Think Like a Doctor
Doctors approach medical diagnosis in a standardized way. First comes the medical history--the information learned by listening to a patient's description of symptoms and by asking specific questions. Then comes the physical examination, often focused on the organ system(s) that appear to be involved. Finally diagnostic tests and possibly consultations may be requested.

You might think that examinations and tests are the most important in establishing a diagnosis, but in fact it is the history that provides the main clues. When good clinicians take a history, they listen for certain key information: your description of your symptoms, their location in the body, their severity, time of onset, and duration; any aggravating or relieving factors; and, the presence of associated symptoms. Therefore, it pays to come prepared with this information.

Let's take the example of stomach pain. What does it feel like? Sharp? Stabbing? Gnawing? Where is the pain located in the abdomen? When did it start? Does anything make it worse or better, like eating, going to the bathroom or lying down? What else have you noticed since the stomach pain began? Weight loss? Loss of appetite? The answers to such questions will guide everything else your doctor recommends, so try to think about them in advance.

Take Notes
Covering even your chief issues in a 10-15 minute office call can be a challenge. It helps if you first write down the items you need to cover with your doctor, so that you can relate them accurately and avoid forgetting something important. Make sure you prioritize your concerns, however, and be sensitive to time limitations. If you have several problems to address, you may need to schedule a follow-up appointment.

In addition to bringing your concerns in writing, it may be a good idea to take notes during or immediately after your visit, so that you are clear on your doctor's instructions and recommendations. If you are unclear about something, ask.

Bring a Family Member
Having a close family member (or trusted friend) in the exam room helps in several ways. First, your family member can relate observations that may not be as evident to you, or that you simply overlooked. Think of it like having two witnesses to an event. Their descriptions may differ in some respects, but together they paint a more complete picture.

Second, a family member can help you to remember what your doctor said after the visit is over. We all know people who return home from physician visits feeling uncertain about recommendations or next steps. Having a trusted second person in the examining room can improve communication significantly.

Finally, your family member can serve as your advocate, especially if he or she is politely assertive about making sure your concerns are addressed. This is especially important if you're not feeling well yourself.

Watch the Chit Chat
Research shows that physician visits with older patients tend to involve more casual chatter than with younger adults. This may lead to a greater sense of trust and satisfaction with the physician, but it can also prevent older patients from having their health needs adequately addressed.

Yes, some chit chat builds rapport, but don't just assume that if the conversation continues in an informal way, there will be plenty of time for dealing with your important medical issues later. There may not be. Better to turn the discussion toward matters at hand.

Bring Your Medications
Miscommunication about medication instructions and dosages is a huge problem responsible for thousands of preventable complications, hospitalizations and even deaths. Do not assume that because your medication records are "in the chart", you don't need to show your physician what you are actually taking.

Many people carry a list of their medications and dosing schedules, yet discrepancies are found when the list is compared against their pill bottles. Better to bring both the list and the bottles to each visit, so there is no confusion. Also make sure to include any non-prescription medications or supplements that you take.

If You're a New Patient
The foregoing tips are applicable to any visit, but you will need to take some extra steps if you are seeing a doctor for the first time. The most important of these is to have accurate information with you about your health background. Bring any medical records that you possess. Also have a written list of your hospitalizations, medical procedures, surgeries, chronic medical problems, drug reactions and allergies, along with relevant dates.

Finally, if you are seeing a specialist to whom you were sent by your primary physician, be sure you can explain exactly why you are there. Ideally the specialist should have already received information about you from the referring doctor, but communication among health professionals is not always what it should be. A surprising number of specialty consultations end up being unproductive for this reason.

July 2003