Health care tips: How to communicate well with MD/Health Pro

The best way to receive good health care is to communicate effectively with your providers. And that’s a whole lot harder than it sounds. 

Anyone who’s been to see a doctor or health care provider in the last several years knows why: Between crazy short appointment times, computerized medical records, and generalized medical system chaos, it’s tough to get anything from your doc beyond a cursory physical exam and a mini conversation. 

Ever feel like you're talking to the stethoscope?  You're not alone.  

The situation is less than ideal for everyone, including your physician, PA, ARNP, chiropractor. It's a challenge to listen well, communicate empathetically, provide a high level medical assessment, and plan for appropriate intervention while madly pecking on a keyboard. Add to that the average of six to ten minutes he or she is allowed to spend with you per appointment and the necessity of tests and medication ordering, teaching and follow up, and it’s no wonder physician/health care professional job satisfaction is at an all-time low. Specialists are allotted a little more time with you—but you have to wait a lot longer to see them and they have more to cover in that time, so the difference might not be measurable.

As rough as it is for providers, it’s tougher still for patients. 

Navigating health care effectively and advocating for your needs is a heck of a lot more difficult when you’re feeling sick, stressed, and vulnerable. It shouldn’t be so hard to receive excellent care. But since it is, the ownness is on you--or those caring for you. 

One positive development is your access to your own online medical records.  If you don't already  have Mychart, sign up for it asap. Since your providers have limited time, you're the captain of your health care ship.  Whether it floats, and how well, is up to you, or to your health care proxies.  (A health care proxy is someone, often a family member or good friend, whom you trust to help you navigate health care.)  Frequent your mychart page.  Check out test results, even notes from your most recent hospitalization.  

If you have routine questions for your provider, send a message via mychart. 

It sure beats being on hold for 3 hours. The allowed messages are short: prioritize what you would like to say and what action item you would like.  Maybe you simply need a prescription refill.  Perhaps you have a quick follow up question or want to report new or worsening symptom. Either way, craft the message so the info is prioritized and succinct.  Start with the most important info: consider numbering your requests and headlining key points.   If you don't hear back in the allotted time, emessage again.  Squeaky health care wheels get the grease.  

RE URGENT MEDICAL NEEDS: Obviously, urgent needs are not best handled via electronic messaging.  If you are very concerned about medical symptoms or an injury, visit an urgent care or an Emergency Room. Call 911 for emergencies.  Know what you don't know. Seek care rather than ignoring symptoms.  Know the cardinal signs of a heart attack in men and women and DON'T DELAY! Call 911. Ditto for Strokes.  Delays cost lives, most likely your own.  Don't die because you're too embarrassed to call 911. It will be a bummer for you, but worse for your family.

RE Routine concerns/Medical appointments: Anyone who wants excellent care is going to need to seek it to keep it. Great communication is the first step.   

Here are some tips:  

