Communicating With Health Care Professionals

People who communicate effectively with their doctors and other health care professionals tend to enjoy better health than people who do not. Effective communication requires active participation in one's own health care. Active participation includes learning about health care issues, visiting a doctor regularly, obtaining appropriate preventive care (see Section 1, Chapter 5), and remaining observant for signs of ill health or bodily changes, such as a change in the color of a mole or detection of a lump in the breast or testicle. Active participation also means monitoring one's health in the case of a specific disease. For example, a person with hypertension would regularly monitor blood pressure; a person with diabetes would regularly check blood sugar level.

Having a Primary Care Doctor

A primary care doctor should be the entry point into the health care system. Having a primary care doctor has many advantages and usually leads to better care. People who do not have a primary care doctor are more likely to inappropriately seek help in a hospital's emergency department or to be seen by a doctor they do not know. In such cases, medical information that could be important to the treatment of the problem is often forgotten or unknown.

Communication is often better, and medical decisions are more easily made, when an established relationship exists with a primary care doctor. People are more likely to trust doctors they know and, in turn, are likely to experience less anxiety when a medical problem arises. Additionally, doctors who are familiar with their patients are less likely to make mistakes and more likely to provide better health care at lower cost. Primary care doctors often have long-standing relationships with their patients and are familiar with their wishes, the manner in which their patients best receive information, how they cope with adversity, their ability to purchase prescribed drugs, and which family members they rely on.

When to Contact the Doctor

Generally, everyone should routinely visit their doctor, dentist, and eye care professional (for example, an optometrist or an ophthalmologist, if applicable) for preventive care (see Section 20, Chapter 225). The primary care doctor should provide a schedule of what type of care is required, why it is necessary, and how often visits should be scheduled. In general, preventive visits are needed most frequently in infancy and in later life, but the recommended frequency varies depending on personal risk factors (for example, a person with genetic risk factors for a particular disease may need to have more frequent check-ups).

Between preventive visits, people may experience a variety of symptoms that require medical care. Many symptoms and problems, however, can be handled at home without visiting the primary care doctor. For example, most routine colds do not require the attention of a doctor; over-the-counter cold medicine can be used to relieve symptoms, and ibuprofen or acetaminophen can be used to reduce fever. Most small cuts and abrasions can be handled by first cleaning with a mild soap and water, and then applying an antibiotic ointment and a protective covering (see Section 24, Chapter 299).

When unsure about the need for medical attention, a person can call the primary care doctor to clarify the urgency of the problem and determine whether a doctor's visit is required. Some doctors offer e-mail access for nonemergency questions; others prefer contact by phone. In general, true emergencies should be handled by calling the local emergency service to provide ambulance service to the nearest hospital. However, deciding what qualifies as an emergency is sometimes difficult. Good judgment is often required, and under some insurance plans, a doctor's permission to visit an emergency department is required unless the situation is life threatening.

Making the Most of a Doctor Visit

Preparing for the health care visit allows a person to get the most out of time spent with a doctor. During a first visit, the person may wish to inform the doctor of any personal, religious, or ethnic considerations that might affect his health care decisions. If the person already has an advance directive such as a living will or a durable power of attorney agreement (see Section 1, Chapter 9), a copy for the doctor's records should be made. If the person does not already have an advance directive, he may wish to discuss reasons for having one and how to proceed if planning to prepare one. Also, the person should ask questions about the doctor's practice, such as whether to expect other professionals (for example, other doctors, nurse practitioners, or physician's assistants) to participate in his care from time to time and how to handle sudden urgent health problems that occur at night or during weekends.

Information about being hospitalized, using home health services, or receiving care from any specialists or other health care professionals should be given to the primary care doctor. Providing the names, addresses, and phone numbers of other sources of health care can facilitate communication and obtaining copies of medical records. Any plans for upcoming diagnostic testing or new treatment should be disclosed.

Arriving at the doctor's office 10 to 15 minutes before the scheduled appointment helps the office staff ensure that insurance information is current and that any required forms are completed. Current insurance cards, any required referrals, and money for payment of any required fees should be brought along. Just as patients have a responsibility to arrive on time, doctors also have a responsibility to run on or close to schedule except when medical urgencies upset the routine.

Before any visit, the person should collect all drugs currently being taken, including herbals, vitamins, and other over-the-counter drugs, to bring to the doctor. Any forms that will need to be completed by the doctor's office should also be brought. Any significant medical symptoms or questions about medical issues should be written down; it is easy to forget a question during a busy office visit.

The person should listen carefully to the doctor and should respond as honestly and completely as possible. A common topic that requires clear and honest communication involves the taking of prescribed drugs. For example, if a person has not been taking a drug as prescribed, he needs to tell the doctor and provide an explanation (for example, "I seem to get stomach cramps from the medicine" or "I can't afford the medicine"). Other common topics requiring honest disclosure include sexual practices and drug, alcohol, and substance use.

