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    A View from the Pew

    Visiting the Doctor: A Proactive Approach

    Your arrive at your 9:00 am doctor’s appointment. A glass partition slides back and a person begins the dialogue with “What is your name? Who are you here to see? What is your date of birth? Do you have insurance? Please have your co-pay ready and a picture ID.” The person behind the partition hands you a clipboard. “Please fill in the information and return it to me when you complete the form. List your medications and dosages, both over the counter and prescribed.

    List your allergies. List your reactions to any and all medications and their dosage. Please list all surgeries in chronological order, beginning the day you were born. Have you left the country within the past year? Where did you go and whom did you encounter – perhaps an unusual fly or a lizard that may have spit on you and the reason for the rash on your hand and the reason you’ve paid us a visit today? Thank you for filling out the paperwork. Please have a seat and fill in the paperwork. Someone will call you in a few moments. And would you mind filling out the exit survey on for quality purposes before you leave?  Thanks so much.” The partition closes for a moment. You take your seat in the waiting room and begin to try to remember all of the required paperwork as you fight nausea, pain, or discomfort of some kind. Perhaps you’re trying to write while maneuvering a breathing apparatus, or just feeling just done in from getting to the appointment.   

    Been there, done that? If you’re the patient, you’re in the doctor’s office because you’re not feeling well and you’re already physically and emotionally drained because any illness will cause that residual effect. You may feel fearful because you anticipate that the visit may include pain or discomfort. Perhaps you’re nervous because you’ve never been really sick before and the whole experience can be a bit unnerving. Your primary care may have sent you to a new specialist and you don’t know their personality, if you like them, how they’ll treat you. If you’re a caregiver and you’re with an elderly sick person, you may not know the answer to some or any of these questions and your person is unable to remember or assist you with the questions on the paperwork.

    All of this required information is necessary for any health provider so that they can offer you the best health treatment that you deserve. They really want to help you, not aggravate you! So be good to yourself and to the people who are the first persons whom you will encounter when you go to the hospital, doctor’s office, clinic or therapy center – the health care providers who ask you for all that general information. Granted, some may be friendlier, kinder and more considerate than others, but I do believe in the old saying that you can catch more flies with honey and a smile goes a long way, no matter how poorly you feel. These trained professionals know that you’re not there for a party but because of illness and attempt to assist you while they multi-task the phone, the computer, the physicians they work with, the assistants, the lab technicians, the surgery centers, the records department, the paperwork required by state law for some of their reports, all while trying to welcome you into the office behind the glass partition. Believe me, none of them are drinking Margaritas and reading magazines back there. The maze of paperwork and people that they navigate on a daily basis on our behalf would astound you if you accompany them through one day of work. And most of them do their work with great skill and compassion. So even if it’s not the best of times for you, be nice. Kindness goes a long way on both sides of the spectrum.

    Creating an information sheet about your medical history can make your visit feel a bit less traumatic, time saving and make a big impression on health care providers. My physicians and providers have thanked me profusely many times for making ready and available a current list of important information that I provide for them. When I’m handed one of those clipboards with all those questions about my medical history, I simply write See Attached and hand them my prepared and updated document that contains all of the information that they need.  I provide a copy for their records that they can keep in my file. Come on - we live in the age of technology, for crying out loud. Use that computer and create and your own form that will supply the necessary information about you to treat you. Health care providers deeply appreciate anything that will assist them to take care of you to the best of their ability.  So let’s get started and follow these steps that will make your next visit to the doctor or hospital a bit easier on you and your health care providers.

    Create and name a file folder that you know is specific for visits to your health care providers.   I call mine My Body, Myself. I keep it right on my desk in its own appointed location, so I always know where I can find it. My family knows where it is as well.

    Create a form that includes your medical history. In the first section called Information About Me, include:

    Your name, address, date of birth, blood type, weight, and height.

    The name of your pharmacy and their location and phone number.

    The name of your physician and contact information.

    The name(s) of your specialist(s) and contact information.

    A principle emergency contact person and perhaps even a second person, if possible.

    In a separate section called Surgical History, list all surgeries and procedures, beginning with the first one you ever had (mine was a tonsillectomy in 1957) and proceed to the most recent. Hopefully, the list will be brief, but whatever your surgical history may be, it informs your health care providers about the traumas to your body and your mind and soul and helps them to understand you. Don’t leave anything out; more is best, in this case! The professionals will sift through the information and glean what they need to treat you appropriately to restore you to wellness.