1. Plan in advance what you want to discuss with your doctor and other health professionals at your next online or in person visit. What information do you need? Medical facts of your case? General overview of illness? Treatment options? Supportive services? Make a list of questions to take with you. (See:  "At Diagnosis: Important questions to ask your doctor.") Bring a print out of your mychart visit and test results, especially those pertinent to why you are seeing the doc/provider.  Providers don't always have time to wade through your records. If you hand them what they need, that helps save time and improve care.
2. Ask for a specific amount of time for this discussion and an environment that ensures privacy. If you feel 6-10 minutes is an insufficient time to discuss the serious issues at hand, ask for extra time; request a 20-30 minute appointment instead. Know that in some circumstances you may be asked to pay extra for added schedule time. It may also be possible to make two separate appointments, on different days. Note: It's pretty uncommon these days to get a longer appointment, but ask anyway.  You never know.
3. Determine who else you want to come to the appointment with you. With the added stress of this diagnoses, you may find that it's difficult to retain all the information from your doctors appointments. Because you will be making decisions based on that information, you'll want to be sure what you hear is accurate. And four ears are better than two for hearing medical info.  Remember: A person's decision is only as good as the information upon which it is based. For this reason, it's a good idea to bring a family member or friend along to record notes, questions, and answers while you and your medical provider are talking. Note: If your family member or friend can't be there in person, put them on speaker phone.  I've never had a physician refuse, and this gives direct, first hand info to people who you want involved in your care. 
4. Explain to your MD/health care provider what you understand about the illness/medical condition you have. Let him or her know what your medical situation is - how you feel, what symptoms you are having, how your condition has changed over time, what medications you are taking, and what other medical conditions you have. (See "During Treatment: Important questions and information.") Tell the provider about changes and concerns. Because of complex medical terminology, speaking with health care professionals can be confusing. Be sure to ask for clarification of terms you do not understand. Request a written discharge summary of the visit. These usually contain teaching and info in layperson's terms.
5. Ask what phone number to call if you have after-hours or weekend questions or needs. With whom should you speak? Who will be in charge of your care when your doctor is not available? Be sure to ask what sort of physical changes require the immediate notification of a health care professional (for example, a fever of over 101, uncontrolled pain, nausea, or discomfort, or unsafe home situation). Clarify if and when you should call 911 for an emergency. (If you are receiving hospice care, clarify whether in some circumstances you should call the 24 hour on call hospice nurse instead of 911.)
6. Share with your doctor your (DPOA)durable power of attorney for health care and your advance directive. Words like durable power of attorney for health care and advance directive can sound pretty complicated. In reality, these are just ways of trying to make sure your health care wishes are honored. The best single way to do that is to appoint someone to be your Durable Power of Attorney for Health Care. This means you pick a trusted friend or relative to make your health care decisions in case you are unable to do so yourself.
7. Ask for the next steps. Will there be additional testing? What sort of preparation is entailed for each test?  Ask for a pre-test List print out.  (For example, am I permitted to eat and drink before tests? Are there activity limitations before or after the tests?) What are the treatment options? What is the time frame between next steps? When is your next appointment? What can be expected over the next week? Over the next 3 to 6 months?
8. How does your doctor want to communicate with your health care proxies/family members or friends you choose to have access to your health care info? Because of federal regulations, health professionals are not permitted to share any information about your health status with anyone unless you grant permission. You need to fill out paperwork authorizing which family members your physician and health care providers is authorized to share information with. And you may want to choose a family spokesperson to coordinate communication. This is especially important for hospitalizations: you want someone there to advocate for you and you want them to be able to call providers to help coordinate your care if you can't.
9. Ask for referrals to supportive resources, such as meals, chores, and transportation services. Ask where you may find more information on your specific illness, support groups, or services. Social workers/MSWs usually have access to this info.  In the hospital, the MSW is often a discharge planner.  Make sure you get the referrals you need before going home.
10. When you leave your appointment you should know: your diagnosis, your treatment plan, your medications, what they are for, and next steps. Continue the conversation until you feel you have the information you need. Your discharge summary should have a list of your medications and should clarify if any meds have been added or discontinued. Take that list and use it to fill your mediset/coordinate your medications. 
11. Discuss among family members and friends how you will communicate with each other. It is helpful to set up a way to regularly update family and friends, perhaps by phone, text, or email. Determine how often communication should occur and who should take the lead. Note: Ask your family members to respect your preferences on who gets what info, when.  Oversharing with an extended group, while you are not conscious or capable of deciding, creates a lot of ill will.  Privacy is important to most people: info shared can be general in nature, such as "She's doing better today", with high-altitude overview vs "too much info"/ private details.  
12. Finally, be sure to 'schedule' respite for yourself. (This goes for caregivers too!) Receiving the news that either you or a loved one has a serious or life-threatening illness is very, very difficult. It can add exhaustion and stress -- just when your body needs all the help it can get to be well and strong -- or at least become comfortable. 
13. Practice saying 'yes' to help, be it friends delivering meals, church members driving you to appointments, or family members coming over to help. In so far as is possible, try to eat well, sleep, and exercise. Rest. And don't forget to make time for prayer, meditation, or reflection.