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DUKE MEDICINE

Making the Most of Your Doctor Visit #2

Here are the rest of the suggestions (had to break into to two parts due to the...

Posted by Joe T Minchew, MD

Here are the rest of the suggestions (had to break into to two parts due to the character limits)

5. Make sure that all records pertaining to your treatment to that point are present at the provider’s office to coincide with your visit. This includes all previous physician notes, hospital treatment records, particularly operative reports. You will usually need to contact the physician offices and hospitals separately to obtain these records as one will often not have the records of the other. Hopefully, the age of the electronic medical record and shared data will eliminate this requirement but we are not there yet. The best way to ensure that the records are present when you are is to take them with you. If you are specifically seeing the provider for a second opinion on surgery, make sure you have a clear statement from the surgeon as to the planned procedure and the rationale for that procedure. You can not get a second opinion if the provider can not review the “first opinion”. Unfortunately, many times physician offices fail to forward records to other offices despite your requests. It is best if you obtain the records yourself if you can. If time and/or distance precludes this option, definitely check with the new provider’s office well prior to your visit to insure that they have received the necessary information. There is a tendency among some patients to want the new provider or physician to “start fresh” without being biased or influenced by the prior records or diagnoses and opinions of others. Unfortunately, while there is some understandable logic in this perspective, the new provider will be severely limited in their ability to evaluate your problem and make recommendations if they can not review clear documentation of the evaluation and treatments you have had in the past. The majority of physicians are extremely conscientious and will make their own diagnoses and formulate their own opinions based on the data
6. As with prior records, make sure that all previous imaging studies and diagnostic test (nerve tests, etc) are available for the provider to review. This includes the actual images as well as the reports. You do not necessarily have to have printed films as most providers can now review images on a compact disc (CD) but it is critical that the provider can review the pictures. Most spine specialists review studies themselves in order to make diagnoses and treatment recommendations. While the radiologist’s interpretations are useful, they do not have the benefit of talking to you and examining you in order to correlate you symptoms and examination findings to the findings on your imaging studies. Unfortunately, most people over the age of twenty have findings on lumbar x-rays and MRIs even if they are asymptomatic. It is critical to correlate your symptoms to the studies. It is also very important to have all the imaging studies that you have had with you. X-rays, MRIs, CT scans, myelograms all have different indications for use and purposes. The do provide some overlapping information but they also provide information that the other studies can not or do not demonstrate as well. For example, MRI scans do not demonstrate problems with bone very well but CT scans evaluate the bone very well. So don’t just take your most recent MRI to the visit.
7. Go to the visit with a clear list of questions that you would like the provider to address and make these questions known to the provider at the appropriate time.
8. Go to the visit with an open mind. Try to listen to the provider’s assessment of the situation and their recommendations without being overly swayed by prior diagnoses or the findings or you x-ray or MRI reports.
Good luck and I hope these suggestions help!View Thread

Posted byJoe T Minchew, MD

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DUKE MEDICINE

Making the Most of Your Doctor Visit #1

Due to the complexity of the problem, the difficulty in determining a definitive...

Posted by Joe T Minchew, MD

Due to the complexity of the problem, the difficulty in determining a definitive diagnosis, and the invasive nature of many of the treatments, patients with back pain often seek evaluation by several physicians or providers. These evaluations and second opinions can be very helpful and worthwhile. However, if you are poorly prepared for these visits, they can end up being of very limited value. The following are some suggestions for maximizing the benefit from your next evaluation:
1. Pay close attention to your symptoms prior to your visit so that you can communicate them well to provider. In particular, pay attention to the pain that is the most problematic for you. Is the major problem your back or pain in one or both legs? Pretend (and it may not be completely pretending) that the pain in the back and leg(s) are separate problems. If you could get rid of one but not the other, which pain would you pick. If you have pain in both the back and leg(s), how would attribute a percentage to the pain? For example, is the pain 80% in your lower back and 20% in your leg or legs. Pain attention to where the pain radiates or travels and be prepared to describe that radiation to the provider. Sometimes the pain is so severe that it seems everything is involved but try to pay attention to whether the pain radiates primarily down the front, side or back of the leg. Does it regularly go below the knee? If so, where.
2. Pay attention to associated symptoms like numbness, tingling, prickling or weakness. Try to be able to describe or draw out with a finger where you experience these symptoms. Try to determine which joint or joints is/are affected by weakness in the legs. Is it primarily your hip, knee or ankle/foot. Try to separate limitations of the use of the leg due to pain from times when you had weakness with minimal pain. Definitely pay attention to any changes in your bladder or bowel function or habits but also pay attention to any prior history you have had with these problems related to medication usage, stress, coughing, etc.
3. Make sure that the visit with the provider is authorized by your insurer or other provider prior to the visit. In particular, if the problem is due to a work related injury make sure that the visit is authorized. Many times patients want to get an “independent” evaluation outside of the worker’s compensation system. This can be appropriate and can be authorized. However, you can not be seen under your health care insurance for a problem that is related to a work injury. This is an exclusion in every health care policy. The provider may have to refuse to see you that day if the visit is not authorized.
4. Go to the visit prepared to have a thorough evaluation. Arrive at least 15-30 minutes prior to the scheduled visit time to complete necessary registration paperwork. Also allot enough time for the provider to review your prior records and imaging studies (x-rays, MRIs, etc.). This also includes dressing so that you can be comfortable with an examination even if it includes being asked to disrobe and wear a hospital gown. A thorough examination of the lumbar spine often requires the patient be in a hospital gown and if you are self conscious about this during the examination if may limit the providers ability to assess you.

To Be Continued....View Thread

Posted byJoe T Minchew, MD

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38 of 61 found this Tip helpful

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