Getting More From Your Doctor’s Visit

Objectives:

After completing this lesson, participants will be able to:

Describe how to get the greatest benefit from a doctor’s visit for the least cost.
Identify potentially useless home treatments.
Explain the prescription for health.

Preparation for class:

Order the free Texas AgriLife Extension Service publication “Family Health and Medical Record” (#B-1377) from your county Extension agent; order enough to give one to each of those attending your presentation.
Make 2 copies of Role Play 1 (One is for doctor and other for player)
Make 2 copies of Role Play 2 (One is for doctor and other for player)
Make enough copies for your target audience of these handouts:
1. Handout 1: The Healthwise Self-Care Approach
2. Handout 2: Ask the Doctor Checklist
3. Handout 3: Saving Your Health Care Dollars
4. Handout 4: Prescription for Health
5. Handout 5: Evaluation

Presentation Process

SAY:
Everyone is having to deal with higher and higher medical expenses. Today, we are going to learn several things everyone can do to control their medical costs. We are going to learn how to get the greatest benefit from a doctor’s visit, identify potentially useless home treatments, and finally, learn about the prescription for health. This is a very serious subject because you can end up not only spending dollars needlessly, but you may also waste time and jeopardize your health.

First, let’s see what happens when you go to the doctor with little preparation. Watch for things which are going to cost this patient with a headache money she did not really need to spend.

DO Role Play 1
[Ask for a volunteer from the audience to read the patient’s part. Give her a copy of Role Play 1. You can read the doctor’s part.]

After Role Play 1, ASK audience:
What did this patient do that cost her extra money? If she has Medicare, she is likely to end up paying for at least half of the additional expenses to take care of her headache problem.

[Answers will vary but here are some possibilities: She talked too much. She did not answer the doctor’s questions. She gave too much meaningless information. Pushed doctor to order expensive test, MRI. Did not know her medicines. Because she was not prepared, doctor ordered new medicines, an expensive MRI and blood work. Also, she had to come back for another visit.]

SAY:
When you need to go to see a doctor, get ready to make the appointment call. Before you make the call for an appointment, write one sentence that clearly describes why you want to see the doctor.

ASK:
What could be a statement the patient in the skit could have had ready when she called to make her appointment?

[Answers may vary, but could be something like, “I need to see the doctor because I am having very bad headaches every day, and nothing I take seems to help.”]

SAY:
When you call for a doctor’s appointment, the receptionist will ask,“Why do you want to see the doctor?” Your answer determines three very important things. First, it determines how soon you will be seen–today, sometime this next week, or within the next several weeks. Secondly, the statement determines how much time you are scheduled to see the doctor. Third, the statement determines the entire focus of the doctor’s visit.

Remember this statement and have it ready when you come to your appointment too, because when you arrive at the doctor’s office, you will be asked the same question—“Why do you want to see the doctor today?” Most times you will be asked that same question again by your doctor when she comes into the exam room.

Doctor’s call this the chief complaint. Doctors make this the entire focus of your visit. If you start complaining of other things, the doctor will probably ask you to make another appointment for a check-up. While this sounds like the doctor is just trying to make more money by having you set another appointment, the real reason why doctors do this is to keep you from having to wait. If you want a check-up to have the doctor evaluate a number of things, say that when you call in for the visit: “I need to schedule a check-up.” You will be given more time for that appointment.

In addition to your one sentence statement, you need to come with some other important information so your doctor can provide you the best help possible at the lowest cost for you.

DO Handout 1, The Healthwise Self-Care Checklist

SAY:
Let’s look at one of your handouts now: The Healthwise Self-Care Checklist. This handout can help you come to your doctor’s visit much better prepared.

Do not write on the copy I have given you until you make copies so you can fill in one of these each time you have a different problem.

This handout comes from a self-care book called Healthwise for Life. This is an excellent book written by health professionals. This book can help you know how to take care of everyday health problems like headaches, backaches and colds—things most families have at one time or another. If you look at the bottom of the handout, you will find instructions for ordering this book. Using this type of book is one way to come better prepared to your doctor’s visit.

When you have a health problem, like a headache, use the Healthwise Self-Care Checklist to determine what you can do at home. It will also help you give your doctor information she might need to help you when you come in for your appointment—so, bring it with you to your appointment.

DISCUSS: Handout 2, Ask-the-Doctor Checklist

SAY:
Next let’s look at the Ask-the-Doctor Checklist. One of the most important things you can do before seeing a doctor is list all of your medicines you are currently taking. List each medicine name, dosage and number of times you take it each day.

