UPDATED: March 23, 2025
Welcome to the Healthy Living Is Good Medicine Newsletter, a free publication covering a wide variety of health-related topics, with timely original articles intended to help people lead healthier and more fulfilling lives.
Today's topic is about how to get the most out of the limited face-to-face time that we typically get with our healthcare providers. Although I am not currently working as a patient advocate, my subscribers are able to ask me relevant questions. Here’s some personal background information:
Soon after becoming licensed, I was hired by a large medical group, and it almost immediately felt like I had taken a position on an assembly line. If I didn't finish with a patient before 10 minutes were up, someone would knock on the exam room door and loudly announce that the next patient was ready to be seen. You can imagine my discomfort, torn between the needs of my patients and the demands of my employer to “keep ‘em moving!”
When I finally saved up enough money to open my own practice, some of my patients from the medical group came to see me there, even though they had to pay out of their own pockets. They expected that with me now being my own boss, their visits wouldn't be rushed, and they were right.
Apparently, the additional time and attention they received from me was worth it, because they kept coming back. Of course, spending more time with my patients meant making less money, but establishing working relationships with them is what made my experience as a physician worthwhile.
Managed Care and Middlemen
Enjoying the luxury of more time with patients happened back in the days before computerized health records were required and insurance companies were managing healthcare. Once those good old days were gone, a rapacious, for-profit healthcare system reigned supreme, and has since become an anathema for patients and doctors alike.
The corporatization of medicine has created multiple third-party intrusions between providers and their patients. Doctors are required to produce lengthy medical records to justify their billing, and deal with even more hassles when the insurance claims are denied. The additional time demands take a toll on already busy doctors, who would rather be seeing patients than doing paperwork.
Exorbitant insurance premiums and co-pays, lengthy waits for appointments, too many hours spent in waiting rooms, and rushed visits with providers, all conspire to discourage patients from seeking necessary medical care. When patients do get to see a clinician, they are often angry at the system, and tend to take their frustrations out on the providers. Our healthcare system is one that relentlessly grinds down both patients and their doctors.
Primary care providers typically feel harried, caught between the pressing needs of patients and the cracking whip of their corporate masters. They are pressured to increase turnover and generate more revenue. No wonder doctors, whose professional responsibility is to help their patients, are so prone to burnout. The stresses they face lead to high dropout rates, alcohol and opioid abuse, depression, and an increased risk of suicide. In the U.S. between 300 and 400 physicians a year take their own lives.
In short, profit-oriented healthcare maximizes corporate wealth at the expense of patient health. It urgently needs to be reformed, and there needs to be an alternative to private medical insurance, such as “Medicare for All.” Please demand that your representatives in Congress support H.R.3421. For more information about our healthcare crisis, see:
My Life After Primary Care
I eventually left solo private practice when the overhead outpaced the clinic’s income, and I could no longer compete with the medical groups. So, I accepted a position as the medical administrator of a remote hospital run by my state’s health department. It was a remarkable experience that I feel fortunate to have had.
Since retiring from that job, I've been spending time educating people about how to stay as healthy as possible, and when necessary, helping them successfully overcome the pitfalls of our healthcare system. Advocating for patients has allowed me to remain engaged in the field of medicine without the responsibilities of a practicing physician. For some excellent advice on how to find the best healthcare provider, see:
A patient advocate is typically a healthcare professional who helps patients navigate the system in order to obtain the best care possible. They can help patients ask the right questions and communicate effectively with medical staff, ensuring patient-centered care. They can also help patients access their medical records and make sense of diagnoses and treatment plans.
Advocacy groups can support patients and assist them in dealing with their insurance companies, understanding their medical bills, and seeking financial assistance. If you or someone you know needs a patient advocate, you can find many such resources online.
This is the kind of advice that patient advocates can provide to help people get more out of their all-too-brief visits with healthcare providers:
1) Know what kind of healthcare provider you will be seeing for an office visit. Your primary care provider (PCP) may be a board-certified physician (MD or DO), a physician's assistant (PA), or a nurse practitioner (NP). If you don't have confidence in their ability to diagnose and prescribe, ask for a referral to someone with specialty training in your kind of problem, such as a neurologist, cardiologist, or gastroenterologist.
