Certain questions seem to come up most often when one is searching for a ripe avocado in the supermarket. One of these is, “Can you recommend a good doctor?”  Sometimes it takes a little effort to resist responding, “Can you recommend a good patient?”

In fact, as our health-care system continues to evolve through the mechanisms of random mutation and survival of the fittest, the amount of information needed in order to maximize success as a patient is staggering. It is not easy to be a patient. And, it is not easy to be a health care provider. Therefore, perhaps we should go over some of the ways we can help to make visits to the doctor more effective and efficient for everybody, resulting in a better outcome to the patient. That means me and you.

First, know what is bothering you. That may sound silly, but putting into words the things that are keeping you from functioning the way you would like to function is the stuff that distinguishes the careers of great poets. That is not to say that your complaints must be fashioned with embroidery, but rather that your complaints must accurately convey to the care provider what is bothering you.

For example, “I feel sick” is not very helpful.  “I feel tired even after I sleep all night” is slightly better.  “I get up in the morning out of breath and can hardly walk across the room without sitting down” does a pretty good job of painting the picture. Try to help the caregiver see what the world is like through your eyes.

Try to be accurate.  A common exchange goes something like this:

Patient: “My hand goes to sleep.”

Doctor: “How long has this been going on?”

Patient:  “It started after my cat died.”

Doctor:  “When did your cat die?”

Patient:  “The day after I had my hair done.”

Such a conversation can fill up an entire afternoon without much progress.

It is always important to let the doctor know what things you have tried at home to address your symptoms, and to indicate whether your home remedies have provided any benefit. One of the strategies that doctors employ frequently is called “empiric therapy,” because if they called it “trial and error” our malpractice lawyers would have a fit. Nevertheless, there is nothing wrong with trying a simple treatment when you suspect a relatively innocuous illness to see if symptoms resolve. An example might be taking a liquid antacid when you have stomach pain to see if the pain goes away.

This brings up the topic of medications. Always bring in a list of the medications you are currently taking, or better yet, bring in a box containing the actual medications. Include any medicines that have been discontinued so that the doctor can help you dispose of them. If necessary, put them in a wheelbarrow and park it next to you in the reception area. A picture is worth a thousand words.

It is not a bad idea to set aside some of your medications in case your main supply is somehow lost.  One way to do so is to set up a weekly container with seven sections, one devoted to each day of the week. There are even containers with alarms to remind you when it is time to take your pills, but such subjugation to a pill-dispensing device may not be the best way to foster a healthy relationship.

Because our health-care system relies ever more heavily upon different well-intended specialists and consultants, it is easy for an array of treatments and tests to be recommended by different caregivers. This can lead to redundant testing, and even to treatment with conflicting medications. The best way to avoid such disharmony is to understand the reasons for any tests that your doctor has recommended and to assure that each caregiver is aware of your other consultants. As a rule, health care providers have names that are difficult to pronounce and they all look alike in white coats, so it is not a bad idea to have your health care providers’ names written down someplace.

Another highly technical tool that is invaluable when you visit your doctor is a piece of paper.  Write down, or ask your caregiver to write down, the important instructions you should take home with you. Simple things like raising the head of your bed if you have reflux may make a big difference in your symptoms.

If tests are going to be ordered, understand what your responsibilities are for scheduling the test. If you need to make arrangements with a particular laboratory or imaging center, obtain the necessary phone numbers.  Also, be sure that your insurance coverage is compatible with the source for the ancillary service.

A patient without a primary care provider is a bit like an orchestra without a conductor. One of the primary benefits of a so-called “medical home” is the idea that at least one health provider has performed a complete physical examination. Sometimes this examiner may leave certain parts of the examination, like the gynecologic or female “pelvic examination,” to a specialist partner. But at least there is one caregiver who has connected all the parts of the patient to see a complete picture.

Be prepared to remove all your clothing for such an examination. Very little is to be gained from an examination of your clothing.

Like individual patients, individual caregivers have established personalities. Even though professionalism will diminish the influence of a physician’s personality on the doctor-patient relationship, there will always be an issue of compatibility. Find a caregiver with whom you are comfortable and with whom you can speak frankly.

If there were a class that taught us how to be a good patient, the final examination would probably include an assessment of our overall sense of dignity. It has been shown that the happiest people are those who readily assume responsibility and are in a position that allows them to exercise that most exciting part of personal freedom.

Making the most of your confidential visit with your caregiver may be an important step towards achieving that end, regardless of the health challenges we face.

Dr. Todd Stolp is the Tuolumne County Health Officer.

© 2009, Friends and Neighbors Magazine