When you come to see me as your regular cardiologist I begin our interaction even before I greet you. I start with your chart, reviewing your previous health history—let’s take the hypothetical patient: previous heart attack, two angioplasties followed by a bypass surgery, high blood pressure, cholesterol, occasional rhythm abnormality—and create a “problem list,” a list of the things I need to pay attention to during my visit with you. This becomes my agenda. I ask pointed questions to determine if you’ve had trouble with any of your specific problems:
- Coronary artery disease (prior heart attacks, bypass surgery): any chest pain, shortness of breath?
- High blood pressure: check out today’s vitals, review home readings, review pertinent medications
- High cholesterol: when was your blood last checked, are you on the right medications, are you at your recommended goal?
- Arrhythmia: any palpitations, lightheadedness? Review need for blood thinners.
Once my agenda is satisfied I come to the most important part: What are your questions or concerns? If you are a patient I’ve never met I will likely reverse the order and ask you your concerns first, but I still cover the same territory.
Whether you know it or not you as a patient also have an agenda and it should come as no surprise to you that your agenda often has little or no resemblance to mine:
- My legs hurt.
- I’m tired all the time and I think it’s due to one of my drugs.
- My wife thinks I eat too much salt and I disagree.
- I hope you don’t start me on any expensive new medication or order another costly test.
You’ve got a limited amount of time with your doctor (generally 10-30 minutes, depending on specialty) and you can bet that you will not be able to get through all the items on both agendas. So whose agenda prevails? Whose should prevail?
Prioritization and prior warning helps
I don’t think the answer is obvious. In most situations I as the doctor will make it through my list—the doctor-patient relationship tends to favor the will of the doctor over the will of the patient. I check all my boxes and feel satisfied that our encounter was successful. Some patients are assertive enough that they launch into their list and occupy most of the visit satisfying their concerns, but such a patient is clearly the exception.
Where’s the right balance? In defense of my agenda, if I don’t make it through my entire list you as a patient might suffer. If I get through items 1 through 3, but miss the discussion about the need for a blood thinner with your arrhythmia, you might be at risk for a stroke. If we don’t get through your list you come away dissatisfied at best, and at worst you failed to convey to me a symptom or problem that could potentially become dangerous.
Here’s my proposal. You should do exactly what I do and come to the appointment armed with a list of items you’d like to discuss. Tell me up front that you have a number of questions so that I know to leave plenty of time for your issues. As we go through your list we may find that some of the items are better addressed by your primary care doctor or another specialist. Some of your complaints may relate to medical conditions for which I (perhaps anyone, for that matter) can’t do anything about and you’ll simply have to live with them. If the list is long enough or any of the problems complicated enough we may have to schedule another appointment to address them all.
But whatever you do, don’t leave the office until all your most important questions are answered. This is your body, your health, and although the office belongs to me (figuratively speaking), its only purpose is to serve you. Our agendas will likely never be the same, but when we say goodbye we need to make sure we are both satisfied.