Transcript Dr Reed`s Presentation - Senior Services of Alexandria

Maximizing Your Visit
with the Doctor
Staying Healthy
Should Not Be This Hard…
Source: Gary Larson, The Far Side
Why Do We Go to the Doctor?
• An acute complaint -- sore throat, knee pain,
headache, etc.
• A chronic condition -- management of
diabetes, hypertension, osteoporosis, etc.
• Preventative care -- cancer screening tests,
vaccinations, advice on lifestyle changes, etc.
• All of the above
• Or, my personal favorite……
Why Do We Go to the Doctor?
• BECAUSE SOMEONE MADE ME COME TO THE
DOCTOR!
• Maybe your physician called and said you were
overdue for a visit, or your daughter said you
should get that cough checked out, or your
spouse said that if you did not get that snoring
evaluated you would be sleeping on the couch
We, as physicians, don’t mind how or why you
came in. But we do want to make sure that the
visit is a good experience for everyone.
The Power of Primary Care:
A Physician In Your Corner
• Someone who knows you
• Someone who can help to coordinate your
diagnoses, prescriptions and specialists
• Someone with whom you can discuss
sometimes difficult topics, including ageappropriate screening tests, life stressors, and
end of life decision making
• Someone who can be a resource for questions
you might have about your general health
So, You’ve Made It to the
Doctor’s Office….
• Arrive early for your appointment
• Please be patient if the provider is running late -We often are tending to someone who is in need
of our attention, and would afford you the same
additional time when necessary
• Bring a second set of ears, especially when
discussing a new diagnosis
• Bring a copy of your insurance information, your
most current list of medications (or the medicines
themselves), and a written list of questions you
might have
So, You’ve Made It to the
Doctor’s Office….
• Keeping a notebook or a pad with questions and responses
is a great organizational tool, especially if you are seeing
multiple physicians and/or have multiple medical issues
– It provides a means for the patient to write down questions
when they think of them, and not be frustrated that they can
not do so on the spot in the physician office
– It also is a means of recording the results of the visit for review
later alone and/or with family/friends -- it helps to remember
who said what and when
Understanding Your Visit:
Different Perspectives
• The physician likely has several objectives he/she
wants to accomplish
– How is the patient feeling?
– Are they compliant in taking their medications as
prescribed?
– Is the patient experiencing any side effects?
– What are the next steps?
• The patient wants remedy for what ails them,
and answers to questions they may have
The perfect visit is when all
this can be accomplished in an efficient manner
During the Visit: What to Expect
• For a focused problem -- brief history, exam
and plan
• For a chronic problem -- history/exam,
discussion and plan
• For a preventative visit -- expect a to-do list of
tests/referrals and lifestyle changes that will
be recommended based on the patient’s
personal history, individual wishes, age and
medical evidence
Types of Prevention
• Primary prevention aims to avert the development of
disease
– Immunizations, life style modifications (smoking cessation,
promoting physical activity), and chemoprophylaxis (aspirin for
primary prevention of heart disease)
• Secondary prevention focuses on early detection
and treatment of asymptomatic disease
– Screening for cancer, hearing or vision impairment,
osteoporosis, hypertension, and abdominal aortic aneurysm
(AAA)
So, Speaking of Age…..
• The profile of aging in the United States has changed
dramatically over the last century
– Average life expectancy at birth has increased from 47 years in
1900 to over 78 years in 2008
– By 2030, the percentage of the population over 65 years of age
will exceed 20 percent, or over 70 million people1
• Decline in function and loss of independence are NOT an
inevitable consequence of aging
• Given the high prevalence and impact of chronic health
problems among older adults, evidence-based
interventions to address these problems become
increasingly important to maximize both the quantity and
quality of life for the elderly
So, Speaking of Age…..
• Tell your clinician about all those things that
might normally be a source of embarrassment in
common conversation
– Have you fallen recently?
– Forgotten where you left your keys?
– Had incontinence that has limited your social
interactions?
– Felt depressed or anxious due to the loss of a spouse?
– No longer read because your vision is poor, but don’t
tell anyone because you do not want to lose your
independence?
So, Speaking of Age…..
• The relationship between doctor and patient
should be comfortable enough to talk about all
the above and much, much more
• It takes a provider who thinks to ask these
questions, and is willing to listen -- Not
everything has a quick fix, but identifying the
problem is the first step
• It also takes a patient willing to discuss issues
that are of particular concern without fear of
embarrassment, and with understanding that the
answers may not be simple
A Special Note on Medications
• Problems related to medication use are common in older
adults. Adults over age 65 in the United States take an
average of three to five medications2
• Notify your provider of all over-the-counter medications,
prescription medications and herbal supplements you are
taking
• It is especially important to review medications following
hospitalizations or stays in rehabilitation facilities
• Drug interactions can be more frequent with increasing
numbers of medications
• Side effects are more likely to occur at onset of medication
use or during dosage changes, although with certain
medication side effects can occur at any time
A Special Note on Medications
• The black box and web searches -- A word of
warning
At the End of Your Visit…
• Feel empowered to ask questions
• If your provider has a electronic medical record,
request a print out of your medication list,
especially if changes have been made
• Understand what is being asked of you
• Know when and how you are to follow up with
your provider (follow up appointment, phone
call, email, etc. )
• Know the warning signs that warrant immediate
attention
Questions
References
1 Centers for Disease Control and Prevention
and The Merck Company Foundation. The
State of Aging and Health in America 2007.
The Merck Company Foundation, Whitehouse
Station, NJ 2007.
• 2 Using medications appropriately in older
adults. Williams CM. Am Fam Physician.
2002;66(10):1917.