Preparing to Visit Your Doctor - Part 1: Don't Just "Wing it"

Preparing for a visit with your physician is a critical step that many people do not take enough time for. I can’t emphasize enough how important this is. I am a practicing physician myself, and could certainly ‘wing it’ through any visit I have with my own doctor, and yet I am careful to prepare every single time. The time available in the doctor’s office is often very limited, and doctors are under ever more pressure to work as fast as they can. Doctors often have to make complex decision fast. Like really, really fast. (I will make a future post on the number of medical decisions that go into a very simple medication refill another day). But we need to have complete and clear information to make those decisions. It is essential to use your time in the office efficiently, to get the most out of it. Your physician is likely
very skilled at gathering the information they need, but there are some simple steps you can take to make it easy for them. You naturally would prepare to go on vacation to enjoy your limited time away, & you should apply the same principle here. You want the visit to work well for you, and being prepared will make this more likely.
 
There are several steps to take in advance of the visit that are very helpful, and will give your doctor more complete insight into how you are doing, and what needs to be done.
 
First, it is essential to understand the general reason you are going in. Most people will think about a specific symptom (cough, headache, etc). But there is probably more to it than just that. Broadly speaking, I tend to think of patients who are coming in to see me as dealing with one of six ‘situations’. These include:

1. To discuss a new symptom
2. To review a symptom, (or chronic health condition) that was already discussed or is being treated
3. To discuss a test result
4. To refill medications
5. For a general health checkup or preventive care
6. To have forms / paperwork completed

 
There are always exceptions, but the list above likely accounts for > 95% of patient encounters. The first step is to recognize which applies to you, and to recognize that for ANY one of the above situations, your physician will want to have enough time to do a complete assessment (I will be discussing more about what a 'complete assessment' means, and how much can realistically be covered during a single visit in a future posting too).
 
But there is more to it too, and this is really key!!! Whichever one of the above situations applies to you, there is also YOUR specific worry or problem with it. While there may not be a major one, more often than not, there is something that led you to be concerned about your situation.
 
Perhaps you are having a cough, and a friend of yours recently passed away when they had a similar cough. Now you are worried your cough might be something serious, like cancer. Perhaps a friend of yours had back pain, and was sent for an x-ray. Now you have back pain and you imagine, well, you must need an x-ray too. Or, perhaps a symptom you had is improving but you are still limited in some important way (ex - your fever is gone, but you are still coughing and can’t possibly give a speech at an upcoming conference). Perhaps you had testing done for a condition, and heard that the test is often done for people with cancer. Now you are wondering if your doctor suspects you have cancer.
 
All the above can be thought of as your feelings, ideas, functions, and expectations. The concepts for this were actually developed years ago at the University of Western Ontario and organized into an acronym taught in medical schools, and used by physicians called FIFE, which stands for:
 
F - Feelings – your worries about your illness

• What are you most concerned about?
• Do you have any specific fears or worries right now? 

 I - Ideas – what you think is causing your situation

• What do you think might be going on?
• What do you think your symptom means (ex – your back pain means your back is ‘messed up’, or perhaps that you must not work because it will get injured more)?
• Do you have ideas about what might have caused this illness?

 
 F - Functioning  - how your illness is affecting you

• How has your illness affected you day to day?
• What have you had to give up because of your illness? (Social plans, work time, a trip)
• How has your illness affected your current goals?
• How does this illness affect important people in your life (ex – I am sick in bed, so my partner can’t work and must look after the kids)?

 
E - Expectations – what do you assume must be done

• What do you expect or hope the doctor can do for you today? (Need that cough to stop for my upcoming speech)
• Do you have expectations about how your doctor will help? (I have bronchitis, that must mean I need antibiotics)
• Do you imagine certain specific tests or treatments are needed? (‘My friend had an x-ray for their back pain, I must need one too’).
• What do you hope this treatment will do for you?
• What are your expectations about what might happen with this illness?

 
Many patients will naturally bring this information up, but physicians will also often spend time in the visit, trying to dig this out, as addressing it tends to lead to more satisfactory visits for both parties.
 
It is essential to understand that you can receive absolutely excellent medical advice, but still leave your visit feeling disappointed, or stressed, if any of these are not addressed!
 
Imagine for instance, that you go in to your appointment telling your doctor you came in because you have a cough. They gather some information about other symptoms, such as sore throat, runny nose, lack of fever. They examine you, and see no sign of serious infection. They correctly diagnose you with a viral illness, and correctly let you know you don’t need an x-ray or antibiotics, and that this will go away on its own over the coming days. The visit is then concluded. You leave, perhaps upset, because you are thinking about that speech you have to give. You
might not have even been that worried about the infection itself, and what you really needed was a cough suppressant so you could get through your talk. Your doctor managed your viral illness itself correctly, but the reason for your visit was never truly addressed. This example is meant to underline how important it is, for EACH condition that you are going to see your doctor for, that you consider ALL the above (FIFE), and then communicate this clearly to your doctor. The patient in the example above would have been well served by making their opening statement that they ‘have an annoying cough, which I am not that worried about, except that I have to give a speech tomorrow, and I really need to make the cough stop long enough to be able to give that speech’. The doctor is far more likely to not only assess the seriousness of the cough, and make their diagnosis, but also address managing the patient's primary concern as well.
 
Doctors are great at getting this information out, but its better still if you just tell them outright. Doctor's have many skills, and are taught how to read body language, but no one can read your mind. A good doctor will want to know all this, and it actually makes the visit go MUCH more smoothly once it's out in the open.
 
The most important part of a doctor’s work is gathering information. It's in your interest to know what you need to get out of your visit, and give your doctor that key piece of information right from the start!