How To Help Your Doctor-Y's Health

How To Help Your Doctor: By:; Why Your Doctor Needs Your Help

Your doctor needs your help urgently.
Almost anyone who has ever been a patient waiting in a physician=s office has direct reason to know that doctors need help. Why is it a common experience routinely to have to wait for an hour or more to see your doctor? The reason is because they can=t get it all done in the time allowed. They can=t get what they think is important done, and often they can=t get even what you think is important done. Why not?
There are two basic reasons. One of them has to do with you. Often you are not prepared to make the most use of strategically important time with your physician. Many patients either have a list of 4-7 things they want to talk about (it is pretty routine to have at least 4 problems once you hit the age of 55 years), and doctors just don=t have enough moments in a 15-minute visit to address so many issues. This is why it is absolutely critical that you be prepared, have a specific agenda, and know your own priorities for that 15-minute interaction. This, of course, is what this article is about. In subsequent articles I will help you plan a very specific agenda for your physician for that 15-minute visit.
The other reason is that doctors generally are blindly trying to follow the advice of various experts in determining how much attention to give each problem. Doctors have an endless set of authorities to whom they defer to help make most of their basic decisions: how many pieces of data to ask you about, how much of a physical examination to do on you, how many tests to order, how many and which prescriptions to write for you, and how soon and how many times to see you again after this visit. The problem is that they have to do this for each of the problems you mention to them. Thus, even if they cut out all the chit-chat (that makes your personal to you), they run out of time half way through the second problem. If they chit-chat, then they barely get the first problem taken care of. It is up to you to determine the appropriate level of chit-chat. It is always a trade-off between getting specific agenda items handled properly and being able to share bits of yourself with this fellow human being. Sometimes absolutely the right thing to do is to just drop all task-related agenda items and talk about your concernsBanxiety, depression, sleeplessness, social embarrassment, difficulty with the kids or your spouse. But this is a decision for you to make, not for your doctor.
In order to grasp the absolute need for you to take control of the agenda in the doctor=s office, you need to understand the nature of the pressure he=s under. Let me try to explain it this way.
You expect your doctor to be able to take care of your chronic health problemsBlike asthma, high blood pressure, diabetes, heart disease, etc. Right? If he doesn=t, who else would? And you also expect her to advise and implement preventive health measures that might be beneficial to you. Right? And, finally, you probably have some specific concern, something not right, that prompted you to schedule this particular visitBwhat physicians call your >chief complaint.= Here=s the dilemma, as presented in a few important studies over recent years.

In a study reported in the Annals of Family Medicine in 2005, investigators attempted to determine how much time it would take an average physician to care for 10 of the most common chronic diseases he sees daily in his office if he followed various expert guidelines published which define quality care for these diseases. The striking answer produced by this study was that it would take 10.6 hours per day just to take care of this handful of common chronic diseases. This answer was reached merely by adding up all the number of expert-recommended visits, assuming a standard 15-minute visit, for these 10 problems in varying degrees of control from stable to actively progressing or deteriorating.
To take an example that I have experience with, consider the management of a patient with diabetes. In 1998 the American Diabetes Association, the recognized expert in its field, published a AStandards of Care@ for the management of patients with diabetes. Their guideline recommended over 30 different, complex pieces of historical information be obtained for all patients at the first visit, that a full physical and neurological exam be done, then about a dozen laboratory test results to review or order, and then extensive patient education both about the disease and about the medications given. A reasonable estimate of the time to do this adequately would be 2 hours. Some specialists (endocrinologists) in private practice may actually have 2 hours of time to spend with a new diabetic patient, but no one I know in primary care, where 90% of all diabetes care goes on, has ever had this amount of time.
In order to try to put a practical face on these recommendations, I convened several focus groups of family physicians in south central Pennsylvania (a rural area where primary care physicians do most of this work). When describing their own experiences, these physicians reported that they were lucky if they were able to spend a half-hour with a new diabetic patient; they reported the frequent experience of making this diagnosis incidentally in adults in the middle of evaluation for another problem and trying to cover the basics in only 10 minutes.