Everything you need to know to be an Organized and Successful Patient.
44 Practical tips to help you stay on top and in control of your health and health records
By Omada Idachaba M.D of http://mylansingdoctor.com/
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Copyright Omada Idachaba MD 2011
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Omada Idachaba MD at mylansingdoctor@gmail.com
DISCLAIMER
THE INFORMATION CONTAINED HEREIN IS FOR INFORMATIONAL PURPOSES ONLY. NOTHING CONTAINED IN THIS MATERIAL OR WEBSITE CONSTITUTES A PHYSICIAN-PATIENT RELATIONSHIP NEITHER DOES IT REPLACE YOUR CURRENT LICENSED HEALTH PROVIDER OR THEIR SERVICES.
INTRODUCTION
My motivation for coming up with these tips
After many years in practice and seeing so many thousands of patients over time, I have come to recognize a few things.
The times have changed. Before the era of the internet, people depended solely on the information given by their physicians and often regarded the physicians words as final. In this present technology age, patients have the ability to research their illness, doctors, medications, side effects, hospitals and a host of other things ever before they set foot in the doctor’s office.
With the ability of information to travel fast among medical providers, we find that the same system that was designed to expedite the process also impedes the process. This is partly because of our reliance on a system that is great but not perfect yet. Therefore information gets missed, delayed, lost etc.
Patients now have realized rights they did not know they had in the past. They now have access to their records, request for tests they feel they should have, treat themselves with alternative medications they feel work better than conventional and request second opinions if the first is not to their satisfaction.
It is very easy to get very confused about your care, medications, hospitalizations, appointments and questions you should be asking your doctors. This is especially so in the elderly, very sick or patients with chronic illnesses.
The following are 40 very practical and easy to apply tips, that will help you take control of your health, get organized and feel empowered.
Who am I and what’s my philosophy?
I am Omada Idachaba M.D, a practicing internist for the past 13 years. I have had the opportunity over these years to treat and impact the lives of my patients for the better. I came to realize this impact when I was moving from my previous practice. My patients in one of the toughest practices all wanted to follow me to my new location. Here I am 6 years later, and I am still getting calls from my patients to join my current practice. The other day, I saw one of my former patients in the hallway and hugs and greetings, she asked me whether I had started my own practice (no I had not). She then said she was still waiting for me to start it because she was going to be my first patient. So, I and my patients enjoy what I do. However I do recognize things that are working and systems that are not. This point was driven home when recently, I had to be in the position of the patient. It gave me the opportunity to look through my patients eyes and see where I could improve as a patient and where the health care system could improve. I now take note of what can make the patient experience better but even more so what can help me help my patients.
After seeing the difficulty in obtaining information or labs or history from previous providers, I have come up with tips that I created based on day to day practice that any patient – young, old, elderly, very sick etc can utilize. At the end of the day, I want my patients to feel they have done what’s in their power to be on top of their health, to feel empowered.
This all starts with being organized. These tips are culled from every day practice. Things that I notice can make the patient experience better, clearer, satisfying and empowering.
What sort of patient needs these tips?
Every one that has been to a medical care provider more than once needs these tips. As you know, even if you are in perfect health, you still need to see your provider at least once a year. The more times you have to see your provider, the more illnesses you have, the more hospitalizations you have, if you take multiple medications, if you have multiple providers then you will need these tips. Do you have sheets and sheets of medical records in no particular order? Do you have a chronic illness that has you in and out of doctor’s offices each of them saying different things pertaining to your care?
SECTION 1: There is only one you. Your health is a priority!
1. Make your health a priority. Your health affects everything you do. If you do not feel good, if your health is compromised in any shape or form, it affects your ability to perform at maximum ability or capacity. Making your health a priority means you take charge and do not wait till you have fallen apart or progressed beyond a point of repair or relief. Take steps to live as healthy a life as you can possibly live. Practice good lifestyle choices. Incorporate what it takes to live healthy like diet, exercise, not smoking etc. Become accountable. Adopt a ‘whatever-it-takes-to- be-healthy’ attitude and then go for it.