If tests are ordered, the person should ask how and when he will be informed of both abnormal and normal results. It is particularly important that the person understand who is responsible (the doctor or the patient) for initiating follow-up of results. For example, some doctors telephone the patient promptly about abnormal results but mail normal results or discuss them at the next visit.

If treatment for a medical problem is discussed, the person should ask about different treatment options, including their effectiveness and possible side effects. Also, questions should be asked about the specific goals for the selected treatment and how the response to treatment will be followed or monitored.

The person should request an explanation of anything that is not understood and ask for an education sheet or handout on the subject if one is available. Having the doctor write out instructions and having the patient read those instructions back to the doctor at the end of the visit is one way to help clarify communication. It offers the doctor the opportunity to correct any miscommunication. If the patient cannot use written materials, other approaches may be needed to keep track of the information (for example, tape recording the instructions or having a family member or friend agree to read the instructions). The same suggestions apply to a trip to the pharmacy for medications.

A person should refer to the list of symptoms and questions made before the visit and ask the doctor about anything not covered. If many issues remain, the doctor may have to schedule another appointment or may refer the person to another health care professional, such as a nurse, pharmacist, or dietitian, for further information and education.

After the visit, the person should schedule any recommended follow-up appointments. Any prescriptions should be filled, and any material distributed by the pharmacist about the drug should be read. Finally, the person may want to consider keeping a diary of important aspects of his care (for example, a person with constant headaches may want to record when headaches occur, their timing and associations, and their response to medication).

Keeping Medical Records

Keeping a personal record that includes hospitalizations (dates, location, attending doctor's name, diagnoses), a family medical history, and significant medical problems is important, because memory alone is not always accurate, and institutional medical records from long ago may be lost.

Immunization records, which are traditionally kept for children, are important to keep on an ongoing basis throughout life. Complicated medical regimens should be written out on one sheet of paper; these can be updated as new events occur and the information changes. Copies of laboratory results are also useful to keep for future reference.

Laws vary from state to state regarding what parts of the medical record in the doctor's office are available to patients. Doctors often have ownership of the records but can be required by the courts to submit copies or summaries of the records for specific legal situations. Upon patient request, doctors' offices usually copy and release medical records or create a summary of portions or all of the record to send to other health care professionals. A patient who wants a copy of all of his medical records for personal use may or may not be entitled to these records, depending on state law. Generally, a complete record is not needed. Rather, a file should be maintained regarding the most important items, as noted above.

Researching a Personal Illness

When the diagnosis of an illness is first made, the patient is often given a handout at the doctor's office that summarizes key points of information. The person may also have some general knowledge of the condition from newspaper or magazine articles or television or radio shows.

Additional sources of information are available to the person who wants to learn more about the condition beyond what is provided by the doctor. There are many books that provide helpful, general information about illnesses. Some local libraries have helpful sources. However, judging the reliability of printed materials is not always easy.

The Internet provides a lot of information, but much of it is unreliable. Some internet sites are credible; some are not. The National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) have internet sites available to the public that provide useful and accurate information. In addition, many disease-specific, patient-oriented sites (such as the National Multiple Sclerosis Society) provide information for people with a particular disease. On the other hand, sites designed to sell specific products or a specific service may provide biased or inaccurate information.

Support groups provide both psychologic support and important information. A person with a serious illness can find such groups through local newspapers, phone directories, hospitals, doctors' offices, other health care professionals' offices, and the Internet. People facing the same situation or illness have many practical and useful suggestions on how to live with a chronic illness day-to-day, such as where to find pieces of specialized equipment, what equipment works best, and how to interact with or care for someone with an illness. Additionally, chat rooms on the Internet may allow people with a specific illness to communicate with one another and to learn more about their condition and possible resources.

Understanding Managed Care

Managed care is a general term that can be confusing and is not particularly descriptive of any one specific health insurance plan. Each insurance plan is different, and these differences can lead to many problems (often in communication) for patients and their health care providers. Anyone insured through managed care should keep a copy of the description of the insurance plan readily available. The restrictions on what is covered is often an area for discussion between patients and doctors.

Many plans have requirements regarding where health care is to be received. If health care is not received at an approved location or is not provided by an enrolled doctor or other health care professional, the co-pay may be higher, or the services may not be covered at all. However, true emergencies handled through the closest hospital are usually partially or fully covered.

Referral forms approved by the primary care doctor are sometimes required before a person can see a specialist or undergo certain diagnostic tests. If this is the rule in the person's insurance plan, the specialist or testing facility will generally refuse to see the person without the referral or will require the person to pay directly for the service. Each person is responsible for having the correct referral form.

Most insurance programs limit coverage regarding some aspect of medical care. For example, certain diagnoses (such as attention deficit disorder) and certain procedures (such as cosmetic surgery) may not be covered. In addition, sometimes the total number of treatments (for example, physical therapy treatments) is limited during a year or over a lifetime. Insurance companies claim that they do not deny a person the right to a specific procedure; however, they can deny payment, which often means that, effectively, the person has been denied care.