Visiting the doctor

Before your appointment 

Resource from: Patient Critical (follow them on twitter @PatientCritical)

1. List your medication: Include all prescription, non-prescription, vitamins & supplements
2. List your goals and concerns: List any health and lifestyle concerns you have, talk about relevant family conditions, any physical, mental or emotional factors. 
3. List recent changes to your life: Include - diet, appetite, stress, mood, body, libido/ alcohol/smoking, and family or job stresses
4. Track your vitals: Weight, heart rate, temperature, period, headache 
5. Prepare for your appointment: Leave early and bring your care provider's contact information in case you are late or lost. 

Reference:

https://patientcritical.com/knowledge-base/5-qs-exams-and-checkups/. Accessed Mar 22, 2019.

When doctors take a history they want to know your story

By: Dr. Daniel Pepe, Family Physician | March 24th, 2019

Often times when patients come into the office they have a main reason that they come in. Sometimes this can be one reason in particular or it could be a combination of a few smaller issues. When telling your story you can help your doctor gather all the important information by knowing some of they questions they will like ask you. 

For example, if you have a knee ache or pain in your back, knee, hip, or arm your doctor might ask you: 

• "What makes the pain better?"
• "What makes the pain worse?"
• "Was there anything you did to injure yourself?"
• "Was there a particular activity that have been doing that could have led to the pain?"
• "What do you do for work?" - sometimes things we do at work over and over again can repeatedly strain muscles or joints
• "What have you tried so far?" - doctors often like to know what you have tried to do so we know where to start! 

For a doctor to understand your symptoms they first need to understand you and so it is important to know the basic information all doctors like to know about their patients.

1. Your allergies
2. Past Surgeries you have had (gallbladder removed, appendix removed)
3. Medical conditions you have (Diabetes, high blood pressure, high cholesterol are all common types of medical conditions)
4. Where you work, who you live with, how you support yourself financially
5. If you smoke, drink alcohol, or use drugs 
6. Your family history of diseases that tend to run in families (breast cancer, colon cancer, heart attacks, strokes, aneurysms)

The physical exam  

By: Dr. Daniel Pepe, Family Physician | March 24th, 2019

Depending on what a doctor needs to check their are various physical examinations they will do: 

Vital signs - for most visits your doctor will want to check your blood pressure and heart rate. If you are sick or have a fever they will check your temperature and some doctors may check the oxygen levels in your blood using a little device that sits on the end of your finger. 

Heart and Lung Examination - for this exam your doctor will typically use their stethoscope over your lungs to see if they can hear air entering both lungs. They will listen for signs of fluid inside the lungs (crackles) or air that is having a hard time leaving the lungs (wheezes) 

Abdominal Examination  - your doctor will use palpation (pressing down) and percussion (tapping with a finger) to try and assess for any tender areas in the abdomen. It is important they are able to examine from just below the ribs to just above the point where your legs meet your abdomen. 

Head/Neck/ Ears/ Eye Examination - your doctor will use an ear scope (otoscope) to look inside your ears and look at your ear canal and ear drums. They will also use an eye scope (ophthalmoscope) to examine around your eyes, look into the whites (sclera) of your eyes, look at the iris (coloured part of your eye), and look at the pupil (black part of your eye) and see how each reacts to light. They may also test all the special nerves that help your face move, provide sensation to the skin and help with your senses of hearing, taste, smell and sight. 

Your doctor will also potentially check for lymph nodes in your head and neck to see if any are swollen. Typically they check - infront and behind the ears, under your jaw, above your collarbone and sometimes elsewhere in the body. 

Muscle and Joint Exam - When doctors examine muscles or joints they usually check for: swelling (edema) , redness (erythema), warmth, or deformity. Usually they like to check the joint above and below the affected joint. For example, if your knee hurts your doctor will check your ankle and hip. This is why it is important to dress in an outfit so that you can be easily examined!  

Gynecologic or Male Reproductive Exam - for these exams which are sometimes performed in sensitive areas it is important that you understand why the exam is being done, that you are provided with adequate privacy and that, if required, you know that you can request a chaperone for a male physician during a gynecologic exam or a breast exam. 

Bloodwork

By: Dr. Daniel Pepe | March 24th, 2019

Bloodwork is a term to describe a test that requires a sample of your blood. 

Your doctor will typically do bloodwork for 3 main reasons:

1. To screen for disease: a screening blood test is one that is carried out every few years or sometimes every year in a person who appears and feels well to check if they might have developed a particular condition. 

For example - your doctor will do a hemoglobin A1c (to check your average blood sugar over 3 months) even if you have no symptoms of type 2 diabetes as knowing you have diabetes early on can help you and your doctor prevent long-term complications. 

2. To monitor for control of a disease or effectiveness of a treatment : a blood test in this situation will help you and your doctor know if your treatment is working. 

For example - when patients take thyroid medicine as they have low thyroid function (hypothyroidism) a blood test called a TSH (thyroid stimulating hormone) can tell them if they are taking enough thyroid medicine. A second example would be to check your A1c to see if it is at an appropriate level 

3. To assist with a diagnosis: When patients present with certain symptoms, such as chest pain, doctors will order test to help determine how likely it is that a patient has a suspected diagnosis. 

For example - if you came to the emergency room with chest pain they might order your heart enzymes (specifically troponin) to see if you have had a heart attack. 

Other types of testing that can be done include: Testing urine for infections, blood or protein; Testing Cerebrospinal fluid (the fluid that surrounds the brain and spinal cord); Testing abdominal fluid; Testing the fluid around the lungs. 

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At the end of your appointment

By: Patient Critical (Follow them on twitter @PatientCritical)

March 27th, 2019 

1. Set your expectations: share your goals, common concerns with your physician. Take notes, ask for a brief summary from the doctor, as permission to record the main details.
2. Ask, Ask, Ask: Do you have any questions? do you need any clarification? Are there words or tests you didn't understand?
3. Confirm Understanding: discuss results and recommendations - are there any alternatives to the proposed treatment?
4. Agree on next steps: Do you need more tests? Is a follow up appointment required? What should you do before the next visit?
5. Book before you leave! always book your next appointment before you leave!