The first goal in the Life Care Planning process is to promote your good health, safety, and well-being at all times. This begins with a dialog between you and your doctor. Many peo-ple do not understand how medical decisions are made, but the truth is that you make most of your medical decisions, not your doctor. The health care community uses a process called "informed consent" to make you aware of your health care options. After you have information, then its your turn to decide what will be done.
Our purpose in providing this memorandum is to make you aware of questions you should ask as you talk with your doctor. We are not providing health care advice. You should get that from your doctor. Instead, we want to empower you to participate in the decision-making process.
You can help your doctor help you by doing the following:
• Making a commitment to take an active role in your medical care
• Choosing to follow your treatment program as best you can
• Getting the most out of office visits
• Talking honestly with your doctor
Thoughts about the Doctor-Patient Rela-tionship
To be more at ease with both your doctor and other health care professionals, try to realize that they are human beings, too.
Doctors aren't superhuman. Like you, doc-tors are subject to moods, pressures, and mistakes. There is no reason to be in awe of your doctor, nor is there any need to blindly follow orders without asking questions.
If you tend to hold your doctor in awe, as many people do, you may not want to "bother" him or her with questions. If you feel this way, try to remember that your doctor's job is to provide you with good medical care. Therefore, you have the right to receive certain services from your doctor.
Most of the information doctors use to diagnose and treat you must come from you. Therefore, your doctor needs to hear your ideas and observations. It's in your best interest to be specific about how you feel and what you think.
Also, if your doctor explains something to you, and you don't understand it, he or she won't know that unless you say so. You might tell the doctor: "I still don't understand. Can you explain it again?" Don't feel stupid if you have to ask the same question again. Part of a doctor's job is to be an "educator," and this often means going over the same point several times.
Many conditions can't be cured, though they can be controlled. However, no one type of medication or other treatment works for everyone. You and your doctor may have to go through a period of "trial and error" to find out what works best for you. Even then your treatment program may continue to change as you change.
Your Health Care Team
Many health professionals may be involved in your care, depending on your condition and whether they are available in your ar-ea. Some of the health care professionals you might meet are listed below. The first seven are medical doctors, and the next seven are other health care professionals.
• Family physicians and general practitioners provide general medical care for adults and for children.
• Internists provide evaluation and management for adult diseases.
• Orthopedists help evaluate and manage bone and joint problems and can perform surgical procedures such as joint replacement.
• Physiatrists are physicians who may direct your physical therapy and rehabilitation.
• Ophthalmologists are physicians who may provide eye care and treatment.
• Pediatricians are physicians who treat childhood diseases.
• Psychiatrists are physicians who may provide treatment if you have mental or emotional problems that need special attention.
• Podiatrists are experts in the care of feet. If your arthritis affects your feet, podiatrists can prescribe special supports and shoes to help you.
• Nurses are trained to assist your doctor with your treatment. They also help ex-plain your prescribed treatment pro-gram and can answer many of your questions. In a long-term care setting, most of the treatment you receive may be nursing care, so your nurse may be an integral part of your care team.
• Physical therapists may show you exercises to maintain muscle strength and use of joints.
• Occupational therapists may teach you how to carry out everyday activities. They may provide you with splints and other devices to help protect your joints.
• Psychologists help to solve emotional or mental problems.
• Social workers can help you find solutions to the financial and social problems you may encounter.
• Pharmacists will fill your prescriptions for medications and can explain the actions and side effects of these drugs. They also advise you about drug interactions and over-the-counter medications.
You Are In Charge
With so many skilled professionals involved, it's sometimes difficult to keep everything straight. You're the central focus of the efforts made by these experts. Therefore, you and your doctor need to make sure that your treatment program is understood by all the team members.
What to Expect
In order to have a partnership with your doctor and other health care professionals, you should expect good medical care from them. Good medical care includes being told about your condition and the essential facts of your treatment. This information should include costs, medications, side effects, and other possible options for treat-ment.
In addition, you should be assured of privacy concerning your records, hospital stays, and finances. If you ask for a second opinion, your doctor should assist you by suggesting other physicians you can consult, and by making your medical records available to the person you select.
Every member of your health care team should contribute to your good medical care. If you don't feel that you're getting the right attention from one of the members, let that person and your doctor know how you feel. Remember, team members aren't mind readers. It is your responsibility to inform them of your concerns. Otherwise, they will probably assume that you are satisfied with the care you are getting.
It is important for you to understand that if you criticize a member of your medical team in a positive way, it does not hurt his or her feelings. Your comments won't be taken personally and you will probably be thanked for helping to improve your care. By letting the team members know your feelings, you can help foster the cooperative spirit that is necessary for the success of the whole team.
Effective Office Visits
Preparing for a visit
To get the most out of office visits, it's helpful to prepare before each appointment. Doctors appreciate your preparation because it makes their jobs easier.
