Questions and Tips for Talking to Your Doctor

We're doing a little cleaning around the office, and I found a nice list of questions to ask a doctor. The list came from ucomparehealthcare.com, but the list is no longer on that site. So, I'm reprinting it here:

Key subjects for the patient to consider

1. Remember, you are the one most interested in your health.
2. You, the patient, are the most important source of communication with doctors.
3. Before your visit, take the time to get your medical facts in order so that you can explain what you know to the doctor. This should include any medications that you take and their dosages; any other doctors that you have recently seen; their addresses and phone numbers; and the reasons why you went to see them.
4. It is important that you listen closely to your doctor and understand what he or she is explaining to you.
5. If you have trouble understanding the medical terminology, see if a family member can go with you to assist you in understanding or to take notes for you.
6. Hand washing is a very effective way of reducing the transmission of various kinds of illnesses. Each healthcare worker who has direct contact with you should wash their hands prior to any examination or treatment.
7. Family members and friends can be great advocates for patients. See if you can bring a family member or friend with you when you see a health care professional.
8. If the doctor does not communicate the results of your test(s) to you, do not assume that no news is good news. Calf and ask the doctor for your results.
9. Learn as much as you can about your condition. Ask your doctor or nurse to explain it to you and make sure you use reliable sources for all information that you seek.

What you should know about your doctor

1. In which field has the doctor been trained?
2. Is the doctor "Board Certified"?
3. Does the physician participate in your health insurance plan?
4. What hospitals does the physician refer patients to?
5. Does the doctor have an emergency number and can he or she be reached in times of emergencies?
6. What are the doctor's office hours?
7. What is the doctor's policy for returning phone calls?
8. Whom should you speak with if the doctor is not available?
9. Where is the office located, including street address and phone number?
10. Is access to the doctor's office easy for patients with reduced mobility?

What you should tell your doctor when you visit

1. Previous hospitalizations and for what reason.
2. List of all medications you are taking, their dosages, and when you last took them.
3. Last time you saw a physician and for what reason.
4. Names and phone numbers of any specialists you have seen.
5. Health habits, which may include smoking, alcohol, and/or drug use, exercise, bladder control, and memory.
6. Any type of problems or changes in your health status.
7. Your family health history.
8. Any supplements that you may be taking and when you last took them.

Questions you might ask relating to Illness or symptom(s)

1. What's wrong with me?
2. Can you draw a picture or show me what is wrong?
3. What causes this kind of problem?
4. Can l give this illness to someone else, and if so, how and for what period of time can I pass this on?
5. Are there any activities or foods which I should avoid?
6. When can I return to work or school?
7. What is the long~term prognosis of my condition?
8. How can I prevent this from happening again?
9. How will this problem affect me in the future?
10. What will happen if I don't treat my condition right away?
11. What treatment should I follow, including dietary, medical treatment, and lifestyle changes?
12. When do I need to see the doctor again?
13. Where can I get more information on my condition?

Questions you might ask about medications that are prescribed to you

1. What is the name of the medication?
2. Why do I need this particular medication?
3. How and when should I take this medication?
4. How long should I take the medication?
5. Whet are the possible side effects of this medication?
6. Is this medication safe to take with other medications I am taking?
7. What do I do if side effects occur?
8. How often will I need to get the medication refilled?
9. How will I know if the medication is working?
10. What are the risks of not taking the medication?
11. Is this a brand name or generic name?
12. Are there less expensive medications for my condition?

Questions you might ask about surgery or a procedure

1. When do I check in to the hospital and where?
2. What can I exped to happen before the surgery or procedure?
3. How long will the procedure take?
4. Can my family go with me?
5. What effects will the procedure have on me in the short and long term?
6. What is the doctor's experience in perfonning the procedure?
7. What medications will be given to me?
8. How long will I have to rest at home after the procedure?

Questions you might ask about diagnostic tests or procedures

1. Why is this test necessary?
2. What will happen if I do not have the test?
3. Are there any risks involved?
4. Will it hurt? If so is there anything I can do to lessen the pain?
5. Can the doctor perfonn the test in the office or will I have to go to the hospital or the laboratory?
6. Is there any preparation for the test?
7. What are the side effects of the test?
8. What changes or effects should I report to the doctor?
9. Who will call me with the results of this test?
10. How long will it take for me to get the results?

