Tuesday, June 06, 2006

What to prepare when visiting your doctor

We are very often confronted with very poorly informed and ill-prepared patients and relatives at our outpatients clinic. They are not familiar with what a doctor is trying to do to form a medical opinion, to help manage a condition. This posting is to familiarise the public about what to expect and prepare when you consult a doctor. A smooth flowing consultation can be pleasant and rewarding for the patient and also for the doctor. It does not take much to prepare, certainly not sleepness nights.

It is obvious that if the visit is to the emergency room, there is no time to prepare and shoddiness is forgivable but when it is an elective visit, or a complaint for consultation, it helps the doctor and also the patient, if he prepares a little for the clinic consultation. It serves well to know the general scheme of things at a consultation.

The doctor always begins by taking a history. The doctor will always wish to know the main (chief) complaint. What brings the patient to consult the doctor. Is it fever, or chest pains, or weakness, or lumps and bumps, etc. This main complain usually has a duration. How long has the problem been, 1 week?, 1 month?, 1 year? or how long approximately.

Having done that, the doc will always wish to have a bit of background information, like past history and past records, like previous admissions, previous history of hypertension or diabetes, or surgery, or mental illness. A history of the family background is very important. Family history of diabetes, hypertension, heart disease, tuberculosis, Then comes some details about the social background including living condition, work environment, social habits like smoking, alcohol, drugs, and where appropriate, sexual history.

I also like to do a general system review by going through the bowel and urine habits, appetite, weight gain or loss and sleep pattern. A history of allergies is also very important. It is important that if the patient had been seen by other medical practitioners before, to bring along the tests done at the other doctor, or the medications that have been prescribed. These can be very helpful in forming a working diagnosis. Sometimes, I feel that the patient or relatives hides these things just to test the doctor, to see if he is on the right track or just to double check a previous opinion. I must say that this is not wise.

The doctor would, having taken a full history, conduct a detailed physical examination of all the systems, beginning usually with the vital signs viz the BP and PR. It is good practice for the doctor to have a chaperone whenever he is examining a female patient. The chaperone could be a clinic nurse, or a clinical assistant. Cardiac, chest and abdominal examination with a neurological examination is routine. Examination of the eyes and ears, and sometimes a rectal examination is warranted. Pelvic examination is usually done by the gynecologist or for an obvious gyne complaint, by the GP. It would be very hard to justify a cardiologist doing a pelvic examination.

Following this, the doctor would arrive at a provisional diagnosis and on that basis, order some test to be done, be it blood test, or X-rays, or scans. If these test requires special preparation, the doctor may schedule the test for a different day.

During the case discussion, after the physical examination, is a good time for the patient to ask the doctor to explain what he feels is wrong. He can also inquire after the management strategy. If the doctor intends to carry out invasive tests or procedure, this must be discussed thoroughly, including the risk of procedure, the reason for the procedure and also the costs of the procedure. The medicine prescribed, should also be told to the patient and also relevant social advice like exercise, diet and also sex. If second opinion is needed from another specialist, the patient should be informed. Having heard everything and satisfied with the doctor's explanation and advice, the patient and relatives will leave the clinic. It is true that most disease condition treated, will have a follow-up visit. This is usual and can be expected.

I hope that this brief discussion will help patients understand what a doctor is trying to do at a consultation, and how to help him. Helping the doctor, is the surerest way to help the patient.

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