How To Visit A Doctor
1--I am not a doctor. No comment within should be taken as doctor's advice or substitution for medical treatment.
2--This article is intended as a tutorial on how to utilize a doctors visit. It does not include all the information regarding a doctor's visit, should not be considered universal and is not the ultimate authority on anything.
3--This article is based on author's observations and experiences as both a patient and an EMT.
Public Health Care
I have been exposed to the healthcare system for many years. Even before I was a provider (as an EMT-emergency medical technician) I was surrounded by it. Both my parents are EMTs and I have assisted in many classes, training events, exams, and seminars in EMS (Emergency medical services). As an EMT my scope of practice is limited, but as an EMT and as a student of biology, I have learned a lot, especially about the public’s knowledge of health. It continues to astonish me what the public lacks in the way of understanding the healthcare system. I do not mean insurance, HMO’s, and law suits. No no. I mean in actually engaging in a conversation about your health with a provider. Let me provide a common, non emergent, scenario.
Brian Regan Comedian about his trip to the ER
June is a 40 year old woman with the requisite 2.5 kids and dual income household. For the last two weeks she has been feeling run down. For the last week it has begun to interfere with her job and her home life. She has decided that if she does not get better by tomorrow, she will use her lunch break to see the doctor. When she wakes up feeling just as icky, she calls her doctor. She can not get an appointment for two weeks, but is directed to the walk in clinic. She attempts to make an appointment there. There are none available except for walk ins, the expected wait time to be a minimum of an hour and a half. She takes a half day in order to accommodate her non-scheduled appointment and arrives at the clinic at 1230. She is asked to provider her insurance card, and fill out a survey sheet. Some of the questions included are:
Reproductive: Have you had any children? How many? Have you had any pregnancies? How many? When was your last menstrual cycle? Have you had any reproductive illnesses? Have you had a hysterectomy? Is it possible you could be pregnant? Are you on birth control?
Psychological: Do you have any diagnosed conditions such as Depression, Anxiety Disorder, or Bi-Polar? Do you find yourself wanting to cause harm to yourself or others? Do you find yourself lethargic and avoiding normal activities. Have you had sudden weight gain or loss? Are you sleeping more or less than normal?
Neurological: Have you had headaches? Have you ever had a stoke? Have you had long sedentary periods in the last 2 weeks such as an unusually long meeting, plane ride, or illness that prevented you from moving? Do you have blurry vision? Do you have numbness, tingling, or paralysis in your face or extremities? Have you been slurring?
Digestive: Have you been diagnosed with Acid Reflux disease or experienced greater than normal heart burn? Have you had a Gastro-Intestinal bypass surgery, or other weight loss surgery, such as the lap band? Have you had abnormal bowel movements? Have you had diarrhea? Have you had constipation? Have you had bloody stool?
Cardiological: Have you had a heart attack? Do you have angina? Have you had any heart surgeries? Do you have high blood pressure? Do you have high cholesterol? Have you had chest pain?
Urological: Do you have difficulty urinating? Do you have blood in the urine? Is there pain before, during, or after urinating? Do you need to urinate frequently? Are you incontinent (unable to control your bladder)? Is the urine an unusual color or flow?
Endocrine: Do you have hyperglycemia, hypoglycemia, or diabetes? Have you been diagnosed with hyper or hypothyroidism? Have you experienced sudden weight loss or gain? Have you had an increased urge to urinate?
History: Have your or a family member been diagnosed with any of the following- Heart Disease? Diabetes? Breast Cancer? Testicular Cancer? Leukemia? Depression? Obesity? Pneumonia? Stroke? Other Cancer? Do you have any medical conditions or are on any medications?
She skims the questionnaire, laughs at some of the questions, but wonders how any of it is relevant. She decides to skip the entire section and go directly to the question “Please describe your symptoms”. She answers “I have been feeling nauseas, tired, and feverish. I have a cough that won’t go away and my throat hurts.”
She returns it to the counter and waits her turn. About an hour and forty-five minutes later her name is called. She has gone through three magazines and lays the last one down, a Reader’s Digest with many jokes she found mildly amusing. A woman wearing scrubs and a stethoscope directs her to an alcove in a hall and directs her to stand on the scale. She comes in at 15 pounds more than she expected, about 30 more than she’s supposed to be. The woman takes her temperature, which is indeed a little high at 100.0 F. She is then directed to an exam room. The primary feature of the room is the exam table covered with the spool of paper. The woman then takes June’s temperature. It comes in a little high at 140/100. The woman makes a notation, checks her pulse, and makes another notation. She then indicates to June to wear the gown, saying she can leave her bra and pants on but to remove her blouse. She leaves. June waits on the exam table, peering at all the posters describing STD prevention, depression awareness, and healthy eating practices, for another half hour. A man comes in wearing scrubs and a stethoscope. He asks her about her symptoms, listens to her breathing, makes her cough, asks her what medications she is on. She remember taking two pills every morning, but isn’t sure what they are for, just that one is small and red and the other large and green. He makes several notations and leaves. Fifteen minutes later another man comes in wearing a white coat over casual business attire and a stethoscope. He verifies her symptoms, asks her what medical conditions she has (arthritis and high cholesterol), asks her a few medication names to see if they ring any bells. At last he clears his throat and tells her something.
