Questions doctors ask patients

Column: 6 questions to ask at every doctor’s appointment

Editor’s Note: Your sore throat just won’t go away, so you schedule a doctor’s appointment. You go in, and your doctor prescribes you some medicine. You gripe about a few other health concerns, and your doctor suggests some blood tests.

A month later you receive a bill: a whopping $500 for a visit you thought was covered by health insurance. What happened?

What happened is you probably didn’t ask the right questions. Below, reporter Elisabeth Rosenthal has six questions you should ask at every doctor’s appointment to make sure you get the right care and don’t get hit with sky-high medical bills. It’s from Rosenthal’s new book, “An American Sickness: How Healthcare became Big Business and How You Can Take it Back.”

1. How much will this test/surgery/exam cost?

“I don’t know” or “It depends on your insurance” is not an answer. The doc­tor should give you a ballpark range or the cash price at the center where he or she refers. Many things that sound like simple little tests are now priced at many thousands of dollars.

2. How will this test/surgery/exam change my treatment?

If the answer is “It won’t, but it might be good to know,” take a pass. Doc­tors likely feel the need to do something or order something if you have a complaint, especially at a time when office visits can cost over $500. When a doctor begins a suggestion with “Why don’t we just …” there’s often no compelling reason for the test at all.

3. Which blood test are you ordering? What X-ray? Why?

When doctors order blood work, they are frequently just ticking off boxes on a long electronic check­list, with no awareness of how much any might cost. Your questions alone will make them more dis­cerning.

4. Are there cheaper alternatives that are equally good, or nearly so?

If you go to a pharmacy or a lab and encounter a high price, call your doctor’s office and tell him or her about it. Force your doctor to learn. He or she likely didn’t know.

5. Where will this test/surgery/exam be performed — at the hospital, at a surgery center or in the office — and how does the place impact the price?

Doctors often practice and do procedures in different places on different days of the week. If you go on a Thursday and that happens to be your doctor’s day at the hospital, it could double the price of your biopsy or colonoscopy. If he or she refers you to an ambulatory surgery center, ask, “Are you an owner?” A little shaming might encourage better behavior.

6. Who else will be involved in my treatment? Will I be getting a separate bill from another provider? Can you recommend someone in my insurance network?

Avoid a lot of unexpected charges up front by making sure that whoever is involved in your care — doctor, physician assistant, pathologist, anesthesiologist — is in your insurer’s network.

For more on the topic, watch economics correspondent Paul Solman’s full interview with Rosenthal on Thursday’s episode of PBS NewsHour.

Preparing for Your Next Appointment: 15 Must Ask Questions [Part 1]

  • Get a printout of instructions from your doctor, brochures, and educational materials. Any additional reading material is helpful especially if you have been diagnosed with a new health condition.
  • Find out when you need to return and schedule the appointment.
  • This list is not all encompassing, but it does include some of the most important information you need to remain healthy for years to come. Make sure you share your concerns, ask questions you think are important and seek clarification from your health care professional. Discussing the non-medical parts of your life is also important, as it can impact the decisions made about your health care, which will be discussed more in our next series.

    For now, making sure you are enrolled in a Medicare plan that covers the doctor visits and services you need is what’s most important. Take our 1-minute Medicare Questionnaire, for free advice from a licensed benefits advisor on selecting a plan that covers your Medical needs.

    Part 3 of a 3-Part Series in recognition of Health Literacy Month

    I’m the parent of a strong-willed, teenaged daughter. Since she was a very young child, she’s always wanted to know the “why” behind just about everything, including the many directives issued by me and her dad. While this can sometimes be exasperating, I have learned to appreciate her desire to fully understand the things that impact her life and her experiences. While every parent (myself included) has likely uttered the phrase, “Because I said so”, you’re much more likely to have a lasting impact on your child’s decision-making when you explain WHY certain choices are important.

    The same is true in the doctor-patient relationship. My dad had end-stage kidney disease, which meant his kidneys were no longer able to remove toxins from his blood. This required him to go to dialysis three days a week. His treatment also included numerous dietary and fluid restrictions. He knew that he was not supposed to eat tomatoes and tomato-based products. Yet, he frequently “cheated” and would do so anyway. He even knew that the reason he wasn’t supposed to eat tomatoes was that it would make his potassium high. My sisters and I would remind him of this restriction regularly, but one day when I was particularly frustrated, I said, “Daddy, do you know that if your potassium rises to a dangerously high level your heart can stop and you can die?” It turns out that he knew having a high potassium level was a serious issue, but he didn’t know it could kill him.

