Get Your Seven Minutes' Worth

The average doctor visit ranges from just seven to sixteen minutes. Sometimes twenty. You can make those precious minutes productive, or you can sit there and waste "your" time while the doctor never gets around to the "real" reason you showed up in the office. It's proven that many patients (mostly men) finally get around to mentioning the blood in the stool or chest pain when the doctor has his or her hand on the exam room doorknob and is about to exit.

To get your seven minutes' worth, try to be the first patient in the morning. The doctor is fresher and might be more on schedule than later in the day. Chances are you'll get more of the doctor's time. You don't want to be scheduled at 11:30 just before lunch. You're definitely not going to get in on time. Another option is to be the first appointment after lunch. Frankly, the best time for a physical exam is the day after Thanksgiving and the week after Christmas. Most people are not focused on their health, and the waiting rooms are nearly empty.

Bring with you everything you think the doctor may need. In fact, send medical records ahead, especially if you're seeing a new doctor. And I'll discuss medical records in much more detail later in this chapter because they really are vital-you need to keep your own records.

What are your expectations when you visit the doctor? One study in the United Kingdom asked patients in the waiting room what they wanted from their visit to a general practitioner. After the appointment, the researchers asked whether the patients' expectations were met. Most patients wanted the doctor to listen to them and then talk about their concerns. They felt this partnership would result in a mutual agreement about treatment. Patients also wanted the doctors to discuss how to stay healthy and reduce their risks for illness.

Interestingly, in this study, when doctors took the time to have a dialogue about a condition, the patients didn't want (or need) prescription medication. How quickly some doctors dash off a prescription, tear it off the pad, and send the patient packing to the pharmacy, when in fact most patients don't want a prescription at all-a prescription for a healthier life, perhaps, but not necessarily drugs.

Unsaid but not forgotten

"Silence is not always golden," according to University of California-Davis researchers in the Archives of Internal Medicine, and what is left unsaid in the exam room is not necessarily forgotten by the patient. This research found that 9 percent of patients had something they wanted to ask their physicians but did not. Subsequently, they reported less improvement in their symptoms. Patients wanted to ask for more medical information, for a physical exam, for a diagnostic test or procedure, new medications, or referral to a specialist-but didn't ask.

Whose fault is that?

Whether the patient felt intimidated or simply forgot, there is a way to assure that your questions will be addressed. I suggest you mail, fax or e-mail your doctor a brief note a day or two ahead of your scheduled appointment to alert the doctor about the major things you are concerned about. Say this: Dear Dr. Jones, I am looking forward to our appointment on Tuesday. I'm especially concerned about a nagging cough and some pain in my abdomen. This clues the doctor in to what is going on. Contrary to what many people do, I advise you not to bring a long laundry list of health concerns because you'll get sidetracked on how much calcium you need to take and not get to the much more important concern about morning headaches. But do bring a list of all medications you are taking, their dosages and frequency, and include herbals and vitamins you buy for yourself without a prescription.

Good communication helps you build trust with your doctor and with other caregivers. A study in the Journal of General Internal Medicine revealed that up to 12 percent of patients surveyed considered changing doctors who did not inform them of their medical options, who did not offer understandable explanations, who did not take time to answer questions or involve the patient in medical decisions. Only 12 percent? I don't understand why someone would continue to see the same doctor who engendered distrust. You don't have to.

I asked [m doctors] if I'd be able to play singles tennis, and they said I could. That made me very happy since I haven't played in five years.

—Walter Cronkite    

Keep Copies of Your
Medical Records at All Times

Unheard of in the past, keeping your own set of records can be truly life-saving. No longer is that manila file in the doctor's office the only place for everything about you, head to toe. Your health records are everywhere. Your family doctor knows when you had your last tetanus shot. The ob/gyn has information on your Pap smear, and the dermatologist has the lab report on the suspicious mole taken off your back three years ago. If you've been in the hospital, inpatient records on your hernia surgery are in their massive record rooms. The walk-in clinic has files on your previous sore throats. And the hospital's emergency department recorded your broken arm or chest pain visit.

Whatever your health status, it's absolutely essential that you gather the pieces of your medical health history and maintain your own master file of medical records.

Why? Because you need them for a number of reasons. First, you need to verify that all information in all your files is accurate, especially regarding information you have told the doctor. I've seen lab reports misfiled, people with similar names getting each other's physician notes, and doctors simply dictating wrong information that is transcribed (or perhaps typed inaccurately) and put into your file.

But why would any of this matter?

• You may need to provide your medical history and past treatment to a new doctor. It would be senseless for a new physician to base treatment decisions on information that was inaccurately recorded or misfiled.

• You might be seeking specialized care from someone like me for a second opinion. We always appreciate knowing the big picture from medical records. I'll give you a life-saving example in a minute.

• Or let's say you are applying for life or health insurance. The prospective insurance company will ask you to sign a release so they can see your medical records. Wouldn't you want to make sure they are correct? You want to monitor what is released and to whom, according to the American Health Information Management Association.

