We all want to get the most out of a visit with our doctor and it might seem that bringing a list of concerns is a great way to remember all of the things that we want to discuss. One website advises:
“How many times have you left a doctor's office only to think of a question you wish you had asked during the appointment? To avoid that, make a list of questions in the days leading up to your visit. The questions can be about something complicated, such as your treatment, or simple, such as whether you should get a flu shot. Make sure you write down your questions. It's so easy to forget what you wanted to ask when there's time pressure and lots of things happening at once.”
Sometimes it can take a while to get an appointment and our time together is over before you know it, so it would be great if we could both make the most of our time together in the office. Why is it then, that family doctor’s hearts sometimes sink when we see a patient carrying a piece of paper with a long list of concerns or questions? The answer is complicated, but there is an explanation and a great way for us both to benefit from the use of lists.
First, all family doctors chose this profession to help and nothing feels better in a day than contributing to a patient’s well being. Helping someone sift through huge amounts of information about their health, or easing a fear about a health condition, or making an important diagnosis are all high points of our days. We also feel proud that we are in a position of trust that allows us to answer the questions found on a list and it feels good that those questions can’t be answered anywhere else. However, we also take great pride in being thorough and careful and sometimes trying to process lists of concerns makes it impossible to feel like we are doing our job as well as we can. So maybe we can make this work better for both of us by using some techniques.
First, we think that it is important to tell your doctor at the beginning of the visit whether you have more than one thing to discuss and to share any list that you may have brought with you. This is incredibly important to us. We can often spot an issue that deserves immediate and focused attention on a list and there are often ways of addressing two or more issues at once. Some of the connections between issues may not be as obvious to you as they sometimes are to us.
Secondly, it is really helpful if we can add to the list, sometimes with our own agenda items that can include preventative health measures or the need for follow up testing. That way, we can both feel satisfied that our work is thorough and proactive. Of course, that also means that some things on your list might not get addressed at this visit. As an example, I recently recalled a patient to discuss her blood tests, one of which had confirmed the new diagnosis of diabetes. When she arrived, she had a list of five things that she wanted to review. I had to insist that we devote most of our visit to discuss diabetes and interestingly, three of her issues were likely related to this new diagnosis. We committed to several visits over the next few months to ensure that she fully understood and mastered this new diagnosis and so that we could address her other issues.
Thirdly, we should negotiate what we can deal with at your visit. Sometimes an item on your list can be much more complicated than you might realize and it is very helpful if we can have a quick discussion about which items we both agree can and should be addressed at your visit. It might be surprising to know that items like an updated referral to a specialist or a medication refill, or a quick look at a mole can actually be very complex and time consuming if done well.
For example, a referral to a specialist requires us to write a letter with updates about your health, your symptoms and a description of what we would like the specialist to review. In these letters we include detailed information about your past medical history, past surgical history, family history, habits, an updated medication list, our exam findings, and copies of recent blood work, X-rays, ultrasounds, etc. When these letters are written well, they help the specialist optimize your care, save you time in telling your story and help you avoid unnecessary repeat testing. A well written letter can also shorten the time that you wait to see the specialist, by capturing the intensity of your symptoms or by effectively describing the impact of symptoms on your quality of life.
Medication refill visits are often surprisingly complicated as well. Almost every medication requires some degree of monitoring to ensure its safe use and there are almost no medications that should be taken indefinitely without discussion. At each of these visits, it would be optimal to discuss the effectiveness of your medication, and any side effects that you might be experiencing. We should review monitoring for safety and the potential for drug/drug interactions, as well as discuss the costs and alternatives and review whether the medication in question should be continued.
Lists also often include a request to “quickly check a spot” or a mole of concern. Again, assessing skin changes can be much more complicated than it appears. We need to take into account your family history, your own history of moles, the degree of sun exposure that you have had in your life, medications you take, previous treatments used on your skin, etc. Some skin lesions can be dangerous and any skin change should be examined carefully, in a well lighted space, with the appropriate body part fully uncovered and in an unhurried manner.
Perhaps these common examples might help you understand why a list with a request for a referral to an ophthalmologist for a longstanding eye condition, together with a request for the refill of several medications and a request to check a mole on one’s back can seem short to you, but overwhelming to us, particularly when we might also have concerns about your recent blood tests or your blood pressure. We might also want to discuss when you are due for a preventative measure like a mammogram or a PSA, and why you might or might not want to have that test done.
Maybe we can work together on this by getting both of our lists on the table at the very beginning of the visit and then by working together to identify the most important items on that list that we can realistically work on in one visit. For any items that we can’t cover, we will ensure that you get prompt follow up. By doing this, we hope that you will leave the exam room with all of your questions answered and we can leave feeling that we have provided you with the thorough, high quality care that you deserve.