“You have a cold. I’m going to give you an antibiotic; the cold will clear up in a couple of days. You need to finish the antibiotic, don’t stop when the cold does. You also should lose a few pounds, eat healthier and get some exercise. If you aren’t already, you will probably be starting menopause shortly and the hormonal changes will cause weight gain and may affect your heart health and cancer risk. You should start now. Here’s the prescription, be sure to sign out at the front desk.” He shakes her hand and leaves, after spending less than ten minutes with her. Feeling dissatisfied and somewhat offended, after all her doctor and her have been going over he cholesterol and upcoming menopause regime between themselves, she checks out. She picks up the prescription and heads home. Three days later the cold is gone. On the fourth day she forgets to take the antibiotic. A few weeks later, she runs across the bottle while cleaning up, finds a sharpie and writes “cold medicine” on it, and figures she’ll save herself a doctor’s visit next time.
Before the Appointment
If this sounds like your doctor’s visits, please please, keep reading, because there are some things you should know.
The fist thing you should learn from this is that healthcare providers (HCP’s) are not all knowing. And while they may occasionally have God-Complexes, they are also there for you, the patient. So let’s see how June could have better utilized her time.
The very first thing June should have done was gone into the doctor as soon as her ailment was interfering with her life. We can all feel icky, and can even feel like crap for a long time. But if you find yourself unable to function at work or at home, then whatever crud has got you needs to be dealt with. Now if you want to take a day off to see if you can sleep it off, then that’s your decision, but if it still isn’t better, then definitely to a doc you should go. Secondly, she could have asked around to see if anything was going around. If anything is, then looking it up on the internet isn’t a bad thing, though it should not be considered medical treatment or substitution. The benefit to looking it up is so that June can construct some questions for her HCP and know what sorts of thing to tell them. That does not mean June goes on WebMD and prints off a list of the symptoms to hand to her doctor. But it may identify symptoms June doesn’t realize are related such as water retention, or thirst. Then, when June called her doctor, she should have emphasized that she has both a standing relationship with her doctor and a current medical condition she wants checked out. Usually there are appointments available for current patients who need to be seen for illnesses and injury. If not, frequently cancellations will occur. The staff is often more accommodating as well. If the relationship with her doctor is a good one, sometimes the doctor will squeeze in an extra appointment. Sometimes, that just won’t work, or a person doesn’t have a regular doctor, in which case a walk-in clinic is a good option.
When she arrived at the clinic and was asked to fill out the questionnaire, June should have done so in as great of detail as possible. She is already checked in so she doesn’t need to hurry to maintain her spot and she has plenty of time. The more detailed the report, even on the seemingly irrelevant information; the better a diagnosis can be made. There may also be red flags in there that don’t necessarily have to do with the illness but the prescription. Many drugs are contraindicated (not prescribed) for certain conditions. If you have a bad liver, it excludes a lot of drugs, as do bad kidneys, because they can’t handle the process of metabolizing and eliminating the drug. Also, what may not seem like a serious problem, in conjunction with a medical background, may be a very big one. If you have hyper/hypoglycemic tendencies and are experience sudden sluggishness and irritability, it could be a sign your becoming diabetic! (But not necessarily, since I am not diagnosing anyone here today!) Especially for women hitting the age of menopause, hormonal changes can hugely affect her health. For men and women in middle-age and struggling with obesity, a plethora of previously un-identified health conditions may pop up.
While certainly not necessary, it doesn’t hurt to check out any medical articles in the magazines in the waiting room. Usually the magazines are at least attempted to be relevant to the client base, and it wouldn’t hurt to get a few more suggestions for questions to ask the HCP. Of course the jokes in Reader’s Digest are my favorite, so I’m not the best one for that!
First Health Care Provider
The first HCP June sees is the one who calls her name and directs her the uncomfortable alcove of the scale. This person is usually a Medical Assistant, or MA. They may be nurses, CNA’s (certified nurses assistant), or glorified clerks, but most commonly in the clinic setting, it is an MA. An MA spends approximately 6 months to two years training in how to obtain vitals, take histories, draw blood, start IV’s, maintain paperwork and other fun stuff. They frequently are also CNA’s or EMT’s, and function as a basic HCP. Basic level means they are able to provide CPR and utilize an AED in an emergency.
