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Getting the Most From A Visit to the Doctor
by Lawren H. Daltroy, Dr.P.H.

Citation: Daltroy LH. Getting the most from a visit to the doctor. Harvard School of Public Health: Health Literacy Website. 2001. Available at: http://www.hsph.harvard.edu/ healthliteracy/talk_drvisit.html. Accessed �insert date.�

All of us go to the doctor at one time or another. Considering how important these visits can be, it is surprising that we don't get any training for them. Visits often just seem to happen, and afterwards we find ourselves saying, "Oh! I forgot to ask about...! I wonder what the doctor meant by�!� Knowing what we want out of a visit, preparing for it, and following some simple steps can help us get the most out of our visits.

Before your Visit

Step 1
Know what you want. Most visits for arthritis are not emergencies, so you will have time to prepare. You may want one or more of the following:

A diagnosis. "A name for my condition."
A prognosis. 'What will happen? What will this mean for me?"
Reassurance. 'Just tell me this won't get worse, and I can cope."
A new treatment so your symptoms will go away or stay under control.
An end to a treatment that does not help or is causing problems.
Help with practical problems, like keeping your job, taking care of your family, and keeping up with exercise and a social life.
Help with feelings, fatigue, or depression. �I need to talk to someone who understands and can help.�

Be honest about what you want from a visit. Arthritis can affect all parts of your life. However, many people feel that they need a physical I complaint to justify a visit. If you are really going to see the doctor because you are having trouble taking care of your family or are feeling tired and blue, let the doctor know this. Otherwise the doctor may concentrate on your physical complaint and never address your other concerns.

Step 2
Make a list. Write down what you want from your visit. Ask your family for good questions. Sometimes the people around us see what we need more clearly than we do ourselves. Family members may want information to reassure themselves or so they can help.

Put your most important questions first. You may need more than one visit if you have a long list.

Step 3
Practice asking your questions. Asking questions doesn't seem hard, so why practice? Practice helps us to act. Practice makes us focus, clarifies our thinking, helps us remember, and gives us courage. Studies have shown that patients who practice first ask more questions and get more of the information that they need. Practice is as simple as telling someone else what you want to ask the doctor Listen to yourself as you practice asking a question. Is it clear? Does the other person understand what you want? If not, ask the question a different way. It will pay off.

Step 4
Gather any information about your health that the doctor might need. This includes names and doses of your medicines. It could be a list of your symptoms, test results, or a letter from another doctor. This is especially important for a first visit to a new doctor. The more complete your information is, the sooner your doctor can help.

Step 5
Bring a family member or a friend. For many of us, a visit to the doctor raises anxiety. We�re worried about a new symptom, about the meaning of a diagnosis. It is hard to think clearly and remember things when we're anxious and feeling ill. Another person can help remember things you have forgotten. He or she may hear things that you miss or write things down if you are busy or self-conscious. Make it clear before the visit, however, that your ally is there to support YOU and should stay out of the conversation unless invited.

During your Visit

Step 6
Ask your questions. Most patients ask only a few questions during a visit. The result? Most patients get information than they want, and doctors think that patients understand more than they usually do. If you don't ask questions, your doctor may assume that you understand, or that you do not care to know more. He or she cannot guess what your concerns are. Most doctors appreciate patients who ask good questions.

What is a good question? A good question is specific, timely, and well thought out. A good question gets results.Here are some tips for asking good questions.

