The Doctor’s Visit: What’s it all about?

I recently took my younger son to a doctor’s visit. The look of fear and concern in his eyes was the same look I occasionally see in my patient’s eyes during their doctor’s visit. Granted my son is barely nine years old, but a doctors visit can be scary to anyone, at any age.  We have so much invested in our health.  We are so concerned about the potential diagnosis, treatment and prognosis that there is plenty to worry about. Beyond that though, I think many of us find the doctor’s visit unnerving the same way we are frightened by scary movies:  Not just by what is actually occurring, but perhaps even more, by not knowing what will occur next.

Fortunately, it doesn’t have to be that way.

Typically a doctor’s visit is a well structured event. Early in our training, doctors are taught a very standard method for conducting a visit.  Most doctor’s continue this pattern into and throughout our working years. If you understand this format, I suspect that your visits will be much less confusing and unsettling and hopefully more productive.

So, let me pull the curtain back some and let you in on the “mystery”.

Secret #1 – Most diagnoses are made or at least narrowed down to several options very early in the doctor’s visit. 

Following the initial introduction, your doctor will likely begin asking you about your medical issue and concerns.  This is perhaps the most important part of the entire exam. I was taught that most diagnosis can be made from taking a good history. Experience has shown me that my teachers were correct. Unfortunately, my experience has also taught me that most patients undervalue this part of their doctor’s visits. Some even, unfortunately find it intrusive.  As a result, they are not always forthcoming.  The more specific the details that you provide, often the better. Typically there are small nuggets of information that can mean the difference between several diagnoses.

Secret #2 – Some information will be more important to your doctor and not all information that you believe to be important, necessarily will be.  

You may find your doctor discounting some things that you believe to be pertinent.  It’s not necessarily because your doctor is uninterested, rude or doesn’t care.  It’s often because that particular bit of information doesn’t help them figure out what’s going on. Frequently, this information is nonspecific…It isn’t distinct enough to help differentiate between diagnoses.

Secret #3 – The physical exam begins when we meet you.

As doctors, we are trained to use multiple senses during an exam. A good examiner uses touch, sound, sight and sometimes smell (phew!).  While speaking with my patient, I’m examining them.  I’m watching how they move, the level of pain they are in, how they hold or move their arms and legs, etc..  I watch a million other things, looking for clues to their diagnosis. In Orthopaedics, simple things like how you sit, move your head or shake hands can often give clues to your problem. This informal part of the physical exam is critical.  It is second only to the history in importance for your doctor.

Secret #4 – The formal hands-on exam is not the most important part.

Even in Orthopaedics, an extremely physical form of medicine, the history is still king.  Depending on the type of medicine, the doctor’s examination will differ, but the purpose is the same. Your doctor is trying to narrow down presumptive diagnoses, confirm their beliefs and eliminate other potential diagnoses by using observations of your physical condition.  However, if we’ve taken a good history, by the time we examine you, we usually already know the diagnosis.

Secret #5 – The purpose of labs, tests and studies is to confirm one diagnosis or eliminate others. It is usually not to make a diagnosis.

In some cases, the results of your studies and tests can be critical in determining your diagnosis (tumors and fractures come to mind).  Usually however, they are not specific enough to do this. Without a known or suspected diagnosis, these tests rarely are definitive enough to provide a diagnosis.  When there is a known diagnosis, they are rarely definitive enough to eliminate it.  We all tend to put a lot of emphasis on test results. Tthe truth is that they often help very little.

Secret #6 – The payoff is in the end.

Many patients are relieved once the examination is over.  I guess as patients, we feel as though our work is done.  We can now relax.  The truth is, that it is at the end of the evaluation that our attention is needed most. Usually the visit ends with some form of a summary.  Your doctor will often explain what they believe your diagnosis is (hopefully in terms that you can understand), why they believe it is and what that means for you.  Finally, they will lay out a plan. Frequently this is followed by an opportunity for you to express any concerns or ask any questions.

As doctors, we want to get you better.  This is often difficult to achieve without collaboration.  You won’t be able to do your part if you don’t understand the plan and what is being asked of you. So please, pay attention at the end. Take notes, bring someone as a second set of ears, do whatever it takes to make sure you understand what is going on, what your role is and what you need to do.

That’s it!  That’s the mystery.

The entire purpose of this organized process is so your doctor can develop a list of possible diagnoses, gather information that helps narrow down the list even further and formulate a plan in a logical and organized manner, without missing any important information.  The art is in making this flow smoothly, while ensuring that you are comfortable.

Hopefully this road map helps with that. :-)

Author
Jeffrey H. Berg, M.D.

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