Special Health Care Visits

     Health care visits take place in many settings.  The primary care doctor’s office is only one such setting.  Many visits take place in other settings that are less controlled such as the emergency room and urgent care center.  Another setting that health care visits take place is in the specialist’s office.

     These special health care visits are common times that the continuity of care is broken.  Errors and problems are more likely to set in here.  It is therefore extremely important that patients assume responsibly for their health care in these settings. 

Emergency Room

     The emergency room or an urgent care clinic makes it more difficult to prepare.   Patients being treated in these situations are usually acutely ill and are in no condition to prepare an extensive list of questions and describe symptoms in detail. 

      When going to the emergency room being accompanied by a loved one or friend significantly improves your care.  This individual helps you transmit information to the emergency room staff.  If you are unable to bring your personal health care record, this individual can bring it along for you.  While waiting for the doctor and nurses to care for you, take some time to fill out one of the acute care visit forms.  This gives you an opportunity to think about your current problem and transmit proper information to the health care provider. 

     Emergency room personal are likely unfamiliar with your past medical history.  In order to provide safe and effective care it is important to transmit accurate and detailed information in this setting.  Your personal health record aids in transmitting this information.  While in the emergency room you are often too sick to remember exact details of your past medical history - the personal health record guarantees your history is transmitted accurately.

     The emergency room form is another tool that can help improve your care in the emergency room.  It is a form that allows you to capture information obtained in the emergency room for your personal health care record.  This assures you do not forget what you were told in the emergency room. 

     Lastly, it will help your primary care doctor understand what happened in the emergency room.  Patients typically have follow up visits with their primary doctor after an emergency room visit.  Poor communication between the emergency room and the primary doctor is the norm.   By gathering all the necessary information you can greatly enhance this communication process and more importantly improve your care. 

     If possible when going to the emergency room bring:

1. Personal health record
2. A loved one or friend
3. The emergency room form
4. The acute visit form – you can fill this out while you are waiting to be seen. 

Specialist

     Specialty visits are initiated when a problem is unable to be handled by the primary care doctor.  Specialist care is common in American health care.  The initial specialist visit is not only an initial visit but also an acute or follow-up visit.  The specialist doctor needs a comprehensive medical history so bring your personal health care record. 

     Depending on the nature of the visit it will also be an acute visit (if a new problem is being evaluated) or a follow up visit (if the specialist is following up on a problem the primary doctor is evaluating).  When you are going to visit the specialist for the first time do the following.

1. Bring your personal health care record.
2. Ask the doctor who referred you what information the specialist will need to provide care.  For example, if you are being seen by a cardiologist for evaluation of cardiac disease, the doctor will need an accurate description of your symptoms, blood pressure readings, any labs you have had and any diagnostic tests already preformed such as a stress test.
3. Ask your doctor to fill out a referral form listed in the appendix to aid the specialist in caring for you.
4. Gather any information for the specialist appointment.  If being seen for an acute problem, provide an accurate description of the problem using the acute visit form.  For example, if you are seeing a lung doctor for cough, stomach doctor for abdominal pain or a heart doctor for chest pain – use the acute care form and acute care describing information in to help transmit information that the doctor needs to provide an accurate diagnosis. 
5. If being seen for follow up on a chronic problem provide the doctor with any information you can on that disease.  If you are being seen by a heart doctor for high blood pressure, provide a record of blood pressures, if being seen by a diabetes specialist provide a listing of your blood sugars. 
6. Bring a self-addressed stamped envelope for the doctor to send you a copy of his progress note and any testing results that he or she has performed.  Give this to the doctor or his nurse at the end of the appointment.  Remind the receptionist on the way out that you want information sent to you.  Add his note in your personal health record.  Your primary doctor will be very impressed when you present him or her with a copy of the specialist progress note.  It will also make the doctor’s job easier. 

Health Care Responsibility - Communicate efficiently

1. Having a firm grasp on your medical history - this is accomplished by completing the personal health care record.
2. Organizing a concise history of your concern - this is accomplished by preparing the forms outlined in this chapter for each health care encounter. 
3. Understanding the chronic diseases that you have – to do this, ask your doctor what chronic disease you have and read up on them.  Learning about these disease can be done through many sources.  Learning about transmission of specific health care information related to common chronic disease can be enhanced by reading the book: Chronic Disease Guide: How to Prevent and Treat Common Chronic Diseases.   
4. Know what questions to ask your health care provider. This chapter provides some general questions. A list of questions through out this book will guide you in communicating with your health care provider.