“It is so hard that one cannot really have confidence in doctors and yet cannot do without them.” — Goethe (1749–1832) German poet, dramatist, and scientist

No one wants to get sick and see a doctor. But illness is sometimes unavoidable and even the healthiest among us suffer aches and pains. If death is the great Equalizer, sickness is, well, the gentle Reminder. After the over-the-counter drugs haven’t done much, and denying isn’t much help anymore, you’ve decided to finally see a doctor.  A medical consultation may seem such an innocuous thing but it is the first, most important event that makes or breaks a doctor-patient relationship.  It is from here that trust is developed for the physician. If a patient can’t trust his doctor, there’s no point going on. The patient’s just “doctor-shopping” and the visit is a failure.

How do you make the most out of a medical visit and get the most out of your doctor? Here are a few practical tips.

Come prepared. Unless it’s an accident (you’ll be seen in an emergency room for that), you will probably go to the out-patient department of a hospital, a Medical Arts building, or simply Doctors’ Offices for your problems. I have taken for granted that you have sought out the right doctor for your complaints but even if you didn’t, doctors have a network for referrals. You can be sure that you won’t be seeing a psychiatrist for your hemorrhoids. I have also assumed that your medical (or surgical) problem has been bothering you for sometime and you already have a story to tell. This is exactly what the doctor will start with, a medical history, which is prefaced by your chief complaint, usually a symptom like pain or dizziness or blurring of vision. 

You will help the doctor if you can be as accurate as possible with your medical history. Don’t lie. If you’ve felt the lump on your breast six months ago but were too lazy or shy to go see a doctor, don’t say it’s just been a week. His differentials (i.e. what it could be, that lump) will change based on the onset. 

A doctor worth his white coat has long ago oriented his brain to a framework in handling your principal symptoms.  In taking your history, he will ask one way or another the answers to these: (for example, for pain),

• Location (nape,  left thumb,  right knee, left chest, and so on)
• Quality (throbbing, radiating, etc.)
• Quantity or severity (tolerable, excruciating, and so on)
• Timing (onset, duration, and frequency)
• Aggravating  and relieving factors (aggravated by movement, relieved by rest)
• Associated manifestations

If you have prepared answers to these questions, the quality of that first meeting will definitely improve. Don’t worry about volunteering information.  The doctor will guide you and he will determine how the facts will fit in when he makes a clinical impression.

Before he can come up with that though, he will first do a physical examination. Coming prepared for this part may mean wearing appropriate clothing.  If you are squeamish about undressing before a complete stranger, ask if you need to disrobe completely. Wear clothes that are easy to raise. Some female patients feel better if they have shorts. Otherwise, ask for a patient’s gown that you can slip on quite easily. It is your right to have a third person present during the clinical examination, maybe a nurse or a relative.

Ask questions. Firstly, ask voluminously about your condition, especially after the doctor has presented you an initial assessment of what it is you are suffering from.  For instance, he may say, “I believe that you have arthritis of the left hip.” This will lead you to ask what the condition is, who gets it and why, what are the treatment options, and what is the course of the disease, and so on. A good doctor will have the facts. It is just your duty to ask. A clinical impression is many times delayed until some laboratory tests are done. Again, without appearing hostile, you may ask what are the minimum laboratory results that your doctor will need to base a working impression on. You must ask for three reasons: 1) to minimize cost 2) to avoid pain, especially in invasive procedures like biopsies, and 3) to lessen risks from radiation and chemical exposure.

Secondly, ask about your doctor’s qualifications. If he will operate on you, ask how many similar cases he has done. Without appearing judgmental, ask where he trained and when. A common myth is that an older doctor is a better one. If you are not satisfied with his answers, ask around: You have a right to a second opinion and even a third.

Finally, there is the small matter of the professional fee.  At some level, a doctor-patient relationship is also a business transaction. Aside from the consultation fee that you can ask the secretary, costs for other services must be discussed with your doctor. A doctor’s professional fee is a reflection of his stature or seniority and never of his appearance or gift of gab. Stature in turn is conferred by peers based on skills, achievements, and ethical behavior. Professional groups, such as the Philippine College of Surgeons, are guided by Relative Unit Value (RUV) manuals that list operations with values for level of difficulties.  Instinctively, a patient knows that he will pay more for a hip replacement than he would for a circumcision. RUV manuals attempt to objectify the differences. If you are medically insured by a health maintenance organization (HMO), inform the doctor beforehand. He must be affiliated with the same HMO if he is to treat you.   

In the end, getting the most out of your doctor is based on the premise that treatment begins with the patient. A patient must be pro-active about his condition and participative in treatment. A patient who wants to get well and is doing something about it has already started the healing process.

E-mail jspujalte@yahoo.com webpage http://www.orthopedicspujalte.com