Be specific. If you ask, 'How am I doing?" you may hear 'Not too bad.' If you want to know how serious your arthritis is or how long a treatment must be taken, then ask that.
Be direct. Do not hint. Your doctor cannot guess what you want.
Be timely and thoughtful. Tell your doctor at the beginning of your visit that you have some questions. Ask when to bring them up. This gives you both a chance to organize your time together. If you let the doctor know at the beginning that you have several questions, you am more likely to get them addressed. In many visits the doctor starts asking about the first problem mentioned, and the patient does not have time to bring up other important problems.
Get an answer. A good question gets a clear answer. If your doctor doesn't answer, or if the answer is not clear, ask again. Ask for details or simpler I words if that is a problem.
What gets in the way of asking questions? Most people, including many physicians, find it hard to ask questions when they are patients. Common reasons include the following:
Forgetfulness. Time is limited, and you may be anxious. This is why you brought your list! Ask new questions right away when you think of them.
Embarrassment. Because arthritis affects such things as going to the bathroom, having sex, or feeding yourself, you have good reasons to talk about such concerns. Becoming comfortable with your physician may take time. Your doctor's job is to help you live day to day with a chronic disease.
Medical jargon. Many medical words are technical. However, your doctor might not realize you don't understand them, because he or she is so used to using them. Ask if you can repeat something in your own words to be sure you understand.
The doctor is too busy. Doctors get interrupted and sometimes act rushed. However, your time is as important as the next patients�. Asking your important questions first can help you and your doctor organize your visit. Also, you can ask for booklets, a follow-up appointment, or a chance to talk with another caregiver, such as a nurse or therapist.
Feeling intimidated. You have a right to answers to your questions, even if the answer is "We don't know yet, until we do more tests."
Fear of the answers. Fearing the worst is natural, but the worst is rarely true. Most problems in arthritis are manageable. The best way to reduce your fears is to look for solutions and take action.
Feeling that "my question is not important." Anything important to you is worth mentioning.

Step 7
Take part in decisions about your care. Make sure your doctor knows your goals (see that list!). The doctor's goals may be to reduce inflammation and pain slow disease progress. Yours may be to keep working or to be able to pick up your grandchildren. Share your goals with the doctor, to make sure that the treatments meet your needs.

Find our your options. Your doctor will suggest treatments and tests based on his or her experience and knowledge of you. Ask your doctor to discuss the pros and cons. Get information from other health professionals, books, and the Internet.

Find out benefits and drawbacks for each option, for yourself and your family. All treatments are not alike. If more than one might work for you, then your preferences become important. What are the side effects, costs, and likelihood of success for each treatment? Will you need a ride to the clinic every week for one treatment, only once a month for another?

Consider which options are modifiable. Even if options are limited, you may be able to change them to suit you better. Perhaps you can take fewer doses of a drug or substitute one exercise for another. Even small changes can make a treatment more acceptable. You are more likely to stick with a program that suits you.

Don't rush. For most problems in arthritis, you have time to think about changes. If you are unsure about trying a new treatment, ask your doctor what will happen if you do nothing new for a while longer. You may have more time for most decisions than you think.

Step 8
Know your diagnosis, the purpose of each treatment, and how to follow it. There are over 100 kinds of arthritis and rheumatic conditions. If you don't know which one you have, you may easily read about the wrong condition and think it applies to you.

You'll want to know the following:

What is this treatment's purpose? Is it for pain? For swelling?
How long will it take to work? A few days? Three months?
How often do you have to take it? With food or without?
Will it cause problems with your other medications?
How long will you have to take it? A month? Indefinitely?
Are there any likely drawbacks? These include symptoms like stomach upset, but also cost and inconvenience to you and your family.
Are there ways to overcome drawbacks? Having a plan can help you overcome obstacles, and your doctor may know of things other patients have done to cope.
What if the treatment isn't working? Many arthritis medicines work for some people but not for others. Or one might work for you for a while and then stop doing so. If so, tell the doctor, so you can work out your next steps together. Don't stop a treatment without telling your doctor what you are doing and why.

Step 9
Get it in writing. People forget half of what a doctor tells them within five minutes. If you get information about your diagnosis and treatments in writing, you will be less likely to forget and make a mistake that might hurt you. Ask the doctor for booklets about your condition and treatments.

After your Visit

Step 10
Review your notes. Read your notes, and write down anything else you can remember. Date the notes and save them, to help you later.

