Have you ever been in a doctor’s office for yourself, or with your elderly parent, and not been able to answer “when did you first start having that symptom?” or “what medications have you tried for that, and what dose worked the best?” or “what did the specialist say about this last year?” Most people find these details hard to remember, especially in the context of multiple chronic illnesses, and several doctors.
What often happens is that tests get repeated, previously ineffective or problematic medications might get restarted, and referrals are made for a specialist evaluation that you already had back with your old provider (but just can’t remember the findings). You enter a cycle of inefficient and possibly dangerous care because you only have 15 minutes to make your case and can’t get back in for 2 months.
We (sadly) also do not have a reliable medical records system in this country yet. Often patients must submit special paperwork in order to receive their records, or navigate bewildering electronic access portals. And when you finally make contact with the records department, the one document you need about your knee x-ray cannot be found. With few exceptions, unless you are in an integrated network (which I highly endorse!) most doctors don’t communicate with each other.
Because no one cares as much about your wellbeing as you, the solution is simple. Manage it yourself! And it only costs about $1.00. Purchase a simple letter size spiral notebook and keep it where you will see it, usually near your grocery list, or to-do list, or in your car. The best way to use it is like a diary, a running tally, placing a date and time and recording any health event large or small, change in medication or summary of a doctor’s visit. You can also paste a copy of the current medication list (take a picture of it with your phone and print it) or lab results. Many providers are willing to make copies of results at the time of a visit if you ask. Paste them into your notebook. In the front of the notebook write down the names of your providers and their contact information, any allergies, advanced care wishes and your Power of Attorney if you have one (or better yet, include a copy of any legal documents). You can also write down, or tape a copy of the Q4Action questions discussed in my last post to prompt you to discuss medications at each visit. Nothing is too minor to record in your health notebook (a minor fall, brief rash, or a bout of diarrhea) and no one will be happier than your provider when you pull it out at your next visit. Take it to every appointment, every time, no matter the specialty (including the dentist and the eye doctor).
Having a CURRENT medication list is crucial, and it should include dosage and time of day to be taken, not just “propranolol,” for instance. It should include over-the-counter medications! When a change gets made, or a medication added, make a note in your notebook about why and ALSO update your medication list. I think it works best to keep the medication list as a separate sheet of paper tucked in the front of the notebook so that it can be easily replaced.
In one of my previous positions in a large university aging clinic, my patients had on average: 6 medical problems, 8 medications and 4 different prescribers. That’s a lot to manage. Patients using a health notebook had more satisfying visits (they had focused questions and got better answers), less duplication of care and fewer adverse events. And when they got home and their spouse asked, “what did the doctor say?” there was no guessing involved!
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