confirm the findings on history.  If the history and physical are inconclusive, diagnostic tests are ordered.  

     Many of these tests can be eliminated with the use of a good history and physical exam.  While many diagnostic tests are necessary to make the diagnosis, many are not necessary and may cause more harm than good.  No test is without risk including immediate risk from the test such as risk of infection with a blood draw or long-term risk such as exposure to radiation from x-rays, CAT scans and MRIs. 

Table 5: Steps in preparing for an acute visit

Follow up visits

     Follow up visits are appointments that take place to follow up on an acute or chronic problem.  At this appointment the doctor needs to know how the patient is doing in regard to the problem.   It is important to have an understanding of what type of information the doctor needs from you to make a full assessment of the problem.  For example, some one with diabetes, the doctor will want to see blood sugar results that the patient has obtained with the use of a monitor. 

     How does the patient know what information the doctor needs?  They ask.   Every time that you have an appointment with your health care provider a key questions to ask is: what type of follow up is required and how you can aid in getting this information.   The acute doctor visit forms aids you in this venture as they provide a prompt for you to ask the doctor what type of follow up is required.  Record on the acute visit form when your follow up appointment is and what type of follow up information that the doctor requests for that visit. 

     Every chronic condition that you have should prompt a question to your doctor about what type of follow up you require.  Examples of follow-up information you can get your doctor include: blood pressure readings if you are afflicted with high blood pressure or daily weights if you have the diagnosis of congestive heart failure. 

Maintenance Visits

     Maintenance visits are visits that do not focus on any one problem or disease state but looks at your overall health.  They are key components to good health.  These visits assure that preventative health care screenings, lifestyle, medications and overall health is optimized.  Based on the findings of this exam more intensive testing or examinations may take place in the form of a follow up visit.  The most common maintenance visit is the annual exam.  Another type of maintenance visit is the initial visit with a doctor. 

Annual Visit

     Annual visits assure optimal health.  The annual visit entails a history and physical exam, review of medications and assures your entire preventative health care measures are up to date.  Schedule this appointment at a time when you are not sick so this appointment focuses on your overall health picture and not on an acute illness.  Doctors are unable to handle too many health problems at one visit.  

     Chronic diseases need to be monitored regularly.  Health care providers are often very busy and do not take the time to adequately test you for diseases that are in the early stages.  The disease states only get worse if they go undetected.  In today’s busy health care setting, helping the health care provider with disease detection – by following guidelines for preventative health care screenings - is the only way to assure you are properly monitored.

     Preventative health care is essential to maintaining a good quality of life.  The annual visit is a time to get your preventative health care taken care of.  Doctor appointments often involve the doctor flipping through your chart to find out what preventative health measures need to be taken.  The chart is glossed over by the doctor and under the pressure of a short office visit many things can be missed.  It is therefore extremely important that each patient is prepared for what preventative measures need to be taken to assure they are all done.

      Health care responsibility is essential in the annual visit.  It is a time when you assure that your overall health care is being evaluated comprehensively.  The guide to your annual exam will guide you through the steps to assure your total health picture is evaluated. 

     Before the appointment, complete the annual visit form including recording any symptoms that you are having and their descriptions, social questions, the depression screen and the functional assessment (for the older adult).  Lastly, assure that the questions at the bottom of page three of the annual visit form are asked during the visit.  Do not rely solely on your doctor – help your doctor care for you appropriately. 

Initial visit

     The first visit with a new health care provider is a time when a patient needs to convey a complete medical history.  The completeness of this medical history is essential to receive quality care.  Health care providers need a plethora of information about you including: past diseases, surgeries, family history, social history, medications, medication allergies and many other items to provide safe care.  The individual who has lived over fifty years has a lot of history behind them, which often translates to a complex medical history.  Without preparation before the appointment it is not possible to convey accurate information to the new health care provider. 

     Maintaining a personal health care record significantly aids this process.  It allows you to record all vital medical information.  Bringing a copy of this information assists your health care provider in giving you the best care possible. In addition, bring a completed copy of the annual evaluation form to the initial visit. 

Summary

     Utilize the forms in this section to adequately prepare for your health care visit.  Maximize the short amount of time that is available for the appointment, by coming into the appointment prepared.  This is will result in significantly improved health care.  It may even save your life.