List everything you are taking with dosages, including vitamins, minerals, herbals, and things like aspirin or Motrin or Excedrin. If you are going to have surgery, be especially sure you tell your doctor everything you are taking whether it is prescribed or not. Things like aspirin or ginkgo biloba or vitamin E could make you bleed more during and after surgery, for example. Be honest with your doctor—your life could depend on it!

Also, have your one sentence statement written down as well as two or three questions you most want answered during the visit.

The Ask-the-Doctor Checklist can help remind you to state your main problem first. Then, describe your symptoms clearly using the Healthwise Self-Care Approach along with any past experience with the same problem.

The Ask-the-Doctor Checklist also has room for you to make notes about the doctor’s findings like your blood pressure, diagnosis and what you should do. Also, this can help your doctor remember to tell you everything she needs to.

ASK:
What other things might you want to bring to a doctor’s appointment? [Answers will vary.]

That’s right, you want to know your allergies, immunizations and past medical history.

ASK:
How do you remember your immunizations, surgeries, allergies, and important illnesses? [Answers will vary.]

DISCUSS: The Family Health and Medical Record

SAY:
One way of remembering everything you should for a doctor’s visit is: keep a written health record. As you get older, your medical history becomes so involved, you may need to have everything written in one place. This especially helps if you become nervous when seeing a doctor—if you are nervous your mind may go blank or you might forget important things.

One way to keep track of your medical history is to get the Family Health and Medical Record (B-1377), a free publication, from your Extension agent. Keep the Family Health and Medical Record in a place you make your “home health center.”

ASK:
How many of you have one place in your home where you keep things like medicines and important health records? [Answers will vary.]

ASK:
What is a home health center?

A home health center is a place where a family keeps things like their records along with prescription medicines, as well as medicines needed occasionally for colds, coughs, aches and pains, fevers, acid stomach, constipation, diarrhea, allergic reactions, burns and stings. The home health center is a good place to keep other things you might need like band-aid, antiseptics, sun screen, a thermometer, a blood pressure cuff, and books like Healthwise for Life and the Nurses’ Drug Handbook to help you manage every day health problems like headaches and learn more about your medicines.

Remember, a well-prepared patient will get much better service during the few minutes spent with a doctor. Also, the well-prepared patient will likely spend less on medicines, treatments and tests too. Somewhere between 75% and 90% of your diagnosis depends on what you tell your doctor during the visit. Your diagnosis will be much more accurate if you come prepared with the information your doctor needs.

After your doctor makes a diagnosis, and you have asked all of your questions, your care becomes your responsibility.

Do what the doctor tells you to do, and take your prescribed medicines and do the other things your doctor recommends. If the treatments are not working right, or if your medicines are making you feel badly, call your doctor’s office, and let the doctor make adjustments. Never, never just stop important medicines like antibiotics, blood pressure medicine or medicine for diabetes or cholesterol because the pills make you feel badly or any other reason. Call your doctor and ask her to make adjustments. High blood pressure, high cholesterol and high blood sugar are all problems you can have for as long as 10 years and not really feel badly. However, by then, there may be irreparable damage done to your body. Stopping antibiotics can cause problems too. If you do not like or trust your doctor’s judgment, find another one or get another opinion.

Do not stop taking your medicine because it costs too much. Do not take fewer pills than prescribed because the pills cost too much. Ask your doctor to prescribe a generic form if possible. Ask your doctor for samples. Ask your doctor for “pharmacy assistance.” Now, pharmaceutical companies almost all have programs that provide people help getting their prescriptions if the person cannot afford the medicine. It is not an easy process, but many communities are organizing groups of volunteers to help older people on many medicines to fill out the papers that will help them get help with their medicine costs. Sometimes, you can save money if you send away for three months at a time. Be very careful about thinking you can get cheaper prescription drugs in Mexico—prices may be higher!

ASK:
How many of you try to treat your own health problems with herbs or other similar things you buy over-the-counter? [Answers will vary.]

DISCUSS: Handout 3, Save Your Health Care Dollars

Here is a list of things you need to ask yourself when someone is trying to sell you a “miracle” pill, herbal, exercise machine or self-help book of some kind. You can use this handout to decide if the purchase will be worth the money you are thinking of spending.

Even if herbals are cheaper than a doctor’s visit and real medicine, if it does no good, it is a waste of your valuable health care dollars. If it interacts with other medicines you are taking or causes an allergic reaction, it may even be harmful.

