Still Doing Your Doctor's Job (October 13, 2015)
Last week I mentioned for the umpteenth time that medical error is the third leading cause of death in the United States. I stated that the area of error that was receiving the least attention but that probably accounted for the most mistakes was the area of diagnosis. (I forgot to mention that last week, actually. But it's true.) And I began telling you how even a layperson who has no clue as to what their symptoms might indicate can still minimize their chances of winding up in the "Oops, sorry" section of the medical morgue.
Thinking about the problem that you are bringing with you ahead of time, and already having the answers to a few questions that will almost certainly be asked in one form or another, will make things much easier for your doctor.That is something you always want to do. Here is what you will most likely be talking about.
1) Where is it?
That's easy if your problem is pain. POINT TO THE PROBLEM AREA. Keep pointing to it until the white coat in front of you actually looks to see where you are pointing. Or you can say, "it's right here" and then stop talking so we have to look up from the screen displaying our Solitaire game. (Hah! You thought we were taking notes, didn't you?)
This is meaningful even if it's a large or poorly-defined area and thus hard to point at. Of course this works better for pain issues or for a weird bump or rash than for something like dizziness, but I'd still try to give a bit of thought to location unless there is absolutely no sensation at all.
2) When did it start/how long have you had it? and what was happening then?
The elderly neighbor of one of my patients once spent almost two days in the hospital getting a heart disease workup because he did not tell the doctor that his left arm pain started when he grabbed onto the lawnmower to keep it from falling over. Why did it take a day and a half for someone to ask him when his arm pain started? Don't ask me -- I'm still trying to figure out what the lyrics to "Mother and Child Reunion" mean.
“I’m not sure” is not particularly helpful here. Even if you aren’t. At least provide a time frame (years, months, days) if that’s all you’ve got. You are pardoned for never inspecting your problem this closely before, because not focusing on things is often how we cope with stuff. But if you've never really thought about it before, start now. Once you're in the doctor's office, the more information s/he has, the better.
3) Is it getting better? worse? more or less frequent?
And if it hasn’t changed, what prompted you to finally bring it to a doctor’s attention? A YouTube video? A movie where the leading lady died of similar symptoms? “I’ve had it for years but I finally got some medical insurance” is sad but true and all too common, and worth divulging.
4) Is there anything else associated with it?
Do you also get nauseous? Do you get a rash a couple of days before it starts? Does it only happen on Mondays, or when you think about cleaning out the attic? (I once knew a lady who went to the ER with back pain every Labor Day for several years -- it turned out to be the weekend her in-laws always came to visit.)
5) What does it feel like?
Dull? Achey? Burning? Let your creativity run wild! “Like a badger is chewing on my ankle” is hard for your doctor to misunderstand. Whereas "it just feels weird" doesn't convey a whole lot to the uninitiated.
6) How bad is it?
And tell the truth. The following happens all the time:
Me: If 10 is the worst pain you've ever had and 1 is barely noticeable, how bad is your back pain on a 1 to 10 scale?
Patient (usually male), writhing in agony on the floor: About a 2.
Something made you finally see a doctor. Tell us, it’s ok. This is not the time for the stoic tough guy schtick. Keep that for later, when you finally start getting your bills.
7) What makes it worse / more frequent?
Getting up from sitting? Lying down? Eating queso dip at Las Palmas?
8) What makes it better / less frequent?
Getting up from sitting? Lying down? Hearing that you've won the lottery? (That would make anything better, so never mind that.)
There is one other thing. If the recommended treatment does not fix the problem, go back and complain. Or go to another doctor and complain. Keep at it until it is either fixed or you have a really good reason why it can't be.
You may never even have gotten a diagnosis. You might have gone to the doctor with a problem, had a bunch of tests run and no one ever called you back. This could be for many reasons, only one of which is that all the tests are negative. And even if they are, well, you still have a problem, don't you? Just because the tests didn't find anything -- or no one called you -- doesn't mean you don't have an issue that deserves attention.
So present your problem as clearly and in as well organized a fashion as you can, make sure you get a diagnosis and that you understand it, and make sure that the treatment fixes the problem. You don't need any specialized knowledge to be able to do these things. And they will go a long way toward making sure that when you do finally land on that slab with a toe tag, that it was for a good reason -- and not because somebody who should have known better dropped the ball.
--dr. diane holmes
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