2. Play an active role in your healthcare. Gone are the days where the doctors knew it all and their say was never questioned. The new way of healthcare is where you and your doctors work together for your optimum health and wellbeing. Of course, your providers are there to lend their expertise to your medical conditions. They are they to explain what you do not understand. Above all they are there to work on your behalf. I personally enjoy patients that come in wanting to part of the medical decision making.
3. Be informed. A successful patient is an informed patient. With the internet, books and magazines, there is a wealth of information out there. The idea is to understand the basic concepts of your condition enough to discuss with your physician without getting overwhelmed.
4. Know who you need. For your primary care needs Family practice physicians where trained in residency to see patients through the spectrum of life. Internal Medicine physicians or internists as they are called where trained in a 3 year or more residency to take care of disease states specific to adults 18 and over. Geriatricians are trained to care specifically for the geriatric population.
SECTION 2: Your very important medical records.
5. Know your history. Or have it documented in a place that is easily accessible. If your history is particularly lengthy or complicated, you will need it clearly written in a format that is easily understood. Your history includes your present and past illnesses, surgeries, hospitalizations and your family history.
6. Who are your doctors? Know all of your current and previous providers and what you saw or see them for and their contact information. For example: Dr John Smith (current), Urologist, Bladder problems, office address, telephone number; Dr Jane Johnson (previous) OBGYN , fibroid surgery, office address, telephone number
7. A computer is very helpful but is not necessary. Even though documentation is easier and more organized with a computer, some people prefer to write. Don’t feel that because you do not have a computer, you can’t be organized. You can have a well organized *medical record journal that is just as good and just as detailed.
8. Utilize a journal or guide during your doctor’s visits. I often times come across patients that come with a computer generated list of their medications or medical conditions. Some patients come with their records from current or old providers or most recent labs. All these can be kept in one place or in a journal or notebook* that you can refresh as needed and take to your appointments. That will definitely put a smile on you and your doctor’s face. This is such a time saver.
9. Release of information. In the event that you are leaving a practice, do request to sign a release of information. By this you are giving your old practice permission to send your medical records to your new provider.
10. Record updates. If you see multiple providers, it does help to request for a copy of the most recent note as you leave the office (from either your primary physician or specialist). With electronic medical records, this can easily be generated on the spot. When you then see your next provider, you can present this information to them so that they know what the treatment is thus far, the treatment changes or what the referral is about.
11. Medication updates. If you have medications that are frequently changed or you take multiple medications, keep a running list of your medications and update the list with each change.
12. Document all your medications. These should include over the counter medications, vitamins, supplements, alternative therapies you may be using.
13. Always have a wallet size copy of your medications. In the event that this list is needed, you will be able to provide this information immediately for instance in the case of an emergency.
14. Keep your medical records as trim and concise as you can. Keep your records updated and relevant. All information is necessary to be documented but not all may be relevant to your current medical status. Provide the relevant information at your doctor’s request but keep all information available to provide when asked for.
15. Do you have stacks and stacks of medical records? I have patients that are very good at obtaining copies of all their medical records. This is very helpful but can easily amount to stacks of disorganized medical history papers. In such a case, file these records according to doctor or condition, labs, radiology tests etc. You can scan them to your computer and file them. Upon request, you can then download your records onto a USB flash drive.
SECTION 3: What you can do at your next doctor’s visit.
16. Arrive on time to your appointment. We all know that we feel calm and in control when we are not rushed or frazzled. It is very easy to omit things or forget things when we are rushing. A recommended time is at least 15 minutes before your scheduled appointment to take care of any last minute details. Sometimes coming early may get you seen early as at times, I find myself running ahead of schedule and therefore seeing patient who arrive early ahead of their scheduled time. That often times translate into more time with the patient.