Before your visit, try to keep in mind:
• The time spent with your doctor may be brief.
• You must make the most of that time.
• If you waste time or don't ask questions, you won't get the information you need to make the best decisions about your health, and you may not get the best return for your money.
Remember, it takes time for your doctor to answer your questions. If you have many, consider scheduling a longer appointment. Don't forget your doctor has other patients.
As you write down your questions, prepare a brief but accurate progress report.
Your doctor will most likely ask: "Have you been following your treatment plan? How have you been feeling? Have you had any problems? What has been happening in your life?" You might find it helpful to jot down the answers to these kinds of questions ahead of time.
Be ready to report the names and the dosages of the drugs you're taking. If you're taking several medications, you should bring in your pill bottles (if you're visiting a physician other than your regular doctor, it's especially important to bring all your medications with you). If you don't already use a "drug usage" chart, your next office visit may be a good time to discuss one with your doctor. The chart lists all of the drugs you take, any special instructions, and when you should take them. To show that you took your medication, simply put a check in the space provided. This way you keep a permanent drug record for yourself and your doctor. If you are seeing your doctor on a return visit, make a list of any refills of medicines you need.
During the visit
• Answer your doctor's questions, and report your progress.
• Be honest. If you haven't been feeling well, or if you are frustrated with your treatment, tell the doctor.
• Be concrete. If you have pain, try to describe how intense it is on a scale of one to ten, with ten being the worst. Try to be specific about which part of your body is bothering you.
• Also explain how your pain or limitation of motion prevents you from doing cer-tain activities that are important to you. These might include driving your car or brushing your teeth.
• Tell the doctor about any fears or com-plaints you have about your treatment. Your doctor can sometimes reduce your fears by explaining the treatment in greater detail. Or if you have a problem with your treatment program, perhaps it can be changed slightly. Listen to what your doctor tells you. If, after giving it careful thought, you disagree with your doctor's advice, talk it out. There may be other treatments you can try, or the doctor may be able to explain in a better way why you should follow a certain program.
• Report any unusual symptoms you have noticed. Drugs used for the treatment of certain conditions can have side effects, so it's important to tell your doctor about any unusual symptoms or bodily changes you have noticed. Typical changes may include a skin rash, sores in the mouth, dizziness, or changes in the color of your urine.
• Remind the doctor of what you want your interests and needs. Your treatment program should be a combination of medications, therapies, and exercises that are suited to you. Remembering your interests and needs helps the doctor develop the best program for you. For example, he or she may be able to help you keep the pain m your knee under control so that you can continue to play golf. Or if you tell your doctor that you find it difficult to take medication four times a day, he or she may be able to prescribe a drug that you take only twice a day.
• Share with your doctor important events in your personal and social life. Events in your life can affect your arthritis and they can also affect the way you take care of yourself. For example, your doctor needs to know if your rheumatoid arthritis tends to flare up after you and your husband fight. He or she also needs to know if you get depressed during the holiday season and forget to take your medication. Learn to share this information and talk honestly about your emotions.
• Ask for an explanation. Always ask your doctor to explain anything about your arthritis or your treatment program that you don't understand. Try repeating what you think you heard. It's a good way to make certain you really understand. If you've got it wrong, your doctor can correct you. Sometimes it's helpful to bring in a friend or relative when you see your doctor so you can discuss what the doctor told you.
• If your physician adjusts your treat-ment program and you don't know why, find out. Ask about possible side effects and what you should do if they occur. Remember, the more you know about your arthritis and your treatment, the more you can help the doctor help you.
• Keep in mind that talking honestly means giving and taking in an atmosphere of respect and trust. However, you should try to be "selective" when you tell the doctor about your complaints. If you always bring a large list of complaints, your doctor may stop listening attentively and could ignore something new that is truly important.
Following your treatment program
Part of developing a partnership with your doctor means trying your best to follow the treatment program. All too often, people fail to follow their doctors' instructions for one reason or another. Perhaps they forget, or they get too busy. Make working for your good health a routine. For example, place your drug usage chart on your mirror or refrigerator or bathroom door to remind you to take your medications. Make a habit of doing your exercises at the same time in the same place every day. Your doctor or other members of your health care team may be able to provide other suggestions to help you follow your treatment program.
• Make notes. After you have visited with the doctor, go to the waiting room to make notes, or write your notes at home. If medication instructions aren't clear to you, ask for an explanation from the nurse before leaving the office.
• Don't change your treatment program on your own without good reason. This is very important! If you have a problem with the treatment, consult your doctor. Many people stop taking their medications once they start feeling better. Or if they don't start to feel better right away, they give up. Either way is wrong. In many treatment programs, you have to understand that the drugs may take time to work. Some drugs can take months before a noticeable change will occur. However, if you improve right away, that doesn't mean you should stop taking your medication. Feeling better doesn't mean that you've been cured. It just means the treatment pro-gram is working.