    The National Patient Safety Foundation’s ( health literacy campaign, “Ask Me 3”, encourages patients and family members to ask their health providers 3 questions in order to be active participants in their health care. In part one of this series, I reviewed the first question you must ask at every doctor visit: What is my main problem? In part two, we discussed the second question: What do I need to do? In this article, we wrap up the series with question #3.

    Question #3- Why is it important for me to do this?

    Studies show that less than 50% of patients follow through with their doctor’s recommendations. One of the most notable examples of this problem relates to medication use. Have you ever completed a course of antibiotics without missing a dose? If so, you are definitely in the minority. Not only do patients struggle to take medications for acute illnesses properly, but they also do not consistently take medications prescribed for chronic illnesses, even when those medications are prescribed after life-threatening events, such as heart attacks. Individuals who don’t take their medications properly have increased rates of hospitalization and death. Knowing these high stakes, doctors often find themselves asking, “Why don’t patients just do what is best for their health?”

    Healthcare professionals have traditionally referred to patients who don’t follow their recommendations as “non-compliant”. The newer, more acceptable lingo is “non-adherent”. The former term implies deliberate or intentional refusal to follow recommendations and the latter acknowledges that there are many barriers that prevent patients from doing what they are asked to do. I’ll admit to having used both of these terms in the past, but the truth is that they are somewhat derogatory and equate to finger-pointing and patient-blaming.

    In reality, health care providers often fail to have meaningful conversations with patients and their caregivers. When patients don’t have a thorough understanding of their medical problem, the purpose of the treatment plan, and the potential complications, they are less likely to follow the doctor’s recommendations. The authors of an article about adherence to diabetes treatment stated, “Patients adhere well when the treatment regimen makes sense to them, when it seems effective, when they believe the benefits exceed the costs, when they feel they have the ability to succeed at the regimen, and when their environment supports regimen-related behaviors. “ This should be framed and placed on the wall of every waiting room and examination room.

    In short, patients need to understand WHY the medications, dietary restrictions, and lifestyle modifications are important.

    One of the unfortunate consequences of shortened office visits and the electronic medical record is that there is very limited quality face-to-face time for doctors and patients to engage in these critical discussions. Healthcare providers must do better, but so must patients and their caregivers. You need to ask “why”. A thoughtful, focused question from an engaged patient or family member is one of the best ways to get a busy, distracted physician back on track.

    Make sure you understand why you need to get a CT scan, why your doctor is changing your medication, and why she’s asking you to exercise three times a week.

    Be sure to ask about the complications that will occur if you don’t follow through with your doctor’s recommendations.

    Be honest if, for whatever reason, you are unable to adhere to the recommendations so that your doctor can consider modifications to the treatment plan that will give you your best chance at success.

    It is critically important that you take an active role in your health. Don’t be intimated by your physician and other healthcare providers. Be that curious toddler or that annoying teenager, and be sure to ASK WHY.

    To recap our health literacy series- 3 questions you must ask at every doctor visit: Question #1: What is my main problem? Question #2: What do I need to do? Question #3: Why is it important for me to do this?

    This article is the last in a 3-part series in recognition of Health Literacy Month. Health literacy is defined as the degree to which individuals can obtain, process, and understand basic health information and services needed to make appropriate health decisions.” For more information about health literacy, please read my article, Do You Understand What Your Doctor is Saying to You.

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    6 Questions Your Doctor Should be Asking You

    By Jeremy Corbett, MD, Special to Everyday Health

    Like many people, you may expect your doctor to drive your appointments and you’re reluctant to proactively communicate your opinions and concerns.

    With the already limited time most doctors spend with you, you could be leaving out critical information. Waiting for your doctor to move things forward could impact your diagnosis and treatment or the degree to which you understand test results, recommended therapy, and medications.

    But there is a way for you to make sure you get what you need from your visit. Take this checklist of questions your doctor should be asking you to your next appointment. Ensuring that these questions are asked will foster better communication between you and your doctor, while simultaneously helping him or her give you the best possible advice.

