As a hospitalist physician, my work centers around providing quality inpatient adult care. However, often there are times when the line between Primary Care and inpatient care is blurred.
Recently, I encountered a situation where a patient with a history of diabetes followed and managed by his Primary Care physician (PCP) expressed frustration. He felt that his doctor had not done his due diligence in giving him more insight into diabetes. He didn’t discuss the different kinds of oral hypoglycemics, for instance, or when it is best to transition from pills to insulin. He didn’t offer a glucometer for him to check his blood sugars. The patient also felt he was not being listened to by his PCP when he complained of increased thirst and fatigue despite reported compliance with his diabetic medications. (Thus, it wasn't a surprise to me that part of his admitting diagnosis was uncontrolled diabetes.)
I am sure my colleague was managing his diabetes in the most appropriate way. However, the patient was very upset and he felt as if he was being neglected.
Honestly, I was saddened by these comments. I cannot speak for every physician in the world, but I can say that I put my heart and energy into the work that I do and make an effort to listen to patients. As someone who has sat on the examination table themselves, I know how it feels to want to be heard during a time of illness. When I am in the role of the clinician, I try my best to listen intently to the patient’s story, signs and symptoms, and concerns. There are moments where patients may deviate from the initial complaint into something not relevant to the issue at hand, however, it is my job as the physician to steer the conversation in the direction that will most benefit the patient.
There are other instances where a physician may become so overwhelmed by the case or even the information provided (scanning through old records, extensive medical history, etc.) when a disconnect occurs between doctor and patient.
Now, when discharging a patient to follow up with their PCP, I make it a point to discuss with them how to translate what happened during their inpatient experience effectively to their PCP. (I also attempt to send discharge summaries to PCPs if my employer has a system is in place for that at the facility).
I also provide tips on how to effectively communicate with their doctor. These guidelines include but are not limited to:
1. Write down your thoughts and questions prior to your appointment.
Nothing is worse than realizing you forgot to ask a question after you’ve left the doctor’s office. By having everything written down either on your phone or on paper prior to arrival, you can clearly discuss the concerns you have.
2. Bring a list medications and conditions.
This list should include all of your previous and current medical conditions and medications, especially new ones prescribed during your admission. The “medication” list should include teas, supplements, herbs, shakes, and over-the-counter drugs.
3. Bring an advocate with you.
There may be times you are unable to fully describe what has been going on with you, but someone on the outside looking in can help you. Having a family member or friend who can appropriately characterize recent changes (i.e. memory loss, snoring at night) can help paint a clearer picture of what is going on. I can personally attest to times where I was grateful to have a patient’s spouse or child in attendance as they gave me a good history of the patient’s issues. (Make sure the individual who accompanies you is someone you feel comfortable discussing your health in front of, of course.)
4. Share your concerns.
If you do not understand what is being said, ask for it to be explained again in a clearer way. As clinicians, we can sometimes bombard patients with medical jargon they more than likely will be unfamiliar with, leaving them confused. It is better to speak up and say you do not understand then to walk away from an appointment without an idea of what is going on with your health. For example, if you are worried about side effects/adverse reactions to medication or therapy then be sure to voice this concern. There may be other treatment options available.
5. Be honest.
We cannot help you unless we have all of the information necessary to make a conclusion. This includes previous medical conditions, sexual history (including the gender of partners), and prior surgeries.
Do not feel embarrassed about your health or preferences; the more information we have the more likely we will be able to help you. Names of previous physicians you have seen in the area may also be helpful as we can request medical records from the past. Added bonus: If you have any previous imaging (X-rays, CT scan, MRI’s) on CD or reports that may be related to your issue, bring them to the appointment.
6. Request an interpreter if needed.
If the primary language of your provider is not the same as your primary language, there may be some difficulty in conveying your thoughts. If you feel more comfortable explaining things in another language, request an interpreter. Some facilities can provide physical interpreters who will attend the visit with you. If that is unavailable, many exam rooms have language phone lines at the bedside and many physicians use language services directly from their cell phones.
7. Ask for a summary.
At the end of the appointment, be sure to ask for a quick summation of everything that was discussed, including diagnosis, plan of treatment, and follow-up. If there is a new medication regimen, be sure to receive a written documentation about the medication and its dosage.
8. Consider a second opinion.
You are the best advocate for yourself. If you truly don’t feel like you are being heard by your physician or disagree with the plan of management, seek a second set of eyes to assess your case.
Managing health is not solely on the side of the patient or physician. As physicians, we must work to provide each patient with the time, patience, and respect necessary to provide sufficient care. The patient herself should also make an effort to be prepared prior to the appointment.
Optimal health and wellness truly are a joint effort.
What other advice do you offer patients to make the most out of their appointments? Discuss in the comments below!
Akua Ampadu, MD is a hospitalist physician who is passionate about quality inpatient and outpatient adult care. As a survivor of work- and life-related burnout, she aims to provide tools necessary to live a life focused on self-care and self-advocacy. She also recognizes the importance of reading to one’s health and in 2016 launched the Healing Words Foundation, a literacy-based charity focused on providing books to pediatric wards and outpatient clinics. She is active on social media. She is a 2018–2019 Doximity Author.