How to prepare for doctor’s visit

Whenever a doctor cannot do good, he must be kept from doing harm. Hippocrates

Remember the last time you had a headache. You really wanted to see a doctor. You where even confused what type of doctor you should see. You didn’t know where to start. 

I will teach you how to get to the right doctor. How to get prepared for this doctor visit. And of course the steps that the doctor will take to ensure you get best treatment. 

Medicine is science. Like science not everything is exact. Most health problems like headache is subjective. This means that your doctor does not really know what is happening to you. He is not inside your body. He will use available information to get to what is happening to you. This is call Diagnosis. This process is very important before (s)he gives you treatment. 

Available information should be good information. It should go straight to the point. Too much information can cause confusion. Too little information is neither helpful. It should be in order and organised. This will help the doctor give you the best treatment. 

Better doctors have wider access to information and tools. It does not necessarily mean they are more intelligent. That is why it seems that doctors in richer environments/hospitals/clinics etc are better than their poorer counterparts. Even if they read the same books. Doctors with access to modern medical equipment like CT scan will make better diagnosis and of course treatment than those with just X-ray. This is a fact. 

Now let’s dive in…

Choose one problem

Whenever you are going to see a doctor or even considering seeing a doctor you should choose one health issue or symptom. At most 2. This is number one. This should be your primary concern. 

For example: Headache.

Do not choose too many symptoms. Just focus on the main problem. Do not be tempted to go off this problem. Do not talk about other things unrelated to your symptom… like if you watched Barcelona vs. Real Madrid match or how it rained cats and dogs a day before, etc. No one has time to waste. 

Description is Key

Number 2 is to learn how to describe this main symptom before you see the doctor.

In this video below, I animated how to describe a symptom to a doctor. Use it as a guide. 

Write it down on a paper and save it online. Google drive is a good place. Remember well explained symptom get the best diagnosis. Give the doctor a chance to get to understand what is happening to you. Be organised. Be simple. Do not write too much. More than one page is too much. 

Certain times you have done some tests already and you have the results with you. These should be related to your initial symptom. We will talk about this as you read on. 

Many patients don’t know how to present their problem to a doctor. That is why the later will ask specific questions. This questions guide the doctor to the diagnosis and treatment. 

Doctors call this Anamnesis. SAMPLE history is a mnemonic acronym to remember key questions for a person’s medical assessment.

The parts of the mnemonic are:

S – Signs/Symptoms (Symptoms are important but they are subjective.)

A – Allergies

M – Medications

P – Past Pertinent medical history

L – Last Oral Intake (Sometimes also Last Menstrual Cycle.)

E – Events Leading Up To Present Illness / Injury

Let the doctor touch you

After the information gathering part the doctor will move to Physical Examination. I call this part objective because the doctor using manipulations will try to gather more information. This is a very important step. The physical examination revolves around your main problem. 

For example if you visit a doctor for headache his primary aim is not to look at your leg. Unless he feels there is a relationship between the headache and your leg. This will avoid unnecessary waste of time and resources (see below). This is also a point of error and bias. There has been cases a doctor fails to get a disease because he did not do the appropriate medical examination. 

Why your doctor can make mistakes

The doctor who diagnosed me with ALS, or motor neuron disease, told me that it would kill me in two or three years. Stephen Hawking

If a doctor does not think of a disease and their posible relation to your symptom(s) then there is a big possibility that (s)he will not diagnose the disease. (S)He will not ask corresponding questions and/or medical tests (discussed later) to get to the root cause. This happened a lot in case of initial cases of Coronavirus patients. This also happens when it is not the doctors specialisation or when they have limited access to medical equipment (remember Information). 

The human body is complex and there are many diseases. Do not expect your doctor to know everything. The bad aspect of medical specialization is that doctors know a lot about their area and increasingly fail outside their area. A lot has been researched on Cognitive bias and its influence on clinical judgement. It is not the objective of this article. 

