Communicating with your Physician

Dr. Evan W. Kligman

Arizona Center on Aging

agewell100@aol.com

www.aging.arizona.edu

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•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

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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

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Problems in Communication

• Misinterpretation – SOB– Surgical– Big words– Frightened, anxious people misinterpret

information– ASK Questions.

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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

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*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

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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

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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

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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?

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Training and experience

• Board certified Internist or Family Practice

• Adult or Geriatric Nurse Practitioner

• Geriatrician- board certified in care of older people

• Specialists

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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?

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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