2) As soon as your PCP enters the exam room, distinguish yourself from being a walking, talking diagnosis, and connect with them as a fellow human being. You can do that by revealing something personal about yourself. What have you been doing lately? Hobbies? Trips? Welcoming a new member to your family?
Keep your "I'm human, too" revelation short and sweet, 30 seconds at the most. It will work wonders in focusing the busy clinician's attention on you, rather than being off in their head about all the things that are bothering them that day, including feeling rushed.
3) Prepare in advance for your clinic visits. Create and maintain a list of all your medications and supplements. Include their dosages, and how often you take them. Have that list with you at every visit.
Doctors (and pharmacists) don’t usually take time checking for adverse interactions between the different medications and supplements you’re taking, so that is something you should definitely do. The website I use is the “Medscape Drug Interaction Checker.” If you find any adverse interactions, immediately bring them to the attention of your main healthcare provider.
4) Be very clear in communicating the reason that you are seeking medical attention. Is this a follow-up appointment, or do you have a new concern or symptom? It will be very helpful for you to have with you a written “problem list” in order of their priority. Refer to this list throughout your visit.
Your PCP will likely not have enough time to deal with all of them, but you'll at least want to present the one thing that has been bothering you the most. That is known in medical parlance as the patient's “chief complaint.” Don't save your most worrisome (or embarrassing) concern for last, and spring it on the doctor just as they are leaving the exam room. Focus on the one thing that you want to make absolutely sure gets addressed in this visit.
If you’re not clear about what your provider is telling you, ask questions, and take notes. Sometimes you’ll have to say, “Would you please put that in plain English.” Don’t pretend to understand something in order to avoid appearing ignorant. Part of a doctor’s job is educating their patients, so feel free to request further education about the subject at hand.
5) Anticipate your provider's questions, and have your answers prepared in advance. They are likely to ask: When did your symptoms begin? How did they progress? How bad are they now, compared to when you first noticed them? What have you tried to relieve them? Did anything help? Has anyone else in your family ever had something like this?
5) You can often get more “bang for your buck” when you see doctors who are affiliated with a medical training program. Medical residents and fellows usually have more time to spend with you than their attending physician, who will then hear their summary and evaluate their assessment and treatment plan. If you want someone to hear your whole story, trainees are dedicated to getting all the details and then accurately reporting them back to their supervisor. You will also get the additional benefit of “two heads” being better than one.
6) After your visit, get online and go to your patient portal to review your provider's clinical notes. If you find any errors (which do occur), call them to the provider's attention at your first opportunity. As a patient, I have found it quite frustrating when what I told the doctor isn't what they entered in their notes. Did they get me mixed up with another patient, or were they just not listening carefully?
What has been even more frustrating is the difficulty getting doctors to correct errors in their notes, which tend to be reiterated in subsequent visits. It pays to be persistent, yet tactful. Doctors tend to have a lot of ego invested in what they do, and it can be hard for them to accept that they’ve made a mistake, and then graciously fix it. Here is a helpful guide on how to proceed.
7) If the PCP has an assistant who records and transcribes what was said during your visit, or if the practice uses AI speech-to-text to generate clinic notes, welcome them. They will help to keep your provider's attention on you, rather than their computer. Also, you may not remember everything that your doctor told you, so having access to an accurately transcribed electronic record of your visit can prove invaluable.
8) Strive to create working partnerships with your providers. Think of them as your advisors, seek as many other qualified opinions as may be necessary, and come to collaborative decisions about how to optimize your care. Any doctor worthy of their degree prefers patients who share in the decision-making, rather than those who passively let them decide what's best. Your care needs to be individualized, so don't be afraid to be an assertive patient. If your PCP can't handle it, find someone else who can.
For an even deeper dive into how to succeed as a patient, see:
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