Whether you were referred by someone or made the decision to see a neurologist, the experience can be overwhelming. Your thoughts may range from, what if there is something seriously wrong with me? To... What if I have a serious and/or life-threatening neurologic condition?
Just the anticipation about the upcoming evaluation can lead to a less than productive visit. In some cases, patients are too nervous to point out all of their symptoms. In the moment, some may even forget the medications that they take, or even which physicians they have seen and who referred them.
All of these are common occurrences, but there are some very simple, concrete things you can do to help your neurologist help you get well.
First, know the reason for your visit.
Is this for a second opinion, such as confirming a diagnosis that was already provided? Is this a specialty opinion?
What are you comfortable doing, in terms of diagnostic assessment and therapeutic intervention? Many patients come into the doctor's office with a clear picture of how they would like to treat their painful syndrome. Some are very adamant that they do not want narcotics/opioids, while other patients specifically ask for narcotics by name - this is usually a red flag. Maybe you're not comfortable taking prescription medicines, but you would be comfortable taking natural therapies. Maybe you prefer chiropractic treatment and not physical therapy. Possibly, you want to avoid radiation and therefore x-rays or CT scanning would not be the best choice for you.
All of these things are important to at least think about and understand, so you can address this with the physician.
Second and equally important; be prepared for your visit.
In the "old days" this may not have been as necessary. Your primary care physician or referring doctor would have contacted your specialist with a complete outline of your medical history, diagnostic testing, tried and failed medications, and indications for the referral. Those days are long gone.
Now, it is you, the patient, who is the quarterback of your healthcare. Even without medical knowledge, each and every patient knows who they have seen, what tests have been done, what medications have been tried, and what therapies have been performed.
Have a copy of your records
For example, when calling for an appointment my staff will ask if you have seen any prior neurologist or neurosurgeons, or even pain specialist for the same condition. If so, they will request the records. Nowadays, you can have your own records by going to the physician's patient portal and downloading your own reports. Having those available for your initial visit makes your diagnostic assessment that much easier.
Having a medication list with current medications, as well as allergies, and a list of previous medications tried is extremely helpful. You can get a list of your prior medication trials by contacting your pharmacists and having them print the last few years of your prescriptions. Interestingly, this will also list the prescribing physician and may jog your memory of additional evaluations that you have had.
If you have ever had diagnostic testing such as x-rays, ultrasounds, CAT scans, or MRIs, it is extremely helpful to have the reports and to also have copies of the studies. All diagnostic centers will be glad to copy your results on a CD for your treating physicians to review themselves. Physicians like to use their own diagnostic abilities to look at scans and interpret those in combination with the radiology reports.
Also, there is no better historian of your healthcare then you! Keeping a simple, one page chronological summary of your past healthcare is extremely helpful.
I often recommend to my patients that they get an old folder, with many tabs like they used in high school for the different subjects. However, now they will use each tab for every doctor they have seen, reports of each surgery they have had, diagnostic testing, and medications (this includes over-the-counter and natural ingredients as well as prescription medicines).
As I review their one-page summary I can ask for more information and they can go to the tab, for example, Dr. X, and show me that physician’s records. This way I get to review the specifics for the information that I need to obtain. Constantly updating the one-page summary is extremely important to keeping your healthcare information current.
Third, engage in the examination.
Some of the most frustrating responses coming from a competent patient can be the simple response of, "I don't know”.
Usually, you the patient might know much more than you think, so it is important to present the physician with whatever information you do know. No detail is too small. For example, whenever the symptoms occur, you do know that. You may not know the exact day and time, but you can give a pretty good estimate. What makes your symptoms worse, what makes them better? What have you tried for them?
Don't be afraid to respond to these simple questions that you do know the answer to, even if you don't think you know the answer.
Helping your physician with the most accurate historical information possible will lead to the best diagnosis and the most effective treatment plan.
The second part of the examination is the physical assessment part. I encourage my patients to remain engaged and do their best. I do not want them to hurt themselves, but not trying is never appropriate. If the patient is competent (no sign of dementia) they should be able to follow simple instructions such as walk on your tiptoes, raise your arms, push against my hands testing the strength in the upper and lower extremities, etc. Again, I point out to patients that if they don't understand the instruction, ask for the instruction to be repeated.
After the examination, your physician will write down assessment, discuss diagnostic testing, and provide treatment recommendations. Many times my patients will be so busy writing notes that they do not hear anything that I am saying. For this reason, I have my checkout staff hand write each and every one of my suggestions so they can discuss this with family and friends later and refer back to this information. For the initial visit, I also ask if there are any additional questions that have not been addressed.
Finally, prepare for follow-up visits
Remember, the most precious thing that you have is your health.
Being an active participant in your medical assessment will sure that you get the best possible diagnosis and treatment plan possible. You and your physician should be on the same team. If he outlines a treatment recommendation that you know you will not do, let the doctor know. There are often many ways to address a similar problem. Returning for a follow-up visit having done none of the diagnostic testing, therapeutic intervention, or medication trials simply and unfortunately guarantees that there will be no change in your medical condition.
I suggest that my patients write four or five questions that they want to have answered, as well as any information they want to be conveyed to the examiner, and have that sent to my office five days before the visit. That way, my staff will have plenty of time to obtain the labs, order the imaging studies, order outside physician records that are to be discussed at the time of the follow-up visit.
To a physician and a patient, there is nothing more frustrating than to engage in questions that are unanswerable. For example, if another doctor orders a test and I am not copied on the report, I would have no way of giving, you the patient information as I would have no way of knowing the test was performed. Having that information sent to me allows me to obtain the records, review the report, and determine if that would necessitate a change to the treatment plan. Here again, being an active partner in your healthcare means that you will get much better healthcare.
When patients make the effort to be active participants in their healthcare, follow instructions, take their medications, that motivates physicians to try harder and do more.
This is the way you can help your physician do a better job, and in the process help yourself!
If you have any questions related to this article or would like to schedule an appointment, please contact Neurology Office for more help.
Neurology Office, Joseph Kandel M.D. and Associates