    1. What’s been going on recently in your life?

    Your appointment shouldn’t just be a rapid discussion of symptoms. Your doctor should know some details about your life and what it’s like: where you live, what you do, if you’re single, how you spend your time, if you smoke or drink, if there were any major, recent changes in your life or lifestyle.

    It will not only make you more comfortable during the visit to discuss these things, it will also provide your doctor with a fuller picture of who you are, so he or she knows what to ask in the future and how to treat you most effectively.

    2. What brought you here today and why does it concern you?

    It’s important for your doctor(s) to not only know, specifically, the reason you made the appointment, but also why it’s a concern.

    For instance, if you come in with back pain due to a herniated disc, you could be worried that physical therapy and medication will cost too much or that you’ll have to get someone to watch your children during visits.

    Your doctor may be able to help, by by ordering a generic prescription rather than a brand name to save you money, giving you samples from the office, or writing a prescription for a longer time between refills.

    He or she may be able to offer an appointment time that’s a better fit for your schedule, or take the time to schedule you at a location closer to your home or office. When you tell your doctor about your specific barriers to care, he or she can you overcome the hurdles that stand in the way of better health.

    3. Do I have the story and details right?

    To avoid incorrect assumptions, near the end of an appointment your doctor should summarize what he or she has learned from the visit: “I understand you haven’t been sleeping through the night and have pain in your lower back.” Such confirmation helps ensure you get a proper diagnosis and treatment plan, and also lets the physician know that he or she is moving down the right path. I have often discovered upon asking this clarifying question that there were important details missing which altered my choice of therapy, or its timing or duration.

    4. Does what I said make sense?

    In addition to understanding your needs, your doctor should prompt you to restate any new information or instructions you received during the visit. A clear understanding on your part helps you begin to navigate what might be a new diagnosis and makes it easier to follow the agreed-upon treatment plan at home. It is not uncommon for patients to be “non-compliant” — which means a failure to follow a prescribed plan of action. Sometimes, this failure is due to poor communication and lack of understanding rather than one’s refusal to take a doctor’s advice.

    5. Do you understand your prescription(s), their purpose, and the doses?

    When it comes to medications, many patients do not follow doctors’ orders. Some don’t fully understand what they’re taking, why they’re taking it, and how often or how much to take. Others may have too many medications to keep track of, trouble swallowing pills, or fear of side effects.

    The more you know about your prescriptions before you leave the doctor’s office, the more likely you are to effectively follow your treatment plan. When in doubt, be honest. Let your doctor know that you need additional explanation, and have his team write down detailed instructions. Sometimes it helps to take along someone to the appointment so that you can compare notes.

    6. What changes will you make going forward?

    A doctor can give you the best advice and treatment available, but it’s worth very little if you’re not willing or don’t know how to follow through. If you are told to drink more water, what’s your plan to do this? If you are advised to exercise more, how will you work it into your busy schedule?

    By asking this question, your doctors encourage you to actively think about executing their treatment recommendations, and can then help you create an action plan to increase your odds of success.

    The degree to which you understand what’s covered during your doctor visit impacts your likelihood of a positive outcome. Regardless of who is driving the appointment, a good doctor-patient relationship leads to a beneficial exchange of information, greater collaboration, and continued trust.

    Don’t hesitate to ask questions about anything you don’t understand, and provide your doctor with all of the relevant information you can; your health and wellness depend on it. If your doctor isn’t willing to listen or to answer your questions, it might be time to look for a new one.

    Jeremy J. Corbett, M.D., is the chief health officer of Nurtur Health — a behavior-change company with wellness and health coaching programs that focus on overcoming life barriers to improve health outcomes. In addition to his expertise in Nurtur’s specialties, such as preventive care, shared decision-making, chronic health conditions, and telemedicine, Dr. Corbett is a practicing emergency room physician in Lexington, Kentucky, where he lives with his wife and three children.

    In a recent column , I discussed history questions aimed at drawing information from patients who are poor historians.

    I was surprised by the response to the article. I received several contacts via phone, e-mail, Facebook, etc., from doctors with positive comments. I am pleased the article was of help.

