(This post is part of a series meant to educate patients and clear up misconceptions that occur in the doctor’s office.)
Dear Patient:
There are some things I think you should know to improve your experience at your next doctor’s appointment.
- When we draw blood from you, we do not run every test known to man. Rather, we do a careful history and physical exam, and then order a targeted list of tests that we feel are most relevant to your case. If you are looking to have a specific test done, or are concerned about a specific condition, you need to make this known to your doctor before the needle enters your vein.
- I don’t know what you mean when you say, “the little yellow pill.” I do know that you are taking Synthroid 100 mcg, which is used to treat an underactive thyroid. You should keep (and continuously update!) a list of all your medications (with dosages and frequencies) on your person at all times. It takes just fifteen minutes to compile, but in an emergency situation, it could save your life.
- I don’t know whether your insurance will cover that. My last office accepted more than twenty different insurances. Every insurance company has its own standards for covered tests. What’s more, these standards change constantly. If I tried to commit them all to memory, I’d have no room left in my brain for any medical knowledge. Fortunately, the folks at your insurance company can easily be reached by calling the number on the back of your insurance card.
- “Covered” doesn’t mean “free.” Just because something is “covered” by insurance does not mean it’s free. There is usually a cost to you, whether monetary (a co-payment, for example) or non-monetary (time, pain, discomfort, possible side effects, exposure to radiation, and so forth). In addition, there is a cost to society. As of 2011, the United States spent 17.6% of its gross domestic product on health care. No other country in the World Health Organization spent more (source: Wikipedia). So remember: even if you’re not paying for it, someone else is.
- In the primary care setting, the typical acute (sick) visit is scheduled for only 15 minutes. Ideally, when the time interval begins, you should be sitting in the exam room, the nurse should already have taken your vital signs, and you should be ready to see the doctor. This is why we may need to reschedule your appointment if you are even a few minutes late. We understand that sometimes things happen—car trouble, a sick child, etc. If you are running behind, we’d greatly appreciate a call from you. More often than not, we’ll try to accommodate your needs.
- All antibiotics are not the same. The antibiotic I prescribed for your skin abscess may not be effective for your urinary infection—it’s meant to treat a whole different class of germ. That’s why I look so horrified when you tell me that you took last year’s leftover antibiotics for today’s condition. Not only have you violated the First Cardinal Rule of Antibiotic Treatment (“TAKE IT TILL IT’S GONE”), but the treatment may not even have been effective.
- An EKG or stress test may not be part of your routine physical. Ditto for x-rays. If you come in to your physical and mention chest pains or shortness of breath, of course we’ll consider these tests. But as of 2012, the United States Preventive Services Task Force (USPSTF), a committee of preventive care experts, has recommended against screening random asymptomatic patients for heart disease with an EKG.
I hope that these hints help to de-mystify some aspects of your next office visit. Stay tuned for more installments of this series.
As always, comments are welcome!