I realize that my blog has been littered with depressing musings on healthcare lately, and so I thought I’d offer up one very positive and “actionable” suggestion for all you patients out there. In the midst of a broken system where your doctor is being pressured to spend more time with a computer than listening and examining you, where health insurance rates and co-pays are sky-rocketing, and where 1 in 5 patients have the wrong diagnosis… There is one “magic” question that you should be asking your physician(s):
“What else could this be?”
This very simple question about your condition/complaint can be extremely enlightening. Physicians are trained to develop extensive “differential diagnoses” (a list of all possible explanations for a set of signs and symptoms) but rarely have time to think past possibilities 1 through 3. That’s one of the reasons why so many patients have the wrong diagnosis – which is both costly in terms of medical bills, time, and pain and suffering.
There is a risk in asking this question – you don’t want to be over-tested for conditions that you are unlikely to have, of course. But I maintain that the cost/risk of living with the wrong diagnosis far exceeds the risk of additional testing to confirm the correct diagnosis. So my advice to patients is to keep this very important question in mind when you see your doctor for a new concern.
- Better tests needed to improve patient care, public health (medicalnewstoday.com)
- Mistakes even good doctors make (consumerreports.org)
- Hypochondriacs Rejoice: WebMD is Beefing Up Its Real-Life Doctor Support (betabeat.com)
- Admit when you fall short: The power of “I don’t know” (kevinmd.com)
Wow, am I the last person on earth sans smartphone?
Most patients I see are surprised to find out that there’s something they should have brought to their doctor’s visit. Granted, I’m an emergency physician, and many of my patients come to me in emergency situations that they can’t plan for. However, most people have some heads-up for going to their doctor. Certainly if you’re going to your annual check-up or a routine appointment, you should bring these items with you.
Keep this checklist readily accessible; even if you’re going to the hospital for an emergency appointment, aim to take the following 10 items with you:
1. A medical card. It would be ideal for every doctor to have a full list of your medical history, but our country is not even close to having a nationally accessible medical record system. To make sure your doctor has your information available, carry a card with you. You can find many cards that easily downloadable on the Internet where you list your medical problems, surgeries, doctor’s names, insurance, and allergies. Especially if you are seeing a coverage doctor or visiting the E.R., he or she may not have your medical record. This makes sure that your doctor can see your most critical medical information.
2. Changes to your medical record. If you have had recent test results since you last saw your doctor, bring these with you. Even if it was your doctor that you’re going to see who sent you to get the test, bringing the results will make sure that they are discussed during the visit.
3. Your medications.
[Read the entire article at http://www.kevinmd.com/blog/2012/10/preparing-doctors-visit-10-bring.html]
8. A family member or a friend. Having someone with you will give you support and company during the appointment. As importantly, they can help remind you of your questions and concerns, and is another measure to help ensure your doctor answers all the questions that you have.
9. A smartphone. Everyone seems to have some kind of smartphone device: an iPhone, a Blackberry, an iPad. There will downtime when you’re waiting. Use this time to look up what your doctor has told you. The smartphone also keeps you busy if your wait is particularly long!
10. Some snacks. Often, there are limited food options are the doctor’s office, and you may be waiting for some time. Unless you’re told not to eat, or have a complaint that you’re not sure how it will go, having something on hand can help make you feel better.
I hope this list is useful for you as you prepare for your next doctor’s visit.
- 5 Ways to Make the Most of Your Doctor’s Visit (sprighealth.com)
- Doctors open their notes to patients – and patients like what they see (washingtonpost.com)
- Think big about mobile health — going beyond medical records (blogs.computerworld.com)
- Benefits of online medical records outweigh the risks (larrysworld.com)
- Why electronic medical records are good for patients (whatsupatupstate.wordpress.com)
- Find out whether your medical record accurate (kevinmd.com)
From Choosing Wisely – a Web site that aims to “aims to promote conversations between physicians and patients by helping patients choose care that is:
Supported by evidence
Not duplicative of other tests or procedures already received
Free from harm
Nine United States specialty societies representing 374,000 physicians developed lists of “Five Things Physicians and Patients Should Question” in recognition of the importance of physician and patient conversations to improve care and eliminate unnecessary tests and procedures.