17. Understand how much time is available to you. This will help you to make that most use of your time. In most offices that take insurances, patient acute or follow up visits are scheduled for 15-20 minutes. New patient visits are scheduled 30-45 minutes.
18. Write the questions you absolutely need answered down. I have personally had instances where I could not remember the questions I wanted answered because I did not write them down. Things worked out differently and much better when I wrote down my questions.
19. What are your top questions? Because doctors have limited time, in reality, your doctor may not be able to answer an unlimited number of questions, much as we desire to. Select those that are of top priority to you for the doctor to answer. As you come back on subsequent visits, the other questions will be answered over time. Better still, if your doctor has email, that can serve as a good way to get some of the questions answered.
20. Know your numbers. Do you a chronic illness like diabetes, hypertension, high cholesterol, obesity etc? Firstly, I recommend obtaining machines for monitoring things like your blood sugar and blood pressure so that routine monitoring can be done by you at home. These numbers go a long way in helping your provider monitor your progress and make the necessary adjustments to your therapy along the way. For other illnesses, it is good to keep a record of lab results and tests done to monitor your progress.
21. Bring your records. This can be accomplished by either recording them in a book or bringing your machine with you particularly if your device has memory. I do advice my hypertensive patients to periodically bring their machines to do a comparison with our blood pressure machine in the office. If the numbers are not similar, the accuracy of the machine cannot be trusted.
22. Ask questions for clarity. If a new treatment or medication is introduced, ask what its purpose is and why the doctor thinks it is necessary.
23. Feel free to request for a test or treatment. Just today, I had a patient who had been having persistent shoulder pain request for physical therapy. I granted her wish as indeed, it was the next step of her care. Conversely, feel free to ask for a particular test not to be performed particularly if you are not convinced of its benefit or you are not sure it is covered under your insurance plan.
24. Come with someone. If you are facing something serious, or just don’t know what to expect or the questions to ask, bring a trusted friend or family that can serve as the objective ear.
25. Take notes. In school we took notes because we wanted to be able to review what was taught as we did not trust our memory to retain everything said. Same goes for our medical visits. Take notes on what’s being said, the home assignments, the new medications and what they are for. A study showed that after the visit was over, older patients on average forgot 75% of what their doctor had said.
26. Be fairly knowledgeable about your insurance. Sure you can’t possibly know everything in its detail but know what tends to be covered by your insurance and what is not. Who are the in network providers for the insurance? How much is your financial responsibility? How much do you have to pay if you see a physician who is out of network? Have the customer service number easily available to ask questions regarding anything not understood in the policy. Understand what your co-pays and deductibles are. Request for a medication formulary so you know which drugs are covered and which will require higher co-pay.
27. Take a cheat sheet to your specialist visit. This cheat sheet just supplies basic information on what the consultant’s diagnosis and plan is. This sheet can serve as the bridge between when the patient is seen by their provider and when the formal consultation report is available.
28. When lab tests are done, request for a copy to be sent to you. In the event that you receive no information about your results, do call the office within a week to inquire about your results. Do not assume that no new is good news.
SECTION 4: You as the hospital patient
29. Whether you are in the hospital for an acute visit or a chronic visit, it is important to be as much on top of things as your situation allows. What tends to happen is patients are seen by multiple providers during any given hospitalization. At the end of the day, they usually can recollect one or two of the doctors seen. What my practice has done is give our physicians picture business cards with the name and picture of the physician and the name of the practice for easy reference and recollection. I do understand that not all physicians carry picture business cards or even any business cards at all. In such a situation, where you or your caregiver is able to, request for doctors to write their name and what they are seeing you for on a sheet of paper. This will serve as a reference and information sheet for your primary care provider on who saw you in the hospital.
30. Know who the primary physician in charge of your care is. This could be your personal primary care physician, a designated doctor of the group or a hospitalist who is not related to your primary care physician or their group but specializes in hospital patients.
31. If you have multiple or serious medical conditions, make arrangements to have a durable power of attorney for health to make decisions for you in the event that you can’t make these decisions for yourself.
