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Optimizing your visit with the doctor

BT Montreal | posted Tuesday, Apr 25th, 2017

Optimizing your visit with the doctor

Courtesy: Dr. Zachary Levine, emergency physician at McGill University Health Centre

 

Average amount of time doctors spend with a patient is less than 15 minutes (this is decreasing)

Female doctors spend a bit longer than male doctors on average

Studies have found an association between shorter doctor visits and increased rate of medication prescription

 

In order to get the most out of a visit, plan ahead:

You have your agenda (particular concerns), doctor has theirs (screening, preventive health)

  • Pick your top 1 or 2 concerns:
    • Think about them — description, what brings them on, makes them better
    • Research (wisely) if you know your diagnosis.  What can you do to help?  What don’t you understand?  What is the doctor’s experience with this condition, advice
  • Ask specific questions
  • Be an active partner — what can you do?
  • Do you need that test/pill?

 

Bring lists:

  • Medication List (DSQ)
  • Past medical history
  • Past surgical history
  • Allergies

 

If you’re going to the ER

  • CTAS — triage — life threatening first, other things wait
  • Typically quieter early weekend mornings
  • Ambulance doesn’t speed up being seen but if you’re not well don’t drive yourself, ambulance can begin treatment
  • Squeaky wheel hard to ignore but doesn’t necessarily get faster or better care
  • Care order should be only based on acuity
  • Best to go where you’re known
  • Consider calling health line (but their threshold has to be low to send you in)
  • Think about your goals and what you want done

Medical symptoms you should not ignore

BT Montreal | posted Monday, Apr 10th, 2017

Almost any symptom can indicate something serious, but it doesn’t mean they are.  For example, back pain is from a benign cause 90% of the time, but it can be life threatening.  Doctors use clues to give us evidence of whether symptoms are of something serious.

 

Here is a list of symptoms you should not ignore:

  • Chest pain — perhaps this is obvious, but not to everyone.  Don’t chalk it up to heartburn unless you know it’s heartburn.  If it’s a heart attack, you need to know.  Symptoms associated with cardiac chest pain include sweating, shortness of breath, dizziness, and palpitations.
  • Shortness of Breath — again, maybe obvious.  Don’t decide “it’s just a cold or asthma,” especially if you don’t have asthma!  It could be your heart, or your lungs.  A blood clot in the lungs, aka a pulmonary embolus, can be deadly.
  • Sudden severe headache — sometimes a headache is just a headache.  But if you don’t usually get headaches and you get a sudden one that is severe, get it checked out.  It could be a bleed in your brain.
  • Rapid, unexplained weight loss — If you lose weight for no reason, ie you are not eating less, or exercising more then you need to find out why.  It may be that you are not absorbing food properly, or it may be a symptom of cancer.
  • Excessive urination — When we drink alot we urinate alot.  That’s normal, as the body keeps a balance of fluids.  However, urinating frequently may indicate other things, such as infection (usually accompanied by burning on urination), or diabetes, especially if accompanied by unexplained, excessive thirst.
  • Bleeding — normally we bleed when injured.  And healthy blood makes clots to stop bleeding.  However, if you are bleeding for no reason it should be checked out.  You may have a blood disorder.  Blood in the stool or black, tarry stools, or vomiting blood means bleeding in the gastrointestinal tract.  This can be caused by benign entities such as hemorrhoids, but can also be caused by cancer, and the bleeding can sometimes be severe.  Blood in the urine needs to be checked.  It can be caused by stones and infections, but also by cancer, of the bladder or the kidneys.  Coughing up blood may occur with infection (in small amounts) but more serious causes need to be ruled out, such as pulmonary emboli and cancer.  Postmenopausal vaginal bleeding needs to be checked out to rule out a serious cause, such as cancer.
  • A swollen painful leg (without an injury) — Leg swelling can result from injury, to be sure.  But a single swollen painful leg is concerning for a problem with circulation, such as a blood clot.  Bilateral swollen legs can result from a heart problem or something blocking the flow of blood back into the pelvis from the legs.
  • Severe abdominal pain — Sometimes benign conditions, such as gastroenteritis, can cause severe abdominal pain.  However, some life-threatening conditions can cause it as well, such as abdominal aortic aneurysm (swelling of the large blood vessel in the abdomen, potentially bleeding), ischemic colitis (lack of blood to the bowel, which can cause the bowel to die), appendicitis or cholecystitis (gallbladder inflammation, which often requires surgery to treat).
  • Severe back pain — Most people experience back pain at some point in their lives, and the majority of back pain is musculoskeletal in nature (due to muscle strain etc), benign, and resolves without any treatment.  Severe back pain may be from kidney stones, which are usually benign, but you need to check it out.  It may also represent serious infection or cancer.  The red flags doctors use to indicate potentially serious back pain include duration of more than 6 weeks, age younger than 18 or older than 50, trauma, a history of cancer, night sweats, fever, chills, weight loss, night pain, IV drug use, and neurological symptoms such as weakness and numbness in the legs or in the saddle area, or urinary retention or incontinence.
  • Flashes of light — seeing flashes of light may indicate an oncoming migraine, but they may also be a symptom of retinal detachment, an eye emergency that needs emergency treatment.

 

All of the symptoms above may result from benign causes, but maybe not.  So get them checked out.