You can treat yourself safely in certain situations. For example, the self-treatments suggested in your Healthwise for Life book are written and reviewed by a panel of physicians, nurses and other health professionals. Healthwise for Life tells you what you can safely do on your own and when you should seek medical help.

Some herbs, vitamins and minerals may help some people in some situations. However, it is important to know several things if you are going to spend your money on herbs, vitamins and minerals. First, if you are an average person in America, your diet will provide adequate vitamins and minerals. If you want to make absolutely sure you are getting enough vitamins and minerals, take one multiple vitamin with minerals each day.

You may need extra calcium—no vitamin and mineral pill can pack in enough calcium because the pill would be too big. Keep track of the amount of calcium you take in each day by reading labels, subtract that from 1200 and the number of milligrams you are left with is the amount of calcium you need each day. For example, if you only have 200 milligrams of calcium in your regular diet, and your vitamin and mineral pill has 200 milligrams in it, you would need to take 800 milligrams of calcium pills in addition each day. Having enough calcium every day is very important to keep your hip, wrist, and backbone from collapsing due to fractures. You can ignore this for many years, but, eventually, you will have a problem. The medicines to re-build bone are very expensive. Calcium pills are a cheap way to reduce the probability of losing your independence due to a hip fracture.

Generic vitamins from a discount store are just as good as expensive vitamins bought at a health food store.

There is one vitamin you might need to take in addition to a multivitamin—vitamin E. Sometimes doctors tell people to take more vitamin E than you can find in a multiple vitamin. Most doctors say you should not take more than 400 international units of vitamin E each day. Too much vitamin E can be harmful because it can be stored in the body.

While there are certain times when a doctor recommends large doses of any vitamin, you should not self-treat with vitamins and minerals—you could cause yourself many problems. With the two exceptions I have just mentioned, calcium and vitamin E, one multiple vitamin with minerals is probably more than adequate for most people.

Be very careful when purchasing any herbal or similar thing. First, no official agency insures that what the producing company claims is in the bottle is really there or that it even works! The Food and Drug Administration has no control over anything called a dietary supplement—producers of herbals and other similar products are supposed to police themselves. In some cases, the amount of active ingredient may not even be present; in other cases, there may be far more than the amount listed on the bottle. No one has studied whether or not these things really work. When you take any of these things called dietary supplements, you are volunteering to take something which has not had any evaluation by an independent group like the Food and Drug Administration.

Always tell your doctor if you are taking any of these home remedies.

Many of these things are very expensive too. Many companies producing herbals, claim secret ingredients that the medical establishment is trying to keep away from the public. Think about this...if a doctor or a pharmaceutical company had a cure for arthritis or cancer ...why would they want to keep it secret? Such a cure could enrich them beyond belief. Many of these companies try to convince people to buy their products because they claim their product will cure a chronic disease like cancer or diabetes. If you have a chronic disease, this means there is no cure. Medicine may help with the symptoms, but there is no cure for a chronic disease.

Avoid taking something just because someone tells you it is natural.

Prescribed medicines like digitalis come from plants too. However, if you take too much digitalis, you can die—it stops your heart! Natural does not mean harmless.

DISCUSS: Handout 4, The Prescription for Health

SAY:
So, what are some other things you can do to improve your health in very significant ways?

Look at the Prescription for Health. These are the things that improve health significantly—actions you can take on your own—actions supported by over 50 years of large research projects—actions which are free or almost free. None of these things are as easy as taking a pill to lose weight or to feel less depressed, but these approaches are absolutely effective—if you do them.

Walking 30 minutes 4 to 5 times each week reduces blood pressure, cholesterol, blood sugar, depression, stress and many other things so many of us complain about. Studies have shown that people who walk regularly have less hospitalizations too. Walking can save your health care dollars in so many ways. Getting started is not easy. Walking with friends is a great way to get started. If you want help to get started and establish this important habit, ask your county Extension agent about working with you and others in your community to organize Walk Across Texas.

All of the things listed in the Prescription for Health Handout can significantly improve your health. These things really do not cost much to do either.

DO Role Play 2

ASK:
How were the outcomes for this patient different from the first one with a headache? [Answers will vary, but she did not need to get new medicines or expensive tests she probably did not need because she came to her doctor’s visit prepared.]

SAY:
In closing, I hope you have learned a number of ways to save your health care dollars while maintaining one of your most important possessions—your health!

[Ask audience to complete the evaluation.]