32. If you have an elective procedure like a surgery, be clear on how long the hospital stay will last. Insurances only allow for a certain number of days for certain procedures like knee replacements and other elective uncomplicated procedures.
33. When admitted to the hospital, have an updated list of your current medications and their doses. What helps is if you bring them along with you for easy reference as needed. Sometimes, the hospital formulary may not have a particular medicine you are taking and you will have to use your home stock.
34. Usually, upon discharge, there are discharge instructions and follow up appointments that you and possible additional medications or medication changes. Make sure you are clear on what these changes are and what your responsibilities are after you leave the hospital. Request for proper documentation of these instructions and any changes.
35. Do ask questions about tests done in the hospital and what the results are. Ask questions if you are not clear on anything that has taken place during your hospitalization.
SECTION 5: Miscellaneous things.
36. Research reputable websites and read books. Do educate yourself regarding your medical condition and ask your doctors questions on whatever you don’t understand. Below are listed help patient friendly websites. ^Patient friendly websites:
Hospitalcompare.hhs.gov
http://emedicine.medscape.com/
37. Organize the records of your parents and kids. Oftentimes elderly parents are taking multiple medications and keeping up with their medication refills and what medication is for what can be challenging. It is helpful to have a system that helps you organize this. It is helpful for parents to know what physical exams their child is due for and when, the vaccinations due etc. A system that provides this information can be invaluable.
38. Recognize that your healthcare is a partnership. You bring what your problems are, what you value and your doctor brings their medical knowledge and expertise. Jointly and by mutual consent a plan is formulated that can only be executed if the patient is in agreement.
39. Start where you are. You don’t have to have access to old records to start being organized. Start with what you know about your history. Dates don’t have to be exact if you can’t remember them. It is okay to put the year. The important thing is that you are starting to the process to being organized.
40. Once organized, you have set yourself up for being successful. Whatever your health journey may be, whether living a healthy lifestyle, or managing your chronic illness, or both, you now have what it takes to participate in your own healthcare and decision making about your health.
41. Knowledge is power. Once you know information about your illness, medications, the healthcare system or whatever it is pertaining to your health, you then come in from the position of empowerment and control. Get informed about you!
42. Find the right doctor for you. The right doctor is essential in the quest to be organized as a patient. Find a doctor that you can build an ongoing relationship with. A doctor who provides continuous comprehensive primary care. You would want a doctor who you can communicate with and who is able to communicate effectively with you.
43. Know that things are changing in the healthcare world. There is more and more emphasis on the patient centered medical home, where health care is provided by a team of people who know you and are through whom your medical care is coordinated. With this, you have more time and access to your physician and communication between various providers is facilitated and made easy. As I write, the health care reform is in debate and accountable care organizations are the talk in healthcare. No matter what is going on, being organized can only be a plus to whatever health care system is in place.
Also with social media like facebook, twitter etc, patients are utilizing these to form communities, forums and connect with each other.
44. Fill out your Advance Directive forms. Advance directives are a way to communicate to your family, friends and health care providers what your end of life wishes are so as to avoid and questions or confusion when the time comes. Make sure there is a plan in place for you.
CONCLUSION:
These 44 tips put into action will certainly put you in charge of your health and health records. By implementing most or all of them, you will notice control, satisfaction, peace of mind and even better outcomes because of the new order and structure to your health and health records. Indeed errors are easily detected in the presence of order.
Your health is in your hands. It is hard enough having medical conditions that you have to keep up with. It is my duty as a physician to provide you with tools that will make things easier for you.
It is always a work in progress. I will like to provide you with helpful medical information, tips, things you should know on preventive and screening test, my blog and a lot more. I also have an accompanying e-guide “The Organized and Successful Patient, Doctor’s Visit Companion available for download on my website http://mylansingdoctor.com/ . Sign up for these today.
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Best Wishes for your health,
Omada Idachaba M.D
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