With many different health-care providers, with lab results being faxed and e-mailed, with CT scans digitally transmitted, your personal medical records can be scattered in several doctors' offices, pharmacies and hospitals. And if you have more than one doctor (and most people do), assembling all the essential information in a time of crisis can be a nightmare, if not impossible.

How to gather your records

• Start your medical record keeping right now. At your next doctor's appointment, ask for a release form, fill it out, and sign it. Even if there's a small fee, pay it. If you have trouble getting your records, contact your state's department of health. It's your right.

• Request a copy of everything including x-rays, reports and correspondence with other doctors. Your doctor is required to make that copy (or might hire a service that will do it for you for a fee) and send records to you.

• Do this every time you see a doctor (and specialists) or are in the hospital (pathology reports are helpful if you have surgery) and keep building your records.

• Track down records from doctors you've seen in the past and no longer see. Request copies of your records. If doctors have sold their practices, retired or moved to different health-care systems, your records may take some time to locate.

• Take key records with you to your appointments in case your file has been "misplaced." If your doctor sees patients in different geographic locations, those paper records are toted around in bins and can easily become lost.

Imagine the horror if you were undergoing treatment for a specific condition or tracking cholesterol, thyroid levels or other blood results from the lab and the doctor's paper file could not be found for comparison. It has happened, believe me.

I had the pleasure of treating a woman whose daughter literally saved her life. When she came to our clinic, she had already seen multiple doctors in many different states. Her daughter kept massive and complete three-ring binders of records during her mother's treatment for a life-threatening illness. When she arrived in my office, I had everything I needed to help her make a life-saving treatment decision, knowing all the efforts and results to date. Otherwise, we would have wasted valuable time and made decisions about treatments that might have already been tried.

During a routine check-up, another patient looked fine except for a spot the size of a nickel on her lung, which was revealed on a chest x-ray. We were naturally suspicious, and everything was moving toward major surgery. Somehow, we were able to find a previous physician who had given her an exam fifteen years ago. The chest x-ray taken then showed the same spot. Then there was no need for surgery, but we wouldn't have known that unless we had the earlier records to compare.

Outcomes for you may not be so critical, but there are times when having an earlier chest x-ray or mammogram (for comparison) or laboratory test results on PSA levels, blood counts, thyroid or liver functions, or adult immunizations can make a critical difference in whether you need treatment or not.

The PSA test (a blood test to screen for prostate cancer) of a sixty-five-year-old patient was 3.7. No problem, right, because normal is in a range between 0 and 4. Most doctors would say, "Thanks for coming, see you next year." But this patient brought along records showing that just a year earlier his PSA was 1, meaning his blood levels had increased fourfold in just one year. So even though he was within a normal range, we arranged a biopsy, caught the cancer early and cured it with surgery. Without his records, he would have been a year farther down the road toward prostate cancer.

Another of my patients showed a very low hemoglobin (a sign of anemia), and we became concerned, until we examined the medical records and took note of his heritage. Hemoglobin is a measure of the red blood cells and their ability to carry oxygen throughout the body. His was 9, and normal is 14 to 16. Fortunately, we had available to us his medical records for the past thirty years. We all breathed a sigh of relief when we saw that he had been at 9 for years. That, coupled with the fact that he was of Italian descent, turned an abnormality into nothing. Mediterranean people can often have DNA blood conditions that would produce these readings.

Until Internet medical record-keeping systems become accessible to any doctor anywhere, with your permission, or until we each wear our medical records on a tiny computer chip inside a bracelet or necklace, we're stuck dealing with paper records scattered in every doctor's office and hospital we've ever been in from birth.

A one-place-for-all-records system in cyberspace is coming. "It's all about empowering the consumer,'' predicts Tom Ferguson, a physician and online health-industry expert. "There's a clear shift in control to the patient," he says, "with an entirely new concept of patient-owned and patient-controlled records that only you can allow access to.''

Until then, take control of your paper records.

Certain key medical records should be with you at all times. For example, keep a copy of your EKG-that's a heart tracing-in your wallet or purse if you have any heart problems. Ask your doctor for what we call a rhythm strip. It's a piece of paper about three feet long and three inches high. Simply fold it to about the size of a credit card.

Let's say you show up in the ER with chest pain, and doctors run an EKG. Let's make this interesting. You're on vacation, hundreds of miles from home. You'll get much better treatment and have a higher chance for faster and accurate treatment if doctors can compare the two readings.

If you're traveling, put this key medical record in your travel bag or briefcase. I also advise my patients who have an abnormal chest x-ray to ask us for a miniature version (about eight by eleven inches). This might show a piece of shrapnel or a bullet that could not be removed. Some metal detectors in airports and sensitive venues will pick up these images, and you will need to explain them. You might also wear this information on a medical alert medallion or bracelet.