• Don't follow other "medical" advice without first checking with your own physician. You may read or see something about a "miracle cure" for arthritis. Be cautious of any claims about cures. If you're curious and feel tempted to try one, call your doctor for an opinion, or ask at your next office visit.
• Stay alert for side effects. Observe your body and judge how you feel. If side effects occur, refer to the notes you took at your office visit and see what you should do. If you aren't sure, call your doctor.
Each time you have an office visit, you and your doctor have an opportunity to further develop your relationship. Discussion is a necessary part of good medical care.
Questions to Ask about Your Medications
Taking medications isn't as simple as swallowing a pill. Medicines can only help if you take them as prescribed. To achieve the fullest benefits from your treatment plan, take part in decisions regarding your treatment, follow the treatment plan you and your doctor agree on, watch for problems, and become actively involved in solving them with your healthcare team. Review the following questions with your healthcare team and take an active role in your health.
• What is the name of the medicine?
• Is this the brand or generic name?
• What is the medicine supposed to do?
• How and when do I take it, and for how long?
• What foods, drinks, other medicines or activities should I avoid while taking this medicine?
• What are the possible side effects?
• What do I do if they occur?
• Is there any written information available about the medicine?
• What happens if I miss a dose of my medicine?
• How often will I have to get the medication refilled?
• How will I know that my medication is working?
• What are the risks of taking this medication?
• What are the risks of NOT taking this medication?
• Are there less expensive medications for my condition?
Questions to Ask about Diet
Learn to read food labels so you can tell how much fat, sodium and other ingredients are in your diet. If your doctor tells you to "watch your diet" or make dietary changes, ask for specifics. Questions you can ask are:
• What kinds of foods should I eat and not eat?
• Should I restrict my calories or fat in-take to a certain level?
• What are some cooking tips that I should follow?
• What can I eat at restaurants?
• Do I need to see a nutritionist or dietitian? If so, can you recommend one?
• Should I keep a diary of what I eat?
• Are there any groups in the community that can help me with my nutrition goals?
• How do I read food labels?
• How can I control the portions? How much salt may I eat?
Questions to Ask about Losing Weight
• Why are weight control and regular physical activity important?
• How much weight should I lose, and how fast? What is a realistic weight goal for me?
• How often should I check my weight?
• What should my daily calorie, fat and cholesterol intake be?
• Are prescription diet pills appropriate for me?
• Do I have to exercise to lose weight? If so, what kinds of activities do you recommend?
• Once I lose the weight, how do I keep it off?
• What diet guidelines should I follow?
• What are the best types of activities for me?
• How much activity do I need to do?
• How much weight gain is too much?
• How can family and friends help?
Questions to Ask about Cholesterol
• What do my cholesterol numbers mean?
• How often should I have my levels checked?
• How does physical activity affect my levels?
• What type of diet should I follow?
• Will I need cholesterol-lowering medicine?
• How long will it take to reach my cholesterol goals?
Questions to Ask about High Blood Pressure
• What should my blood pressure be?
• How often should my blood pressure be checked?
• What about home blood pressure monitors?
• Should I use blood pressure machines at stores?
• How does physical activity affect my blood pressure?
• What's my daily sodium (or salt) limit?
• Will I need to take blood pressure medicine?
• Will I always have to take medicine?
• Why do I need to lose weight?
Questions to Ask about Physical Activity
• Why is regular physical activity important?
• What are the best activities for me?
• Can I exercise?
• Can I play sports?
• How much activity do I need?
• Can I have sex?
Questions to Ask about Quitting Cigarettes and Tobacco
• What can I do to stop the cravings?
• How many minutes do cravings last?
• What about a nicotine patch or gum?
• Can I take a smoking cessation medication?
• After I quit, when will the urges stop?
• What if I start gaining weight?
• How can I keep from gaining weight?
• How can family and friends help?
• What if I slip and go back to tobacco?
• How long will it take to reduce my risk?
Questions to Ask about Heart and Stroke Health
• What are my risk factors for heart disease?
• Am I at risk for stroke?
• What are the warning signs of heart disease and stroke?
• Do I need to lose or gain weight?
• What is a healthful eating plan for me?
• What kind of physical activity is right for me?
• What is my blood pressure, and is it at a healthy level?
• What is my blood cholesterol, and is it at a healthy level?
• What can I do to lower my risk of heart disease and stroke? (If you smoke, ask for help in quitting.)
• If you're a woman, ask, "What should I know about the effects of menopause on my health?"
Healthy Living: What You Can Do to Keep Your Health, http://familydoctor.org/086.xml.
Talking With Your Doctor, http://www.niapublications.org/pubs/talking/index.asp.Copyright 2013 Solomon, Steiner & Peck, Ltd.