The Medical Minute: Making the most of a doctor visit

September 06, 2006

By John Messmer
Penn State Family and Community Medicine
Penn State Milton S. Hershey Medical Center
Penn State College of Medicine

There's an old joke about the man who visited his doctor for a cold. By the time he was seen, the cold was gone. The doctor didn't prescribe anything but charged him anyway. We don't know what really happened in the joke author's visit to provoke this story, but to make the trip to the doctor worthwhile, it helps to understand what is supposed to happen and how to prepare for it.

When visiting for an illness, it helps to understand that the physician can not cure some things such as colds, while problems such as back strains resolve through treatment the patient does at home; medication just helps the symptoms. The doctor needs to know if the patient expects a cure, so telling the doctor what you want avoids miscommunication. The physician should explain what treatment options are available and what improvement is realistic.

Some conditions necessitate regular check-ups. Most patients with chronic conditions, such as high blood pressure, diabetes, high cholesterol and heart disease should see their doctors a few times a year. While it might look as though the visit is just to measure blood pressure or review lab tests, the physician is trained to assess much from questions about symptoms and from examination. The doctor may not be fixing something broken or providing a treatment for a pain, but he or she is assessing the patient for effects of the medical problem and deciding what must be done to reduce the risk of complications developing down the road.

Everyone should have a medical home, that is, a practice which assumes long-term responsibility for helping patients achieve and maintain good health and which is comprehensive in its approach. Usually, each visit to such a practice includes an assessment of health maintenance. Although the visit may be for an ear ache, the physician will consider whether the patient should be screened for high cholesterol or diabetes, whether a woman has had a Pap and mammogram at the proper interval, whether an over-50 patient needs a screening colonoscopy, if immunizations are up to date and more. Most physicians take every opportunity to counsel smokers to quit.

In the case of the man in the story above, it might be assumed the physician examined him and reviewed his records, discussed cold prevention and considered whether any other problems needed to be addressed, including health maintenance issues. But why did it take so long to be seen by his doctor? There can be many reasons.

Depending on the physician's specialty, generalist physicians -- that is, family physicians, general internists and general pediatricians -- will set aside from 10 to 20 minutes for a typical visit. The average visit in 2001 lasted about 18 minutes, an increase of two minutes from the preceding decade. Some problems take a lot less time and many take longer. As our population ages, individuals have more medical problems to manage and that takes more time.

Physicians are slowed down for many reasons. Some patients need more time because of the nature of their problems. Many times people decide to ask about other issues while visiting for their usual medical problems. Others call for one thing but would like other issues addressed while they are there. Occasionally an emergency happens that takes more time. Physicians may be reluctant to interrupt the patient and ask them to reschedule because they have more people waiting. After several appointments last five to 10 minutes longer than planned, by the end of a session the doctor can be running an hour behind. It helps if someone from the office informs those waiting and gives them the option of rescheduling. On the other hand, when setting up the appointment, patients can help themselves and everyone else if they tell the receptionist they have many other things to discuss so they can be given a longer appointment or a second appointment to address the extra problems.

Once in the exam room, the patient should be prepared to provide important information. For an acute problem, an explanation of the when, where, why and how of it helps the physician sort out simple versus serious problems. For example, a sore throat can represent one of several viral or bacterial infections in the throat or sinuses or in the tissues behind the throat, but it also can be due to tumors, acid reflux, allergies or even a heart attack. It is impractical and expensive to test for all possible explanations, so having a history of the symptoms helps the doctor sort it out.

For ongoing health issues, the physician will ask about things that represent good or bad control of the problem and complications that may arise. He or she will want to confirm the patient is doing their part. It is critically important that patients know the names and doses of their medication and the reasons why they take them, particularly since many are now generic and may have a different name than when first prescribed. Other physicians may have prescribed a medication but the primary care doctor may not have been told about it. Working as a team, the patient and physician will get better results. At the visit's conclusion, the patient should be clear as to what the plan is until the next visit and request written directions if necessary.

Ultimately, there is little a physician can do if the patient does not participate. There is more to medical care than prescribing medication. The best results happen when the patient understands what the treatment goals are and works with the physician's recommendations for diet and exercise, control of destructive habits and getting health maintenance care.

As society moves into a new age of sophisticated communication, electronic records, genetic manipulation, and so on medicine is moving ever farther from the days when only sick patients visited the doctor. The future is about prevention of disease and minimizing complications of those problems that can not be prevented. Doctors can not do it all without the active participation of their patients.

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Last Updated March 19, 2009