Your Medical Visits: Using Limited Time Wisely

We all know that the pressures on our medical system, both for providers and for patients, are greater than ever. We hear about staffing issues in every industry, and health care is not exempt. There probably are fewer people trying to do the same amount of work. It behooves us to prepare thoughtfully for our meetings and to try to ensure that we will leave the office feeling heard and understood. Separately, for general health care, it's important to know where to go based on the type of medical care needed.

Frequency of Appointments

One of the ways to divide the citizens of “Cancer World” would be those who would like to meet with their doctors weekly and those who would prefer never to have to see them. For most of us, the ideal would be somewhere in between, but we usually don’t have much of a vote.

As we go through active treatment, we usually meet with our doctor, nurse practitioner, fellow, or physician assistant at every visit. Some people are disappointed that these regular meetings are not always with the senior oncologist, but most of us understand the demands on their time. If there is a concern or urgent problem, it is almost certain that the senior doctor will be part of the meeting. Many appointments, even in oncology, are scheduled for half an hour or less, and it is very important to use our time wisely. As frustrating as it can be to wait when your doctor is running late, remember that s/he is probably talking with someone in trouble.

Once treatment has finished, we often have less appointments, and we still probably will meet with one of the members of our care team—but not necessarily the one with whom we most want to meet. Some hospitals or medical practices routinely graduate patients after several years have passed since treatment was concluded. Whether that means beginning to have follow-up appointments at a survivors’ clinic, being returned to the care of a PCP, or something else is variable. At BIDMC, many patients choose to continue to meet with their oncologists for years after active cancer treatment, and that is structured into the system. These follow-up visits with long-healthy patients are possibly the favorite part of the day for many clinicians, and patients continue to feel reassured by the meeting.

Preparing for an Appointment

Appreciating that our appointment times are precious, how can we best prepare and make the most of the meeting? To begin, think about what is most important to you right now.

• Are there specific worries you want to discuss?
• Are you having side effects from any medications or continuing symptoms from your treatment?
• Are there more general health issues that you worry may impact your cancer health?

Write your questions down. However, don’t write down (or at least don’t take in) three pages of questions. There won’t be enough time to get through everything, and both you and your doctor will be frustrated. I have read recommendations that you go in with no more than three questions, and that is probably a good goal, but may not be possible. In addition, keep your questions pointed. Never ask a “doorknob question”: a question or comment, sometimes the most important of the whole conversation, that the patient asks on the way out of the door. By the time your hand is on the doorknob, the discussion should be done.

After the Appointment

Studies have indicated how much we don’t remember about what our doctors have said to us. Especially when we are anxious or stressed, we don’t remember as well as usual. These are common feelings during medical appointments, especially in the beginning or times of treatment changes and decisions. A recent study found that, a week after the appointment, most people remembered less than half of what had been discussed.

Understanding that the rules have been different during the pandemic, it is often useful to take someone with you. Two sets of ears and two brains are more likely to recall information; you can ask your companion to take notes. Sometimes people want to tape record a medical discussion. Most doctors are comfortable (or at least comfortable enough) with this, but you do need to ask permission. A good trick to help you remember what is being said is to repeat it back: “Let me make sure I understand this. I think that you just said...”

Remember that our medical records are also legally available for us to read. You can always ask, and many hospitals (including BIDMC) routinely post physician notes as well as test results on an online patient portal. This practice is called OpenNotes. Many clinicians understand the value for patients of being able to read their summaries.