These lists represent specific, evidence-based recommendations physicians and patients should discuss to help make wise decisions about the most appropriate care based on their individual situation. Each list provides information on when tests and procedures may be appropriate, as well as the methodology used in its creation.
What tests and procedures should patients and physicians talk about? Read the lists:
[Links at http://choosingwisely.org/?page_id=13]
American Academy of Allergy, Asthma & Immunology
American Academy of Family Physicians
American College of Cardiology
American College of Physicians
American College of Radiology
American Gastroenterological Association
American Society of Clinical Oncology
American Society of Nephrology
American Society of Nuclear Cardiology
- 5 Things Doctors And Patients Should Question (boston.cbslocal.com)
- Six Common Medical Procedures You Probably Don’t Need (businessinsider.com)
- Medical societies list unneeded tests to reduce healthcare costs (medcitynews.com)
- Physician Groups Call for Fewer Medical Tests (cherished79.wordpress.com)
- Physician Groups Call for Fewer Medical Tests (news.health.com)
- U.S. doctors advised to reduce routine tests, treatments (ctv.ca)
- Which Medical Tests Are Really Needed? (connecticut.cbslocal.com)
- Choosing Wisely, Continued… (rjwh617dotcom.wordpress.com)
- US doctors urge fewer tests‚ less costly treatments (thehimalayantimes.com)
- Doctor Panels recommend fewer tests for Patients (maryannebachia.wordpress.com)
From the 19 December 2011 Beth Medical Newsletter
Study gauges baseline interest in three-site OpenNotes trial
BIDMC Contact: Jerry Berger
BOSTON – Patients are overwhelmingly interested in exploring the notes doctors write about them after an office visit, but doctors worry about the impact of such transparency on their patients and on their own workflow, a Beth Israel Deaconess Medical Center (BIDMC) study suggests….
While many of the more than 100 primary care doctors who volunteered to participate in this experiment predicted possible health benefits from allowing patients to read their notes, the majority of those who declined participation were doubtful about positive impacts. And among the 173 doctors completing surveys, the majority expressed concerns about confusing or worrying patients with the content. Doctors also anticipated that they would write their notes less candidly and that responding to patient questions might be exceedingly time-consuming.
In contrast to the doctors surveyed, the nearly 38,000 patients who completed the baseline survey were almost uniformly optimistic about OpenNotes, and few anticipated being confused or worried
“The enthusiasm of patients exceeded our expectations,” wrote Walker. “Most of them were overwhelmingly positive about the prospect of reading visit notes, regardless of demographic or health characteristics.”
More than 90 percent favored making the notes available. Well over half anticipated improved adherence to their medications, 90 percent expected to feel more in control of their care, and four out of five predicted they would take better care of themselves….
- Doctors are cautious, patients enthusiastic about sharing medical notes (eurekalert.org)
- Patients eager to see doctor’s notes; physicians, not so much (seattletimes.nwsource.com)
- Patients Want to See What Doctors Write about Them, Says Survey (onehealthyblog.wordpress.com)
- Patients, Docs Differ on Online Notes (abcnews.go.com)
- Patients Want Electronic Link To Doctor’s Notes (informationweek.com)
- How much guidance do patients want with their medical decisions? (jflahiff.wordpress.com)
(CNN) – As much as she would like to, Dr. Lissa Rankin, a gynecologist, will never forget the woman who planned her wedding while lying naked on her examining table.
“Every 15 seconds, her cell phone was going off, and she was answering it!” Rankin recalls. “It was like, ‘That’s not the cake I ordered,’ and, ‘No, it’s the other gown,’ and I said to her, ‘Is this a bad time? Should I come back later?’ “