Step 11
Phone your doctor if necessary. If you forgot to ask the doctor something, don't be shy. Call and ask your question. Your doctor would prefer that you get it right! If you have a problem with your treatment, call your doctor. He or she may want to make adjustments or see you again.

Summing up

You have the right to full information about your health and medical treatments. Make a list of concerns before your visit, and practice asking your questions clearly. In the office, present your most important questions early. Be specific and direct. You can help your doctor help you by providing clear information and by sharing your goals and concerns. Find out the pros and cons of each option. Participate in decision making; you will be more likely to stick with a treatment you helped design. Make sure you know your diagnosis, the purpose of each treatment, and how to follow it. Get it in writing to help you remember. Finally, if you forget something, call back and ask. Doctors are human and they vary in their ability to communicate. It is up to both of you to make your conversation work well.

Lawren H. Daltroy is Associate Director of the RBB Arthritis Research Center at Brigham & Women's Hospital in Boston, Associate Professor in Medicine, Harvard Medical School, and Associate Professor of Health and Social Behavior, Harvard School of Public Health.

Definitions

Clinical Trial
A scientific study designed to test the safety and effectiveness of new treatments that have shown promise in laboratory and animal studies.

Treatments are tested in three phases so as to minimize the risks to participants. In phase I studies, the treatment is given to a small number of healthy people to find out how the drug acts in the body, evaluate safety, and see how big a dose can be given without causing unacceptable side effects. Phase II studies, of a slightly larger group, look again at the treatment�s safety and also at its effectiveness. Phase III studies, which are much larger, look at the treatment�s safety and effectiveness again, comparing it with the current standard of treatment. In a typical study, one group of participants (the �treatment� group) receives the treatment being tested and another group (the �control� group) is given either the standard treatment or an inactive treatment, or placebo. Testing the new treatment against the standard treatment allows researchers to see if the new treatment is better. Testing it against a placebo allows them to see if the participants� response is psychological rather than physiological. (People taking a placebo generally feel better, because they believe they�re doing something to help themselves.) (Edited by Robert S. Dinsmoor, a freelance medical writer and editor based in Massachusetts).

Questions and Answers

Q. My daughter wants me to eat fish three times a week because she things this will help my rheumatoid arthritis (RA). Is she right?

A. Animal studies have shown that components of fish oil called omega-3 fatty acids block the ability of cells to make some of the substances that cause inflammation. These fatty acids are eicosapentaenoic acid (EPA and docosahexaenoic acid (DHA). They are found in cold-water fish such as salmon, mackerel, bluefish, sardines, and tuna.

Studies in humans found that when people with RA took fish oil capsules containing a total of around 3-5 grams of EPA/DHA every day, some of the me experienced a modest decrease in stiffness and joint tenderness. And some were able to decrease the amounts of nonsteroidal anti-inflammatory drugs (NSAIDs) they were taking. In other words, EPA and DHA do not have any major effects on RA, but they might help with symptoms in much the same way as aspirin and other NSAIDs do. Studies have shown that fish oils are also modestly effective in some people with psoriatic arthritis and Raynaud�s phenomenon.

But fish oils do not work for everyone. There�s no guarantee that they will moderate your symptoms. If you want to try fish or fish oils, be sure to discuss this with your doctor. They can interact with other medicines you�re taking, including blood thinners and some herbs.

To get as much EPA/DHA via fish oil capsules as the people in the studies did, you�d have to swallow around 10-15 capsules a day. The capsules aren�t cheap, and your insurance probably won�t cover them. Eating four to six meals of cold water fish weekly may be equivalent to using fish oil capsules and would be part of a healthful diet. (Richard Panush, M.D., Professor and Chairman, Department of Medicine, St. Barnabus Medical Center, Livingston, New Jersey).

Reprinted with permission from Arthritis Self-Management. Copyright � 2001 R.A. Rapaport Publishing, Inc. For subscription information, call (800) 234-0923.

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