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Introduction: Einstein Health Care Network in Philadelphia, Pennsylvania presents Doc Talk with Dr. Donee Patterson, a board certified family physician and Einstein's Director of Medical Community Outreach. In each of these podcasts, Dr. Donee will talk with an Einstein medical expert on a variety of health topics important to you. In this podcast, Dr. Donee talks about how to make the most of your visit to your doctor. Dr. Donee, take it away.
Donee Patterson, MD: So we wanted to talk about how to make the most of your doctor's visit, because a lot of people don't realize that your doctor's visit is usually scheduled for about 15 or 20 minutes, so it is really important that you come prepared so that your doctor and you can make the most of that visit. I have here with me today,Dr. Nina Mingioni, who is in internal medicine. Do you want to talk about your title?
Nina Mingioni, MD: My name is Nina Mingioni, I am an internal medicine physician here at Einstein and I've been here for some years now. I am board certified in internal medicine and I work here in the Klein Building.
Patterson: Some studies have shown that you can really improve your health if you get the most out of your doctor's visit so we hope you will learn some tricks today. What I really want you to think about is think about your doctor's visit as three different stages,so there is before, there is during, and there is after. Dr. Mingioni and I, we want to teach you how to make the most of those. So beforehand, we really want you to have your medical records sent ahead of time, so if you are a new patient, or you've seen one of your specialists, we want to make sure that you have your records sent to your doctor ahead of time and you can even call ahead and make sure that your records have arrived. Then, write down any questions you have. You can get a book from the dollar store or just a nice notebook and kind of write down any questions that you have. Bring all your medications and that includes herbal and birth control medications and then a list of your specialists. But do you find, Dr. Mingioni, that people sometimes come unprepared to your doctor's visits?
Mingioni: Unfortunately people frequently come unprepared to their doctor's visits and it just unfortunately takes the valuable time away from the doctor/patient interaction for me to do the discovery work during that visit. It is very, very helpful when people bring all the medications to their doctor's visits and that includes anything they take over the counter as well, even if you take it just as needed, it still has to come. It is not just the list that you carry in your wallet, it has to be the actual medication bottles because that is how we discover that maybe a pharmacy dispensed the wrong medication, if you, by mistake have been taking two very similar medications and this happens unfortunately quite frequently, but we will not know that until you bring all your medicines for us to look at during your visit.
Patterson: A lot of times people will have medicines that are expired so it's very important as Dr. Mingioni was saying to please make sure you bring your list but also bring in a bag, everything that you are taking, even if it is just taking it here or there. But also,very, very important, if you have specialists, please write down the specialist's name and phone number and if possible write down their fax number and their address as well. Dr. Mingioni,what I find is sometimes people come and they save things that they want to talk to you about for the end of the visit and I wanted us to talk about that today because it is so important that people don't save it for the end of the visit; get it right out there. How do you handle that?
Mingioni: I usually specifically ask my patients what they come to the office for and I just presume they come there because I asked them to come three month's ago but I think it really helps if people give me their lists of questions in the beginning, because I can address those either first or in the middle of what I am talking to you about and doing. A lot of times what you want to talk about and what I want to talk about actually overlap quite a bit but I need to have those questions in advance so that I can portion my time and I can address those during the visit.
Patterson: So if you save something so important like chest pain to the end of the visit, sometimes other doctors may be rushed and it may not get addressed exactly how we want it to be addressed. I want you to get it right out there in the front. You can even tell the nurse, I'm here for a urinary tract infection and then sometimes you can get a urine in advance or I'm here because I've been having chest pain and maybe they might want to do an EKG in advance. All those things are very, very important. Also, we want to talk about, sometimes there is some embarrassing things that people don't want to talk about and they end up leaving the visit without actually talking about those embarrassing things. I want to assure you, we are physicians, and we think that those things are important too. You just have to sometimes broach that subject because sometimes doctors may not always address it. How do you feel about that Dr. Mingioni?
Mingioni: So I feel very strongly about that and a lot of people feel very embarrassed about things that a physician, a doctor, would never find embarrassing, these are things that we deal with everyday. Please, get it out there, talk to your doctor about anything and everything. I assure you we have heard it all before.
Patterson: Tell me some of the specifics that people might not want to talk about, that they may be embarrassed about.
Mingioni: Things like rashes, sexual problems are a big one that people are very afraid to discuss but obviously it affects people's lives quite significantly. Sometimes people feel…women may feel very embarrassed to talk about their gynecological issues and will not discuss those with me but I do need to know these things and Ido appreciate when people discuss them with me and I want to help you, I want to be able to address all your concerns during a visit.
Patterson: So sometimes my patients, my male patients, they may have problems urinating, again, the sexual problems, they may have problems asking me those questions about getting medication or treatment for it, so we want to encourage people just to make sure that you are honest with your doctor because we really need to be able to help you. Do you, as a doctor, get embarrassed yourself when patients are asking you these questions?
