GETTING THE MOST OUT OF A PHONE CONSULTATION OR OFFICE VISIT

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Nearly 95% of diagnosis is the history. The quality of the advice you get from your physician depends on the quality and amount of information he obtains from you.  Be prepared.

Phone Consultation

When you come to the office, you don't like to be interrupted or kept waiting while the doctor takes routine phone calls.  Others expect the same courtesy.  Instead of asking to speak to the doctor, tell the receptionist the reason for your call.  She may be able to help you at once or to identify the need for the doctor's urgent attention.  Otherwise, your doctor will call you back when it is convenient.

Be ready to describe your symptoms.  Having the flu, feeling feverish, or being dizzy mean something different to everyone.  Take a few minutes to organize your thoughts with the PQRST of your symptoms:

P.  Parts involved:  ``I hurt all over'' or ``my stomach hurts'' doesn't tell your doctor much.  Instead, ``I have a pain in my right upper abdomen that goes into my right shoulder'' is helpful.

Q.  Quality of the symptom:  Is it a sharp pain? A dull ache? A burning sensation? Does it throb?

R.  Relieving and worsening factors:  Does eating make it better?  Does walking make it worse?  Did an antacid help or not?

S.  Severity and associated symptoms:  Is the pain so bad you have to stop what you're doing and lie down?  Do you have nausea, shortness of breath, sweating, blurred vision, or other symptoms as well?

T.  Time Course:  How long have you had it?  Is it getting better or worse?  Have you had it before?  Has the location changed since it first started?  What were you doing when you first noticed it?  Does it come and go, or is it constant?

Before The Office Visit

To maximize the time with your physician, here are some things you can do in advance of your visit:

1. Define your goals.  What do you want from the doctor?  A complete check up?  A consultation on a specific problem?  Tell the receptionist so she can schedule appropriately.
2. Organize your symptoms (See ``PQRST'' above) and make a list of questions.
3. Get your medical records from previous physicians.  Be familiar with your family history.
   
4. Make a list of medications you're taking, including prescription and over-the-counter drugs.  Know the dosages.

Questions to Ask Your Doctor

Use this list as a guideline when you see your doctor:

Diagnosis.  What's wrong, what causes it, and how serious is it?

Tests: What tests do you recommend, and what is the purpose?  

Results:  How will I find out about the results?  Will I be advised if nothing is wrong, or only if something needs attention?

Options:  What treatment choices do I have?

Medications:  What are my choices?  What are the side effects, and how will it interact with other prescriptions or over-the-counter drugs?  What's the dosage and frequency?  Should I take with or without food, or avoid alcohol? (See ``Prescriptions,'' page 8.)

Doctor's Orders:  What activities do I need to avoid?  Am I contagious?  Do I need a follow up visit? Should I watch for anything special?

My Questions:  (Jot down things you want to discuss so you don't forget them, but try not to overwhelm the doctor with a ``laundry list.'')

FEES

Fees charged depend upon the difficulty of the problem, the amount of time required, and the expense of the supplies and equipment used.  Remember, a large part of the fees you pay go toward the doctor's overhead, such as staff, office expense, supplies, insurance, and taxes.  And unfortunately, reduced fees under government-controlled programs such as Medicare and Medicaid tend to shift the costs to private patients.

If you have a question about how much the charge will be, ask the receptionist ahead of time. If the fee seems high or is more than you can afford, don’t be afraid to negotiate or ask for special arrangements.  Most doctors are sensitive to the issue of cost and don't want it to interfere with their ability to give you the best care they can.

Should I File My Insurance Myself?

Even if the office will file your insurance claim for you, you might want to consider filing it yourself.  You may have more control over how much confidential information is released to the company.  Also, many patients report much faster payment than when filed by doctors and fewer denials. 

TESTING

The medical profession has a myriad of tests available to help diagnose your problems.  But to the layperson they may sound like alphabet soup.  Some are expensive and can be intrusive and uncomfortable.  To help you understand why a test is needed and know what to expect, ask these questions:

• Why do I need this test? Your doctor can explain what he will be looking for, and why it is the most appropriate test for your situation.  One of the most important things to know is what difference the test result will make in your treatment.
• What can I expect during the test? Ask your doctor to explain the procedure, including pain involved and the amount of risk.  Find out the amount of time needed so you can adjust your schedule.  Be sure you understand the directions for any preparations that you need to make so that you will get the optimum results.
• How reliable is the test?  No test is 100% accurate, but you should know the limits.
• What if I don't have the test?  You have a right to refuse a procedure, but first find out the alternatives or risks.
• How much will it cost?  Prices vary.  Remember, sometimes the cheaper test is not the best deal: low-cost contrast materials used in certain x-rays have a significantly higher risk of side effects, which can be quite serious.
• How will I get the results? For especially important tests, such as pathology reports or x-ray reports, you may want to keep a copy in your records. That way you don't need to worry about it getting lost in a huge institution or about delays in getting the report to a new doctor.  You should know that many institutions routinely discard x-ray films and recycle the silver after about 7 years.  You may want to ask to keep a copy of the actual film.  For some conditions like a nodule on a chest film, an old picture that shows the same nodule can save you months of worry or a risky and expensive work-up.
• What is the physician's relationship with the laboratory?  You have a right to know if the physician has a financial interest in the business.  It may still be the best and most economical facility, even if the doctor owns it, but you should always be aware of your options.