I am a Neurosurgeron (brain and spine surgeon). If you ask me specific questions about Hematology you may notice that my in-depth knowledge about blood related diseases is limited. This is where referral and doctors forum come in. There are panels etc to bridge these problems. Thanks to internet, there are online platforms and videoconferencing for this. 

It is highly recommended you follow a doctor that gathers information before passing to the next step. 

Other Examinations

The next step is Complementary examinations. Like the name it is Complementary. Not Primary as discussed in Number 1. These are specific tests for specific diseases. This is where some of your money will go to. Machines are always evolving so as diagnostic equipment. This also means more financial resources. People with better economical situation will have access to better diagnostic equipment and treatment in a place that have these tools.  

Depending in what you tell your doctor, he will ask for specific tests. If you have headache he should not be asking for knee X-ray because it is not related. If you have a slight headache of 2 weeks without any other symptom, the doctor should not initially ask for a Brain CT scan. It is unnecessary and expensive. 

When I was in medical school and residency, I used to remember the senior doctors will ask you to explain why you need a specific diagnostic test. So do not ask for a test that is not necessary. Things have changed though. These days people with access can pay for a Brain MRI even before seeing the doctor. 

Many patients go to internet to get information. There are online doctors like www.docotal.com. They can show up to the doctor’s office with related and sometimes unrelated tests. There is still room for improvement. 

There are routine tests in a blood test that are not necessary. The central point is to understand that these exams are just complimentary. It means that the doctor uses these diagnostic tools to narrow the possible causes of your disease. It should not overrule Anamesis and Physical Examination. This is the central idea. 

As you can see doctors are limited to what they can do. This is partly because of inadequate knowledge. Remember what a doctor doesn’t think of, he doesn’t diagnose. Other times it is lack of diagnostic tools. A doctor without access to ECG equipment may have difficulty differentiating (see Differential Diagnosis below) heart attack from sternum pain. 

Differential Diagnosis

What a doctor does not think of, he does not diagnose. Dr. Nnamdi Elenwoke

Speaking of differentiating causes, diagnostic tests help doctors in selecting a specific disease thereby eliminating others. This is called Diferencial diagnosis. Doctors work with algorithms. These algorithms help to determine a disease and of course the final part of the patient’s visit: treatment. 

Example: Differential diagnosis of headache 

Source: www.aafp.org

So how do you go about this? The answer is gathering information and using algorithms to get the particular disease and give effective treatment. 

Let’s review headache one again. From the questions the doctor will determine if the headache is a slight one that requires only painkillers or a one that requires complementary exams before treatment. This is why description is key. 

Diagnosis is usually the hardest part of doctors workout. It can easily become the longest and time consuming part. Thanks to complementary exams, this will continue to be less difficult. 

Lastly treatment

This is the final stage of the medical visit. With good diagnosis treatment is usually straightforward in most cases. There are different modalities of treatment depending on the disease. Traditionally treatment are divided into 2 parts:

1. No surgical

2. Surgical. 

After treatment, many people feel the work is over. This is especially in the case of effective treatment. If patients get better, they disappear literally. It is important to have follow-up even after treatment. Not only when things go wrong. Discuss this with your doctor before the treatment. 

In my case after surgery I follow up patients 1st month, 3months, 6months and then yearly for 5years after surgery date. This helps the doctor to make sure you are doing well and avoid consequences during post-surgical treatment. 

Lastly you should build confidence with your doctor. The best doctor is not the most intelligent but the one you trust and can communicate in a way you will understand. Sometimes this is not possible. The best time to find a doctor is when you don’t need them. Not really in the office. You have to make a doctor your friend. Treat them well. Be genuinely interested in them. They always come handy. Getting sick is a natural part of life. 

Now you know the process and what to do when you meet a doctor. Try it, you will see how great it works. Help others. 

Summary

Whenever you are going to see a doctor you should choose one health issue or symptom.

Focus and describe well the symptom. 

Depending in what you tell your doctor, he will do physical and complementary examinations.

After gathering information, the doctor will tell you the cause of your symptom/disease. 

With good diagnosis treatment is usually straightforward in most cases.

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