Mingioni: No, I haven't been embarrassed as a physician for a very, very longtime. I really have heard all kinds of stories in my life before and I just need to hear if people have issues because I want to help people. I frequently tell people that sexual health is part of your health, so therefore it fits under the umbrella of what we need to talk about during your visit.
Patterson: You have to know as part of our training to be a physician, we go through four years of college, four years of medical school, three or four years of training, so we've seen it all so I don't want people to feel like they can't talk to your doctor. What do you think about being realistic with your doctor because a lot of times patients will come in and they have literally 30 questions,how do you handle that?
Mingioni: When people have a very, very large number of questions, I do askthem to prioritize. My time with patients is, unfortunately,very limited but if I see that patients have a lot of questions I ask them to pick several that are the most important to them, that they absolutely want to discuss today and those will be addressed right away. For the rest of the questions, I usually will bring the patient back into the office pretty quickly to discuss the rest of the questions in more detail and we can specifically address those during a specific visit.
Patterson: You have to know that sometimes the things that are the most important to you may not be the things on your list that are most pertinent to us. It may be very bothersome for example that your feet are itchy but you may also have chest pain on your list, so of course for the doctor, we really are going to want to get to the bottom of that chest pain, but not to just blow off the itchy feet,but just to make sure we are covering the most life threatening things. I just wonder and not to put you on the spot, but do you sometimes get embarrassed when you see your doctor yourself,just so the people can kind of put themselves in your shoes?
Mingioni: I can't say that I do at this point. Maybe when I was much younger I used to he more embarrassed, but at this point I feel I really know that my doctor is there because I picked him to be my doctor and that means I put great faith and trust in them and that means I can discuss anything with them and they are professionals,they are not going to tell anybody, there is a thing called patient doctor confidentiality and everything I tell my doctor just stays between me and my doctor.
Patterson: So that's very important. The doctor visit is confidential and we need people to know that and thank you so much for your honesty, but it's confidential, so anything that you say we can't talk to your loved ones unless you give us permission. That is very important to know. I also want to make sure that people are using the right words when they make an appointment. I often see people say the word check-up when they actually mean a physical exam. That means a little bit different to a person scheduling an appointment. How do you feel about that word check-up? I want people to be clear about that. If you are calling actually for a physical, a complete physical exam, we want them to use the right words.
Mingioni: I usually tell people that they need to ask for an annual exam and that has certain condentations and that means I will address certain things during the visit. To me, check up could be you are coming for a check up of your high blood pressure and diabetes and high cholesterol. What is going to get addressed at your next visit is very different depending on what you come therefor. So an annual exam is the one exam that happens every year where you get a head to toe physical exam and you get specific discussion that's tailored to discuss things like whether or not you had your age appropriate cancer screening and other screenings that you may need based on your age.
Patterson: How do you feel about people who go to multiple different hospitals for multiple different care? How do you feel about that? Multiple different ERs when we are kind of stationed in one place?
Mingioni: At this day and age, a lot of my patients have a misconception that there is one big computer system and we can easily get records from Temple, Jefferson or whatever and unfortunately, that is just not true. It is incredibly difficult to get medical records from other places and frequently impossible without direct patient's assistance where they physically go to that place to pick those records up. So I really prefer that my patients to get all their healthcare here at Einstein, specifically because we really are equipped to address pretty much every procedure, every test that people need; it does happen here on campus. We are equipped to address everything here and those records are easily accessible to me; I do get the results as soon as the tests happen or within a couple of days which is very convenient. If people get their test elsewhere, I may not get the results at all;I may get the results very, very late, so it becomes very difficult to take care of patients like that. I do prefer that everything happens in the same hospital. Specifically too as it pertains to specialists, since I have been here for a while, I actually know specialists very, very well. I may e-mail them,I may pick up the phone and call them and since I know them, things happen very quickly versus me to find a doctor in another hospital whom I don't know, it's a much more difficult thing to do.
Patterson: Thank you for that. I just want to step back and talk about the confidentiality piece. For young adults or preteens that may come to the office, I am actually a family doctor so I see teenagers here in the office. Dr. Mingioni is an internist so she sees adults here. But I just want to comment to the fact that if I am seeing a young adult that is there with their parents,I will ask the parents almost always to step out so that I can talk to the young adult or teen by themselves and then explain to them that this is confidential; that I can't share this with their parents and to make sure we are getting all their questions answered. So I want people to be aware of that as well.
Mingioni: Even as an internal medicine doctor, people frequently bring their love ones or significant others or family members to the visits and I will usually ask the family member to step out for at least a portion of the visit to see if there are any other concerns the patient may have that they may not necessarily want to discuss in front of somebody else. Just be ready for that; don't think anything of it; don't think you are being singled out; it is just part of us trying to provide the best health care that we can.
