How to Celebrate Older Americans Month
Are You an Elder Orphan?

Planning a Routine Doctor Visit

For me, the less medicine I am subjected to, the happier I am so in the arena of healthcare, I rely on two principles from the non-medical world:

  1. If it ain't broke, don't fix it.

  2. The hammer and nail rule (if you're a hammer, everything looks like a nail) applies equally to physicians: If your job is to heal people, everyone looks sick.

Now before we go one ssentence further today, let's be absolutely clear: the above is NOT a recommendation for anyone else. Period. Full stop. It's just a jumping off point to help explain how I came to write this blog post.

Okay? Moving along.

It's still two or three weeks until my “annual” wellness visit (“annual” in quotation marks because it's going on two years since the last one). It's a routine visit – I have no complaints - but I want my time with the doctor (which isn't much these days) to count. So I'm already preparing.

This is the kind of checklist I've used for many years and it has served me well particularly, I think, because with so little contact there is no reason the doctor should remember me. But it's a good idea even if you see a doctor more frequently, so you don't forget anything you want to know.

LIST OF MEDICATIONS
This time there are only two but one is a supplement the doctor said I need last time I saw him. So I want to be sure the test is ordered to check current levels.

Some people, particularly those who take a variety of prescription drugs, just drop all the bottles, into a bag to take to the appointment. Be sure to include over-the-counter supplements, pain killers, etc. and dosages.

MEDICAL CARE SINCE LAST VISIT
Another list, this one of health care the primary physician doesn't know about but should probably be in your main record. In my case, cataract surgery, the results of some short-term physical therapy, annual flu shot, pneumonia shot, and my ongoing dental work that includes bone grafts.

If care from other medical professionals is ongoing, include their names, locations and contact information.

MEDICAL/HEALTH QUESTIONS AND CONCERNS
Yes, another list. This one is of changes in how my body is working (it could be my mind, too, if/when I think that is in question) or symptoms that I want to ask about.

There are three or four items I'll ask about during this appointment. There is nothing that worries me but I want to confirm that and ask what's going on.

Such symptoms as dizziness, falling, hearing, incontinence problems, weight changes up or down, insomnia and chest pain among others become more common in old age. Don't ever be reticent about discussing anything of concern with your doctor.

If you have researched the web about any issues you have, bring printouts of what you think is applicable or about which you have questions but use your head. Don't give him/her a sheaf of pages – only what is minimally necessary.

UPDATED CONTACT INFORMATION
If any of your contacts have changed, that's another list to bring. Emergency contacts, health care surrogate, medical insurance changes if any, pharmacy name and telephone and, of course, copies of any DNR (do not resuscitate) and other emergency and end-of-life instructions.

As luck would have it, when I was mostly done with writing this, an email arrived from the National Institute on Aging titled Talking With Your Doctor: A Guide for Older People.

It covers most of what is listed above and one other thing I left out that is important: family and friends.

Many years ago, when she was in her 30s or so, a friend was diagnosed with breast cancer. She is a reporter and of course, went into research mode to see what treatment was recommended for her kind of cancer, what outcomes were expected and what were the variables, among other information.

But she realized, too, how rattled she was so she brought a close friend, another reporter, with her to every appointment and discussion with experts about her case so that she would be certain to have all the notes she would need to make her treatment decision.

I've always been impressed that she thought to do that, especially back when doctors were still perceived to sit on the left hand of god.

It's much more common today to be involved in our own treatment and you can bring a friend or family member with you, even on a routine visit if you need or want to.

The section about talking with your doctor at The National Institute on Aging is very good and there are prepared checklists for doctor visits that you can print out. You'll find it all here.

Comments

I start a list a month before my annual wellness exam of questions or issues that I want to ask about and take the list with me. I am on no prescription drugs and take only a supplemental Vitamin D capsule. I do go annually because I'd like to have a physician who is at least acquainted with me if I really do get sick.