    In another section called Vaccination History, include information about Influenza – Pneumococcal (flu shot), MMR, and Tetanus/Diphtheria.

    In another section called Health Care Insurance Plans, list your provider and number information.

    In another section called Non-Domestic Travel History, include the places you may have visited in the past years, particularly the most recent. Remember that little insect that took a nibble off your finger when you were away? Could that be the reason that you’re in the doc’s office? List your travels; they count in the care of your health.

    In a section called Current Medications, list the brand or generic name of the medication, who prescribed it, dosage, when you take it (how many times a day), purpose. If you stopped taking a medication, list why and when you stopped taking it. (It upset your stomach, it interfered with another medication and you noticed a behavior change or side effect, etc.) Remember: no information is unimportant.

    In the next section called Over the Counter Medications, list anything that you may take on a regular basis and how many times a day. Ex. Ibuprofen 200, 1600 mg daily. Calcium with D, 1 tab daily. Senna, two tablets daily. List any herbal or dietary supplements, such as St. John’s Wort, Gingko, kava kava, etc., or anything that you take every day. If your physician needs to prescribe a new medication for you, some of the over the counter medications may conflict or cause reactions with your current medication routine and not all ‘natural’ medications are FDA approved and can even be harmful if they combine with something else that your physician needs to prescribe. Practice an ounce of prevention and list them all.  

    In another section called Medications, Food, Environment that Cause a Reaction andAllergy, Side Effects, Reaction or Intolerance Experienced (symptoms, severity, date of event), use this method:  

    On one side listed under the Medications section, list whatever that may be. For example, I have an allergy to anything that contains Paba, which includes some topical lotions and medications, like Aloe Vera (Do you know how many products contain aloe vera?! I turn as red as a Christmas light, itch and burn for days and finally scar at the end stage. It’s not pretty.) So I thought that I could never use a topical ‘caine’ medication (Novocain, Lidocaine, etc) to numb a skin area if someone needed to probe a wound to get a culture. But a great wound care physician who treats me told me that Lidocaine doesn’t contain Paba, so he can use it to treat me to numb an area when he has to culture an open sore (bless him). If I hadn’t listed Paba, we never would have discovered that I can use a medication I thought could not. Lesson learned: nothing is too non-essential to include in this list.

    Next to the Medication section and under the Allergy/Side Effects/Reaction section, list what happens when you use a particular medication: For example: Morphine: induces tachycardia, headache, vomiting); cat hair or dust causes profuse wheezing, etc. List anything that you think may be helpful. Nothing is unimportant.

    In another section called Medical Conditions, name all of your medical conditions in a section of their own, such as asthma, diabetes, heart disease, cancer (type), high blood pressure, spine diseases, and any other critical condition that you may have, even if it’s under control (silent reflux disease is a good example).

    In the next section under Health Care Documents, check Yes or No to

    Healthcare Proxy  Y   N__ (I encourage you to get one if you already do not.)

    Healthcare Durable Power of Attorney Y x N__ (Consider finding an attorney who practices Elder Law and appoint someone as your Power of Attorney if you haven’t already done so. If you haven’t created a will, get on it! )

    Interest in Organ or Tissue Donation   Y__ N__ (You may or may not be eligible. Talk to your physician before you consider tissue or organ donation.)

    You may want to create your own form or you may want to download one from a web site, such as this one from the Massachusetts Coalition for the Prevention of Medical Errors.  I store mine in my Blackberry as a Word document in Docs to Go. If you use Southcoast Health Care System in the southeastern region of Massachusetts, you can download an IPhone application that stores all of your medical information. How cool is that; go Southcoast!

    If you’re a caregiver, do yourself a favor and create a folder and a form for the person for whom you provide care. Make yourself a copy, so that you have the same information in case of an emergency or your person forgets to bring the information to their doctor visit. 

    Whenever I go to any of my providers for my own appointments, or if I bring my dad to one of his appointments, I bring the folder with me, which contains an updated copy of my medical history, my insurance card, a picture ID, a prepared co-pay (if you have one), along with a pleasant smile for the first person who greets me on the other side of the partition. Remember: you may not be the only one who isn’t feeling well that day. The person on the other side of that partition is a human being with aches and pains (and maybe heartaches) of their own. Your smile may be the only one that person receives from a long line of all the patients who visit that office on that day. Despite our illness, pleasantry goes a long, long way. And when you hand them this form, they will not only be so impressed but truly grateful for your cooperative spirit as they work to make you well that they might even dazzle you with a wider smile than your own.

    To your good health!