communicating with your physician
Post on 07-Jan-2016
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Communicating with your Physician
Dr. Evan W. Kligman
Arizona Center on Aging
agewell100@aol.com
www.aging.arizona.edu
Geriatrics 2
•Aim for a PartnershipLet your PCP know what you want
Do your own researchAsk “why”
Ask about alternativesConsider watchful waiting
State your preferencesCompare expectationsAccept responsibility
Geriatrics 3
Partnership
• Five ways to be a good partner– 1. Take good care of yourself– 2. At the first sign of a health problem, observe and
record your symptoms– 3. Practice medical self-care at home– 4. Prepare for office visits– 5. Play an active role in the medical visit
Geriatrics 4
Problems in Communication
• Misinterpretation – SOB– Surgical– Big words– Frightened, anxious people misinterpret
information– ASK Questions.
Geriatrics 5
Check list for Office Visits
• Make a list-– What are the top 3 things you want to address?– Make a list of all medications.– Write down your questions.– Be prepared to take notes.– Review your progress with your provider.
Be Prepared!
*Old medical records
*Current medication and OTC list, including herbals and vitamin supplements
*Names of current physicians
*Bring notes about items you want to bring up
*Emergency contacts; allergy lists
Be Prepared - 2
*Insurance card (make sure your coverage is active for particular physician BEFORE making appointment)
*Symptoms: when first appeared, how long, severity, where, same symptoms as before, self-care (what are you doing?), what makes symptoms better or worse
Be Prepared - 3
*Advance Directives
*Hidden Agenda: Don’t wait until the end;
begin with these issues
Present Emotional Problems as Well as Physical Problems
Over 50% of Common Symptoms Result from Overactive Arousal
System (Stress)
Common “Stress” Related Complaints
• Neck, back, and shoulder pains
• Myalgias and arthralgias
• Headache• Crying• Poor sleep• Appetite changes• Poor concentration
Stress Related Symptoms - 2
•Skin tension and rashes
•Frequent urination
•Diarrhea and constipation
•Shortness of breath
•Chest pain
•Fast heart rate
•Poor immune function
Request Adequate Visit Length
Ask for greater than 15 minute visit if you think you need more time when
scheduling
Take Notes during Visit
•Don’t leave until you have clear understanding of diagnosis, treatment, and your role in recovering health
•Your role - what you need to do to be a partner in care
•If you can’t write, have an advocate or tape recorder
If you are Hard of Hearing
Consider owning a pocket-talker if hearing aids don’t work sufficiently
Feel Free To Inquire About Options to Conventional Tx
•Many common conditions, if not very serious, can first be treated with nonpharmacologic agents (drugs)•Exercise, good nutrition, and stress reduction•Herbs, supplements, and vitamins•Mind-body therapies
Common Problems Best Treated Initially Without Medications
•Glucose intolerance, early type II diabetes
•Mild hypertension
•Mild osteoarthritis
•Tinnitus
•Anxiety and depression
•Viral upper respiratory infections
If cost of medications a concern, ask about generic efficacy and
safety and other options
Indications
Contraindications
With, without food
Impact on trace vitamins and minerals, and other prescriptive medications
How long to take medicine
What to do if not feeling better
May ask pharmacist
Geriatrics 18
Appreciate Your Provider’s Limitations
• Most are not accessible 24/7/52• Inquire about back-up and whether or not hospitalists
are used for inpatient care• When is best time to make routine, non-urgent phone
calls (Rx refills, schedule appointments, etc.)• Time and reimbursement issues (over 60% of revenue
for overhead expenses); panel size
Geriatrics 19
Know Provider’s Office Policies
• Walk-ins seen?
• If urgent care needed, can be seen within 24 hours?
• If need routine care, can be seen in 3 days of a week?
• Penalty fee for no show to visits or cancellations less than 24 hours?
Know When to Use Primary Physician Vs. Specialist
Know policy of your insurance coverage and whether second
opinions are covered
Geriatrics 21
3 big questions
• Is this PCP well trained and experienced?
• Is this PCP available when needed?
• Is this PCP going to work in partnership with me?
Geriatrics 22
Training and experience
• Board certified Internist or Family Practice
• Adult or Geriatric Nurse Practitioner
• Geriatrician- board certified in care of older people
• Specialists
Geriatrics 23
Availability
• Questions:– What are the office hours?– If I called right now, how soon could I be seen?– How much time is allowed for a routine visit?– Will the PCP discuss health problems over the
phone?
Geriatrics 24
Money- Cost
• Ways to cut your health care costs:– Keep your immunizations current
– Don’t put off needed services
– Reduce your medical test cost
– Reduce your medication cost
– Avoid surgery when the risks outweigh the benefits
– Substitute home care for an office visit when appropriate
– See your PCP in his or her office instead of going to urgent care or the emergency room
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