BY:Daniel Wnorowski, MD
A common complaint you hear from anyone who has ever had a doctor’s appointment is that you wait too long to see the doctor and the actual visit with the doctor is too short. Patients often remark, “I didn’t have time to hear what the doctor said.” “I didn’t understand what the doctor said was wrong with me, and don’t know what to do next.” “I didn’t have time to ask questions.” Ideally, patients would be seen immediately upon arriving at the office and the length of the visit with the doctor would be mutually satisfying. There are some steps patients can take to prepare for their appointment to get the most benefit from it, and I will outline them here.
But, first, let me provide some background on how a typical medical office works and some factors not in the control of the doctor or staff that can contribute to the length of your appointment. To begin with, several patients are scheduled to be seen throughout a day, and if even one of them is late, it begins to throw off the schedule, so I encourage every patient to arrive promptly for their appointment out of courtesy to other patients. Also, some patients that are expected to have a routine exam may end up with a complication or more urgent diagnosis the doctor must address. For these, and other reasons, unexpected delays can occur.
Also, there is a process to follow to ensure that all relevant information is gathered from a patient. It is necessary to obtain each patient’s medical history, at every visit to note any changes. A nurse or medical assistant typically gathers it. The history consists of past medical issues (prior medical problems and surgeries, medications, allergies or drug reactions); family medical history; and social history (smoking, alcohol and drug use, employment and recreational activities). These can all shed light on the medical issue the patient is being seen for that day.
However, the most important part of the interaction at the current appointment is the “history of the present illness” or HPI, the main problem the patient is being seen for that day. Most doctors, especially orthopedic surgeons, will, in most cases, have a pretty good idea of the diagnosis, or at least a short list of possibilities, from a good, detailed HPI, especially in a specialist’s office, where they often see similar problems.
I was told in medical school that to get a good HPI it is best to let the patients tell their own story; after all, who better to explain their symptoms than the person experiencing them. This is the ideal, but in fact, some patients have a difficult time telling their story - some are nervous, some provide too much detail, some provide irrelevant information, some even try to diagnose themselves. Quality is more important than quantity when it comes to providing information for the history. For a patient, the key to telling a good HPI is to know what they are going to say prior to the visit, and to keep it simple, to the point and limit it to one to two minutes. The doctor will ask directed questions to fill relevant gaps, if necessary.
As with most things in life, if you want things to go efficiently, it is useful to be prepared. Think of the HPI as a short job interview for a job you really, really want. Key information to be prepared with includes: your chief complaint in good detail, (e.g., right knee pain after injury); a short description of the injury, if any, or the condition surrounding the onset; symptom location and timeline; other associated symptoms (e.g., instability, swelling, stiffness, numbness, catching, etc.); aggravating/relieving factors, prior evaluation, testing, or treatment, etc.
Strive for several short sentences: e.g., “I have had intermittent right knee pain since an injury in high school in 2001. It includes non-contact twisting, with a pop, swelling and instability after. I had an MRI, then arthroscopic surgery with cartilage removed and physical therapy after. That helped for 10 years but over the past five years I have noticed progressive pain on the inside of my knee. There is worsening instability with twisting activities followed by swelling. I have stopped pivoting sports and taken ibuprofen, but the problem persists.” This type of presentation is the goal, and extremely helpful for the doctor.
After the HPI, the doctor will conduct the physical exam, focusing on the problem area; and X-rays may be done during the process. The doctor may be able to reach a diagnosis, or at least several possibilities. Then, either a plan for further work-up or initial treatment can follow. But, the most important part, the key in most cases, is the history. At the end of the day, physicians are trying to identify the patient’s problem. If we do not understand and address a patient’s concerns, the real problem may not be addressed and the patient will leave unsatisfied. We must all remember, doctors don’t treat an exam or X-ray or MRI findings. We treat patients.
HERE ARE A FEW TIPS FOR PATIENTS TO GET THE MOST OF A DOCTOR’S APPOINTMENT:
- Arrive early to complete the expected paperwork. If possible, complete it online prior to the visit.
- Think about what you will say ahead of time, paying particular importance the HPI elements above.
- Make a succinct, written, brief outline, bring it with you to the appointment and follow it when talking to the doctor.
- Talk about and describe your symptoms. Don’t speculate on a diagnosis. Your physician will determine it through observation and possible tests.
- Speak carefully, don’t repeat yourself and make sure all the important information is told, as it adds confusion to have to return to the history late in the process.
- Remember, there is limited time to tell your story, approximately a minute or so. A doctor pressed for time will start focused questions in order to expedite the process.
- Focus on one problem per visit so that the doctor can remain focused.
- After the exam, listen intently to what the doctor says. You should expect a discussion of the diagnosis (or possible alternative diagnoses), testing and/or treatment plan, risks and benefits of the alternatives, and next steps
- Take notes so you can refer to them at follow-up appointments and keep track of your questions. If you are going to record the visit, please ask permission.
- Ask questions, particularly to clarify something you didn’t fully understand or hear.
- For hip, knee, ankle or foot visits please bring or wear cotton shorts with only an elastic waistband. For shoulder visits please bring or wear a tank top.