Questions you might ask about a hospital

1. Is the hospital a teaching hospital?
2. How many patients have this procedure in this hospital each year?
3. Is the hospital accredited and by what organization?
4. Where do I check in? When? What will 1 need?
5. Do l need a pre-operative visit to the hospital?
6. What services does the hospital offer that are specifically helpful to the type of procedure that l am going to have?
7. What is the hospital's policy on family members staying overnight with the patient?

 

JAMA talks low back pain

The Journal of the American Medical Association (JAMA) ​recently published an article on low back pain on its Patient Page. This article contains a good discussion of the anatomy of the back, the sources of low back pain, and the range of treatments that should be considered.

JAMA notes that low back pain can result from problems with muscles, bones, or nerves, but muscle pain doesn't move down the legs. When the patient has had trauma, imaging studies such as x-rays, MRIs, and CT scans are appropriate. JAMA reports that treatment may include exercise, physical therapy, chiropractic, acupuncture, over-the-counter or prescription medication, and, in rare cases, surgery.

One of the things that we found interesting is that the JAMA article cited a clinical guideline by the American College of Radiology (ACR). This article discusses the appropriateness of several types of imaging studies under different clinical conditions. The ACR guideline states that most uncomplicated low back pain resolves on its own, but that intervention is needed for more complicated cases. ​The guideline considers low back pain to be "complicated" when it is accompanied by trauma, cumulative trauma, or lasts longer than 6 weeks. The ACR guideline confirms that x-rays are appropriate for evaluating alignment and instability in the low back.  

The ACR guideline was published by the National Guideline Clearinghouse (NGC). The NGC is a governmental organization created in partnership with the American Medical Association and the American Association of Health Plans (now America's Health Insurance Plans [AHIP]). Its mission is to provide health professionals, health plans, and others a mechanism for obtaining objective information on clinical practice guidelines.

We are glad to see JAMA referencing the NGC's Guidelines. As lawyers who deal with health issues for our clients, we like to work with doctors who utilize the latest health guidelines in their practice. 

Jury finds health insurer discriminated against patient-advocate doctor

The LA Times reported today on a verdict against a health insurance company that discriminated against a doctor for being a patient advocate. The doctor’s wife was murdered and his children assaulted in 2005, which gave him an appreciation for the patient side of the medical profession.

The doctor challenged hundreds of health insurance claim denials in his provider network when the insurance company contended his treatment “wasn’t medically necessary and would not be covered.” According to the doctor, “many doctors are unwilling to challenge powerful insurance companies because their incomes are so dependent on being in these provider networks. ‘Physicians are so afraid to come forward,’ he said, ‘and I hope this changes that.’” 

A healthcare lawyer interviewed about the case believed it would send a message to insurance companies about the need to be able to justify claim denials and exclusion from provider networks. The loudness of that message will be determined tomorrow, when the jury decides the issue of punitive damages — punitive damages are designed to deter intentionally abusive conduct.

New study shows pain meds don't work for 27% of whiplash patients

A new study published in the Scandinavian Journal of Pain explored the effectiveness of pain medications for whiplash patients with chronic pain. The patients were administered morphine or ketamine (both powerful pain drugs). 27% of the patients were classified as non-responders, meaning that the powerful pain drugs were ineffective in relieving chronic whiplash pain. The article "stresses the importance of individualizing the assessment and treatment of subjects with chronic whiplash-associated disorders."

Whiplash treatment isn't a one-size-fits-all approach. Injuries can be painful, permanent, and progressive, and treatments need to be tailored to what works for individual patients. A combination of family doctors, radiologists, neurologists, osteopaths, chiropractors, physical therapists, and massage therapists, among others, is not unusual for patients seeking relief from chronic whiplash pain.

The full citation for the article is M. Persson, J. Sorensen, B. Gerdle, Whiplash Associated Disorders (WAD): Resposnes to pharmacological challenges and psychometric tests, Scandinavian Journal of Pain 3(2012) 151-163.

Little progress made in ensuring patient safety

A decade after the National Institute of Medicine's landmark study on patient injury resulting from medical treatment, little progess has been made, according to a recent report in the New England Journal of Medicine. The article reports that "[d]espite enhanced attention on patient safety following the 1999  Institute of Medicine report on medical errors, 'the penetration of  evidence-based safety practices has been quite modest.'" One evidence-based safety practice is the use of electronic medical records, but just 1.5% of hospitals have adopted new electronic recordkeeping technology.

The most frightening aspect of this report is, perhaps, the conclusion that 63% of the patient injuries were preventable. We would be interested to know how hospitals treated those preventable patient injuries — that is, did the hospitals do right by their patients and fix what they could, help what couldn't be fixed, and make up for what couldn't be helped?