'I know health care is intimidating and a doctor or
nurse can be very intimidating to people. But I think
it's true, the squeaky wheel gets the grease.' -- Ann-
Marie Eugley, above, RN, ombudsman for Salem's
North Shore Medical Center.

Making the most out of your doctor's visit

By SUSAN FLYNN

News staff

A visit to the doctor is supposed to make you feel better. Yet countless patients have left offices feeling frustrated, rushed, embarrassed and even a little bit dumb.

In today's age of managed care, a doctor's ability to spend time with patients has been hindered by demands for more efficient and less costly services. As a result, patients are now encouraged, if not forced, to be in control of their own care.

"I know health care is intimidating and a doctor or nurse can be very intimidating to people," said Anne-Marie Eugley, a veteran nurse and ombudsman for North Shore Medical Center in Salem. "But I think it's true, the squeaky wheel gets the grease."

Eugley and other health-care professionals say there is plenty patients can do to make the most of their 15 minutes — sometimes more, sometimes less — with the doctor.

Some tips include taking a detailed list of questions and symptoms; leaving children at home; and requesting explanations for medical jargon.

According to a February 1995 Consumer Reports survey, people who said their doctors didn't communicate well were less likely to follow doctor's orders and have their conditions improve. The lesson: Speaking up is good for you.

Taking notes

Most people would never consider relying on memory in the grocery store. Why do it at the doctor's office?

"I really appreciate the patients who come in — and there aren't very many of them — with a little notebook," said Dr. Lawrence Caliguiri, a Pittsburgh allergy specialist and advocate of patient empowerment.

To help the doctor, the patient should also bring to the appointment bottles of any medicine they're taking, he said.

Caliguiri serves as chairman of the Board of Governors of the American Academy of Allergy, Asthma and Immunology. The organization recently published a new handbook for asthma sufferers, "Making the Most of Your Next Doctor Visit."

Studies show the average doctor's appointment is less than 10 minutes, so it's understandable that some patients feel rushed, he said.

To alleviate feeling rushed, the patient should tell the doctor at the onset they have a list of questions. They should also know how to reach the doctor if they have a question after the visit, Eugley said. Sometimes it's hard for people to think on their feet, especially if wearing a johnnie.

Dr. Philip Triffletti, an internist with Beth Israel's Medical Care Center North in Chelsea, said some patients show up with computerized printouts listing what they ate and charts chronicling blood-sugar levels, which he thinks is great.

Triffletti teaches a class to first-year students at Harvard Medical School on the proper way to talk to patients. He said a good doctor will take the time to develop a rapport — ask about the job, the wife, the golf game.

This isn't just small talk. "We consider that vital information" to make an accurate diagnosis, he said.

So little time

Dr. Triffletti often writes down instructions for his patients and said people should ask their physicians to do the same. Patients forget about half of what doctors tell them before leaving the office, he said.

"You should be looking for someone else if you don't think your doctor is listening enough," he said. "One of the good things today is there is a lot of competition."

Triffletti said he schedules the amount of time he spends with patients, but not all doctors have that luxury.

"Some (HMO) doctors have to see a patient every 15 minutes," he said. "Doctors face so many pressures today. There are not a lot of incentives financially to spend a lot of time listening and counseling (patients). In fact, it's probably the opposite."

What often makes people anxious is the wait to see a doctor. Ideally, says Dr. Caliguiri, the patient should not wait longer than the office visit itself. But 'ideally' rarely happens.

Furthermore, a patient should never be expected to discuss the reason for a visit in an open reception area.

"That violates a patient's confidentiality," said Elizabeth Hill, administrator for Family Practice Center in Danvers. She said the information given over the telephone when making the visit should be sufficient enough.

Steve Broydrick, a health-care consultant employed by Salem Hospital, said a long wait may be the sign of a good doctor who is willing to spend extra time with patients.

"I do know people have less tolerance for (doctors running late) today than they did 10 years ago," said Broydrick, author of "How May I Help you: Providing Personal Service in an Impersonal World."

"I know patients who changed doctors because they were left waiting," he said.

Fortunately, Broydrick and others say, the medical profession lately has paid more attention to the patient, from holding focus groups to customer-training seminars for staff.

"I think it is the right thing to do from a business point of view," said Eugley. "We are in the business of care and care is not just the technical piece. It's also the interpersonal piece."

A patient can always switch doctors, said Broydrick. But he recommended first writing a letter to explain your complaints.

"I think every doctor's office should be given the chance to correct those kinds of problems," said Hill. "They could be clinically superb, but just have to work on people skills."