I recently did my annual visit. I was given a form that the doc says is required by Medicare for these annual visits. It requires much of the info you have gathered, and also the names of all doctors treating you for anything right now. I do have any specialists send their diagnosis to my doc during the year; in case something happens, I want my primary care doc (i.e., electronic medical record) to have access to the complete history. Like you I make a list; my alleged brain works much better with the list and I make sure I get all my questions answered. Put Pneumonia vaccine on your list; apparently, Medicare changed their recommendations early this year, and you might be eligible for the new Prevnar vaccine as well as a booster for the original vaccine. Cheers!

I got a reminder that I'm due for a tetanus booster. I think it's recommended to have one at least every 10 yrs. Since I do putter.......literally, in the garden I may get the shot. Then again, maybe not. Dee

Every time I see a doctor, I am always afraid to mention the minor things that are wrong with me for fear of having that "pain in my elbow" become some life threatening illness for which there is no cure. Personally, I'd rather not know. With that said, I have an appointment with an ENT doc tomorrow. Wish me luck.

Caution: It's great to use the internet as a source - but the physician is more than likely going to dismiss it. In fact, I have been told by a few - "Don't read that stuff!". What I am saying is, do not waste those precious few minutes (20 minutes) discussing something you read. Use your time more wisely.
But I have found it helps me to identify symptoms more clearly so I explain them accurately. Not really sure why they dismiss it - perhaps it's a safeguard to creating some peripheral psychological problems (hypochondria?).
Regarding retaining records on things like vaccines taken at Walgreens and CVS - once I noted these to my physician's assistant - they had been already noted. The pharms had forwarded the data.
Just trying to help . .

I also have advance directive on file at my doctor's office. I was so grateful we had done this when my husband passed away unexpectedly.

Thanks to my husband's pre-retirement position with an HMO, we have an excellent Medicare supplement plan. The HMO maintains a consolidated set of medical records for each patient. Now that they're electronic, they're available online, and occasionally I check for accuracy. In general, any problems have been rare and easily corrected. I do take a short list of questions to routine doctor appointments. However, I would not be at all comfortable with having someone else sit in on my visit. I'm sure that's a great idea conceptually, but I suspect a lot of people feel as I do.

Since the cost of out-of-network care is prohibitive and we don't travel, there's no need to keep detailed lists since the system has all my data in one place. No billing hassles, either. I get a monthly summary (EOB). Many people don't like HMOs, but we have had very good experience with ours.

@Dee, Getting another tetanus shot is a really good idea. A person may be bitten by a cat or dog which is not immunized and get tetanus. Even from your own cat or dog.

It happened to me years ago. When my cat sank her tooth into my hand and it looked red and swollen the next day, I called my doctor immediately. He told me to get right over to his office.

I've also read newspaper articles about people being bitten by a dog and unable to find out whether the dog had received a tetanus shot. A person can't wait to check that out. He or she needs to call a doctor ASAP.

Since I have MS and its related problems and also lots of sinus issues, I take lots of medication, both prescription and OTC. I have kept an Excel spreadsheet of all of my meds and surgeries for many years. Since it's on my computer, it is easy to update, delete items, etc., and print out a copy for each doctor visit.

I also keep a computer list of all discontinued meds, date stopped, and the reason. This is helpful when the doctor discusses a different med to try or I change doctors, for instance.

Another Excel file I keep is a list of all medical-related appointments I have: doctors, tests, PT, OT, etc. I have columns on it that have the who, what, when, where, and why for each appointment. The "where" is useful when I do mileage for medical deductions for my taxes, and the "why" helps me remember the reason for the visit: lumbar spine MRI, surgery on right hand, PT for neck injury, for example. I've been keeping this particular file since the mid-1990s.

Maybe I go overboard a bit with these different files, but it is helpful to me, and it might be useful to others who had complicated medical histories.

Wow, Beth, this is ambitious, though setting it up initially is probably the most time-consuming, with gathering information and all. I think I'll give it a shot. My physician will be happy to not see me spilling loose papers all over her room.

Presently, I keep a file year-round just for my annual, that regularly gets stuffed with notes for discussion and also medical information I come across (usually to convince her that I don't need meds), such as the recent change in cholesterol food guidelines.