Patterson: Absolutely. We live in Philadelphia and we have a lot of different nationalities that come to our hospital. A lot of times English is not their first language, so we want to make sure that we emphasize to people that there are translators available. If you need a translator, please let us know in advance when you are scheduling your appointment so that we can make the most of your visit and not have a language barrier. Sometimes family members do come, but we would prefer a translator to be there because sometimes some of the medical jargon gets lost and the translator is trained to do that. How do you handle that?
Mingioni: I do prefer to talk to patients whose English is not their primary language via a translator. We do have a very robust translator service here on campus and they can actually provide areal live translator during the visits if they are given enough notice. It is very, very helpful if patients call in advance and say things like I would prefer a Spanish or Vietnamese translator present during the visit and we can arrange for that if it is done in advance. If it happens during a visit and we discover there is a language barrier, there is a language line that we can use to help us with the translation needs, but obviously it is just not as effective as having a real person there. So please, please, please mention it to whoever schedules your appointment that you will need a translator. We really prefer not to use family members as translators. It is actually not even legal in many states to do that and that's because family members believe it or not may not always translate things correctly, not only from the medical perspective but sometimes when very sensitive things get discussed, like mom has cancer and the kids may not want mom to know that because they believe that she will give up and the doctor thinks the patient should know, they may not translate that correctly, which is obviously a really big problem. We prefer to have a real certified translator present during the visit.
Patterson: So again, I want people to think about their doctor's visits as three phases: before, preparing before, during, what happens during that visit but let's transition to afterwards. When the patient leaves, I want you to make sure that you know when your doctor wants you to follow up and I need you to know what your homework list is to do before you come back. I call it the"honey do" list. I want people to have a list of what they are suppose to do; refill their medicines, whether they are suppose to follow up with their cardiologist or get lab work done. So how do you handle that Dr. Mingioni?
Mingioni: My patients who I send home with a lot of homework if you will, I do take a piece of paper and I write things out for them on what needs to be done, but sometimes I may forget to do that and sometimes doctors don't do that. If you feel overwhelmed and that happens actually quite a bit with the amount of things that the doctor is asking you to do, don't be ashamed or don't be afraid, tell your doctor please write it down for me; they don't mind; they would rather write this down for you and make sure things actually happen then to see you in three months' time and nothing has happened at all because things got lost because you got too overwhelmed. Please ask your doctor to write things down for you to do. Then also, if you left a visit and you go home and you say to yourself hey did she say this or that, what was I suppose to do? Call the doctor back. We would rather speak to you on the phone and clarify what we wanted you to do then to see you three months from now and nothing has been done because things were unclear. Do not ignore things; call the doctor back.
Patterson: Absolutely. So with that said, do you think there are times when your patients are afraid to follow up with you because they haven't done what you've told them to do so they tend not to comeback because they are really kind of concerned that you are going to be upset with them?
Mingioni: This certainly happens unfortunately. A good example would be I have some patients with diabetes that maybe have not been taking their medicines like they should and they know when they are going to come I am going to check their blood work and I am going to be very upset because their numbers got worse. Then I see them back six months later when they are really sick because they haven't seen me and that is also not good. If you haven't done what your doctor asked you to do, we still want to see you back, we will love you no matter what; we may fret at you; we maybe upset that you didn't do certain things, but we definitely want to see you back because we need to know that you are OK, we need to exam you and make sure that you are still alive and well and if you are not we need to do something about it. Don't assume that we just don't want to see you at all.
Patterson: That's very good. I hope people hear that. I also want to mention that when you go to specialists, please make sure the specialist has your primary care doctor's phone number and fax number because that way we can have communication between the two of us.
Mingioni: You can actually ask the front desk in the office for extra business cards of your doctor so that you can give them to your specialist and they will put them in your chart and that way they can always either send us a letter that they have seen you or if something is urgent or critical, they can actually pick up the phone and call us to let us know what is going on.
Patterson: I love that idea. Just to wrap up; one more time, there is before, where you have to be prepared, during when you have to narrow things down so you can get everything in in that 15 minutes and after where you are clear about what the doctor wants you to do and you are not feeling overwhelmed or you have a list so you can check it off when you get home and then make sure you schedule your follow up visit. So if you have any other questions, make sure you call your doctor back. If you need a doctor, you can always go on the website at www.einstein.edu or you can call 1-800-EINSTEIN and schedule an appointment with a family medicine doctor or an internal medicine doctor. You can also follow us on facebook.com/einsteinhealth. That is our official site and you can go and get more information and daily health twits. So I am Dr. Donee, I hope you learned something; we would love to hear your feedback. Hit us up on Facebook, thank you.