Health Care Providers
Second Health Care Provider
The second HCP June saw may be anyone from an MA to an RN (registered nurse). If you are seeing an MD (medical doctor), this person is probably the RN. The RN usually has about three to five years of training and usually an Associates or Bachelor’s degree in nursing. They may have several more years training if they hold any specialty, such as respiratory specialist, OB/GYN nurse, and so on. This person does most of the patient contact, checking history, symptoms, vitals, and so on. They do not make a diagnosis, but prepares the preliminary report to the doctor. When June talked to her HCP here, she made one very big error; not knowing what medications she was taking. In addition to knowing what they are for, a patient should know what they are called, the dosage if they can, how long they have been on them, who prescribed them, and if they are currently taking them appropriately. Additionally, they should indicate if they are taking anything over the counter (OTC) such as cough syrup or decongestant, any supplements like multi-vitamins, any weight-loss pills, drinks, bars, and so on, any recreational drugs, legal and otherwise. They are not supposed to call the police on you. Any recreational drugs being taken will of course make a huge difference in diagnoses and treatment. Birth control pills should be included here as well, because of the hormone adjustment they can impact multiple systems in your body and you may have to go off them during treatment. As in the case of many antibiotics, birth control may be ineffective during treatment.
Usually when checking on symptoms, the HCP will get fairly specific. For example, if your coughing, the HCP is going to want to know if you are producing anything? If so, what? What color? What thickness? How often? Has the color changed? When did the cough start being productive? When did it stop? Does the coughing wake you up? Does it wake others up? For each symptom you have, try and be as specific as you can, vagueness will only hinder your HCPs and ultimately you.
What the Doc wants to hear, from ABC news--#1 and #2 especially!
Third Health Care Provider
At last the third and final HCP arrives. A patient’s most two most common mistakes are assuming they are seeing a doctor and not asking any questions. Many HCP’s that we see nowadays are Nurse Practitioners (NP) and Physician Assistants (PA). Both must attend several years of schooling. They work under a somewhat limited scope of practice and must have a doctor to “oversee” them. This doesn’t mean that they have to check off with a doctor before every patient, but rather that a doctor in the area checks up on their paperwork and reviews their skills. Sometimes NP’s and PA’s work in the same facility as a doctor, or their doctor, but frequently they do not. They can prescribe medication and do invasive procedures. They are basically mini-doctors. They are very knowledgeable and skilled people. They just aren’t MD’s. This knowledge has very little affect on your visit to the clinic, but you should be aware, as should June, just who is taking care of her medical treatment.
People generally assume that a doctor’s visit, or rather a visit to their HCP, is all about answering questions, and for the first part, they largely have to. But when the person in charge of your diagnosis and treatment is there, it becomes time for you to ask the questions. People by large assume the they have little input on their treatment, that their opinions are not considered, that their preferences are not important but that is not the case. But in order to be an active member in you healthcare regime, you need to understand what is going on. If you did your research before hand, you can ask about other possible treatments. While it does not apply to all HCPs there is an unfortunate trend where the demands of patients who merely want their symptoms curtailed or to feel as if they are being treated regardless of what’s needed, the pressure of pharmaceutical companies, and the onslaught of pharmaceutical advertisements in the hands of worried patients often leads to an attitude of “give ‘em a ‘script, and get ‘em out”. It is often why a patient feels neglected and belittled by an HCP. Most HCPs, however, respond positively when a patient involves themselves in the appointment. Asking questions about treatment choices, the specifics of a condition, the longevity cause and prevention of the condition, and pretty much anything you want to know, is a great way to engage your HCP.
CNN story on MRSA
Abudabi Mens College Podcast on Antibiotic Resistance--Excellent!
In light of the “Scrip ‘em and leave ‘em” attitude, something really rather terrible has happened and that is the over-prescription, mis-use, and abuse of antibiotics. Let me re-iterate that I am not a doc. A few general rules though are these: Colds are caused by viruses. Antibiotics do not treat viruses. Most minor bacterial infections and most minor viral infections will clear up without treatment in 10-20 days. Antibiotics take up to10 days to affect a bacterial infection. Antibiotics do not treat symptoms. When antibiotics are not taken as prescribed and completed (usually a twice a day, ten day regime), we build up antibiotic resistances. MRSA (methicillin resistant staphylococcus aureus) is a very serious bacterial infection that is antibiotic resistant and highly contagious. When June was prescribed an antibiotic for a viral infection (her cold) she was mostly being placated. Unfortunately this happens a lot. Now not all antiobiotic prescriptions are bad, if you have a bacterial infection (including many STD’s, which are commonly treated with Penicillin and penicillin derivatives such as amoxicillin and methicillin) they are effective and frequently necessary (the best treatment for syphilis is penicillin), so don’t automatically assume your HCP is giving you an unnecessary prescription. Ask them, What kind of an infection do I have? How will this prescription help me? What symptoms will it treat? What side effects will I have? Are there other options besides this treatment? How does it compare? How often do I have to take it? How should it be administered? Will it conflict with the meds I’m already on? Should I take any OTC drugs? Should I avoid any OTC drugs? All these questions will help you make the most out of your treatment. And in the end, if you don’t agree, trust, or think your HCP has your best interest in mind, find another. If you must go to the clinic again, request that you don’t see that one. You are not just the master of your own health, you get to decide in your own healthcare too.