Run your doctors appointment like a board meeting

Elizabeth O'Brien's Retire Well

July 25, 2013, 8:33 a.m. EDT

Run your doctor visit like a board meeting

Patients need to set the agenda in the examining room.

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By Elizabeth O'Brien

We generally sit down for an hour when we meet with our lawyers, financial planners and accountants. But when it comes to the people who oversee our most important asset, our health, the whole visit can last less than the small talk at these other meetings. Treating a doctor’s appointment like any other business meeting is a good way for patients to make the most of their limited time.

Across all specialties, the average time that physicians spend with each patient is only 20.8 minutes, according to the most recent data from the Centers for Disease Control and Prevention—and more than half say they spend 15 minutes or less. And those precious minutes are getting harder to come by, with more lead time needed to book an appointment and longer waits in the waiting room, experts say. Doctors continue to face falling reimbursements from private insurers and the government, forcing them to see more patients in order to meet their expenses. What’s more, many boomer doctors are retiring or cutting their hours in preparation for retirement.

This physician squeeze is expected to worsen next year with the full implementation of the Affordable Care Act, as millions of previously uninsured Americans obtain health coverage. Meanwhile, patients’ needs have been growing. “People are getting older and getting sicker, living longer,” said Dr. Susan L. Turney, president and CEO of MGMA-ACMPE, the largest membership association for medical practice managers in the U.S.

An inability to make the most of your face time with the doctor can have serious ramifications for your health and wallet. Clear, effective communication, on the other hand, can help the doctor make an accurate diagnosis. And an accurate first take can help ensure the most efficient care: Getting it right the first time not only improves health faster, but it also helps prevent unnecessary follow-up visits and inappropriate referrals, whose costs can quickly add up.

Set your own agenda

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Prepare for your appointment like you would for any other business meeting, experts say. “Create a little agenda,” said Dr. Albert Wu, a practicing doctor of internal medicine and the director of the Center for Health Services & Outcomes Research at the Johns Hopkins Bloomberg School of Public Health. Boomers often have multiple maladies, and it’s important to prioritize. A new concern—say, a tightness in your chest when you exercise—should be discussed before you offer an update about a stable chronic condition.

Identify your goal for the visit, your top 3 concerns in descending order of priority, and the main question you have about each. Write it all down and bring it with you, along with an up-to-date list of any medications you’re taking and their dosage. Too often, Wu said, patients will come in with a list of 10 or more concerns, in no particular order. “I try to hear what is the most pressing problem,” Wu said, but time pressures mean patients rarely make it to the end of the list, and that could mean missing the most important issue if the patient doesn’t mention it early on.

When voicing your concerns, borrow communication strategies from the boardroom, experts suggest. Know your audience and don’t take it personally if the doctor dispenses with pleasantries—she’s there to help you as efficiently as possible and doesn’t have time to discuss the weather or the Yankees’ starting lineup. To help, state your concerns succinctly: “I have knee pain that’s gotten progressively worse over the past year, and the purpose of my visit today is to figure out why.” Sitting up straight with squared shoulders will signal that what you’re saying is important, and keeping your arms uncrossed will signal that you’re open to the doctor’s reply, said Rachel DeAlto, a communications expert.

Anticipating the doctor’s questions will also help you make the most of your time. A doctor will generally ask how long you’ve had a problem, what makes it better or worse, and what it feels like, Wu said; it will help to have ready answers. If you have a question, frame it using the doctors’ words to show you’re listening, DeAlto suggested: “You said this medication will help with my knee pain. How will it do that, and how often should I take it?” If you think the doctor missed your main point, say something like, “I appreciate your thoughts, but what course of action do you recommend for my knee?” DeAlto said.

If you have a complex situation and worry you won’t be able to cover everything in less than 20 minutes, ask the office scheduler if it would be possible to have more time when you make your appointment, said Linda Adler, founder and CEO of Pathfinders Medical, a professional health care advocacy firm in Palo Alto, Calif. Schedulers will usually do their best to accommodate you—especially if you’ve established a good rapport on prior visits—and if an extension isn’t possible the scheduler can at least tell you the exact duration of your visit so you can plan accordingly, she said.

Strategies for elderly patients

The doctor-patient dynamic becomes even more complex when a caregiver or family member accompanies an older patient to a visit. Instead of speaking for the patient, experts say a caregiver should give gentle prompts if the patient forgets to mention something: “Mom, remember we talked about X when we were preparing for the visit? Why don’t you tell the doctor about that?” Buckley Fricker, author of “Elder Care: The Road to Growing Old Is Not Paved,” and a geriatric care manager in northern Virginia, often recommends technology to save time in the doctor’s office. For example, blood pressure cuffs that connect to iPads or smartphones can graph a patient’s blood pressure in a way the doctor can quickly digest, versus a caregiver shuffling through reams of handwritten notations.

(The Wall Street Journal recently wrote about another way that technology can help make consultations with doctors more productive, through the use of physician-sanctioned online symptom-checkers that patients can use before the appointment.)

When memory loss makes a patient an unreliable storyteller, a caregiver might take extra steps to alert medical professionals. When Fricker accompanies a patient with dementia to the doctor, she sometimes slips a note to the nurse and requests that the doctor read it before coming into the exam room. In it, she’ll introduce herself and briefly explain the patient’s situation. Both professional and family caregivers must have what’s known as a HIPAA authorization, a release form named for a federal health privacy law, if they want to discuss a patient’s situation with the doctor outside the exam room. A patient can grant the authorization herself if she’s mentally competent, and if not, her health-care proxy can. For more about health-care proxies, read “Make your heirs happy: Update your will.“

Older patients especially might feel intimidated by doctors, but it’s important to quell those feelings by realizing that the doctor is there to help. Most medical professionals welcome questions within the allotted visit time. On a couple rare occasions, Fricker said she’s seen doctors bristle at questions as a challenge to their authority. If that happens, find another doctor.