My frustration more with her and others I see is they have little to no knowledge of alternative medicine, which I've recently begun exploring. The "meds" would best be included in my OTC meds, but she doesn't know their interactions with my prescriptions. So this appears to be an area where I'm on my own. And no, I wouldn't expect her to devote time to this. Hopefully with the emerging acknowledgement of their usefulness, this will change.


I agree with "If it ain't broke, don't fix it." Since my daughter died at the hand of physicians in the early 1990s, I have been terrified of most every doctor I have seen.

I, too, try to avoid unnecessary meds. whenever possible.

I keep a list of the things I want to discuss with my doctor. He usually thinks old people are too slow and takes the list from me to scan on his own. This irritates me because I can't go over each item and he picks anything he thinks is important and gives me a quick answer or asks a question. By this time I am rattled and forget what I wanted to say.

I recognize that doctors are on a tight schedule, but I want at least 15 minutes of his time (more if necessary) and I think I am entitled to that.

Darlene, make an extra copy, give one to the doc and you still have one.

Good advice.

Something else?

Don't forget to bring a book to read,

Sometimes the wait is long, even when you have an appointment.

Pack a snack.

Nothing noisy, like corn chips.

Pipe down.

Voices carry.

The only person who needs to know about anyone's raging haemorrhoids, is the doctor, and not the entire waiting room.

It's a clinic, not an auction.

Doctors! The longer I live the more I disbelieve them! Recently I had to have an MRI on my 'brain', It showed I had 'something on my retinal nerve on the left side. Since I had no intention of going through brain operation I did however take recommendations (referrals) to other experts to find out what it was etc.
Three referrals later (all with huge titles and degrees) the answer was very mixed! And the 'something was not on the left side but on the right! Certainly left me with even less confidence than previously.
At my age (87) I absolutely will do nothing about anything unless I am in extreme pain--then give me all you got!!!
Life is precious but as a person who has had a very productive life and a very full one I want to go before I become a complete nonentity!
Have all the DON'TS in place,
in my doctors office and right on my desk. Never one to be the last to leave the party and the same goes now!

I agree completely with NWD. I'm 70, but my doctors are aware of what I'm willing to do/have done to me, and what I won't, and I'm very happy that they respect my decisions.

Darlene, you have an absolute right to your 15 minutes but I'm not sure you're missing much without it. Studies have shown that when doctors are not available---say, during a strike of residents or attendings---fewer people get sick and the death rate goes down.

My medical care is provided through an HMO serviced by the largest medical teaching institution in the State. I have 30 minutes with my Primary Care Physician every three months. He spends most of that time meticulously going through a list of not just my five prescriptions, but every OTC thing I use or put in my mouth, including omega 3 caps, powdered fiber, low-dose aspirin, heat patches, vitamins, etc., etc. I am not allowed to interrupt and just say that all meds except (yadada) remain the same, even if it's true. I guess he doesn't trust me to know what I'm using. Nor can I disrupt this ritual,which eats up most of my time, with a question about something that's really bothering me. I have learned to simply ask for a referral to a specialist, which is readily given, but in many cases shouldn't be necessary. My PCP is essentially a traffic director, who also ensures that I get my vaccines as needed. A physician's assistant could easily do what he does at a fraction of the cost.

However, my cardiologist (a woman) is top notch, as is my ophthalmologist (a woman) who saved my sight from macular degeneration. Ditto my dermatologist (a woman) and my rheumatologist (a woman). I guess my main problem is that I have to waste my time and the drive to the clinic to see this guy at all. The medical care I get from him could easily (and literally) be phoned in. But the system is set up so that I can't see any of the doctors I need without his recommendation, no matter that it is largely pro forma.

SO agree with your basic premise.
One of my mottos for years now with regards to operations is, "You gotta catch me first!" We go yearly for check ups and have a terrific doc. for over 40 years and he's smart, knows drugs and what they can do and not do, and is a minimalist.
Great guy and have told him he may never retire!

Re: your two "rules" at the top. I have thought of your hammer saying often in the last few days. A very good reminder when I get taken in by an
y salesperson's hype. And anymore, doctors are sort of salespersons. sandwiched between the paient and the insurance co's.

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