    The responses to the article coincided with ads I began seeing in the back of a state association newsletter by doctors offering fill-in work for other chiropractors. The combination of the responses to my article, the ads and personal experience sparked another 20 questions.

    The ads offered facts about the fill-in doctor’s technique proficiencies, the availability of malpractice insurance, and assured potential clients of smooth transitions into and out of the practice. These are important factors for a doctor to consider in hiring another doctor to cover their office. The doctor is looking for someone who can practice as close to their methods as possible. This keeps the patients happy and the business up and running in the doctor’s absence.

    The Hiring Doctor’s Concerns

    Malpractice coverage is of particular importance. The hiring doctor worries about quality of care and the substitute doctor’s abilities, especially if the substitute is unknown to the hiring doctor. And the concerns are not limited to adjusting abilities. The substitute’s abilities to record a patient’s history, perform a good examination, take and read X-rays, diagnose, write a treatment plan and give a report of findings are also important.

    It is a tough decision for a doctor to hire a fill-in doctor. It always appears to be a choice between the lesser of two evils: Should the doctor close the practice for period of time, potentially upsetting patients and losing income, or take a risk with a substitute? Hopefully, the doctor chooses the substitute. Chiropractic is safe and with the parity among our colleges these days, everyone is well-trained. Most patients are satisfied and the business operates until the owner’s return. This is an especially logical decision if the hiring doctor’s absence is due to a long-term illness.

    For extra assurance, the hiring doctor could institute a rule regarding patient care in their absence. The recommended policy would be to not persist with treatment if the patient expresses concerns about being treated by a fill-in doctor. Don’t talk the patient into care. This rule will go far toward patient satisfaction and safety. It just makes sense.

    The Fill-in Doctor’s Concerns

    The unusual aspect of this topic, to me, rests in the vantage point from which the topic is almost always discussed: the hiring doctor’s point of view – their concerns about patient care, malpractice and income. What about the fill-in doctor’s concerns? What if the doctor who owns the practice has poor records, equipment that is in poor condition, uses obscure techniques and/or has inadequate malpractice coverage? While everyone is well-trained, some make minimal effort. What if the owner and their staff are ineffective at filing insurance and obtaining reimbursement? Will the fill-in doctor be paid?

    What if a young doctor filling-in while trying to develop their own practice is sued because of the practice owner’s treatment? The fill-in’s career could start with several marks against them. What if a retired doctor looking for something to do or a little extra retirement money fills in and is sued because of the practice owner’s treatment? A stellar career may conclude with a black mark.

    20 Questions to Ask Patients When Filling in for the Doctor

    Regardless of the concerns, whether a patient, hiring doctor or fill-in doctor, there are ways to improve everyone’s sense of assurance. An additional 20 questions are offered here to that effect. The 20 questions are designed for the fill-in doctor to ask to patients during their encounters.

    You might wonder, can history questions alone really be that effective in providing safe quality care in times of coverage? I believe they can. McGuirk and colleagues, studying routine imaging of patients with acute low back pain, showed that from history alone, using a red flag checklist, no serious conditions were missed in over 400 test subjects.1 There is definitely a reason why history has always been described as having the ability to provide 80-90 percent of the information necessary for many diagnoses.

    These questions will not apply to every patient. For example, a 14-year-old does not have a high probability of having had vascular, spinal or joint replacement surgery. The probability of having heart disease or an occupation would also be rare at 14. There will be times none of the questions is applicable. For example, the patient’s records may be available, up to date and clear. The aim for the following 20 questions is good patient care that obviously is of benefit to all parties.

    Past History

    1. Have you had previous vascular, spinal or joint replacement surgery? Scars from these procedures are often less than obvious especially in the practice where gowning is not performed for routine visits. Surgeries such as enarterectomies, aneurysm repair, spinal fusions and hip replacements can all affect the type of treatment that can be rendered.
    2. Have you had any form of cancer? Especially bowel, breast, prostate, lung, thyroid or kidney cancer? The list here includes some of the most common cancers known to metastasize to the spine.2
    3. Have you had any significant traumas? (previous / current) Previous dislocations, fractures etc., should be known. Joint instability and degeneration can be lasting consequences of such trauma.
    4. Are you diabetic or suffering from heart, lung or kidney disease? Diabetes affects healing time. Cardiovascular health is an issue in aneurysms, stroke, etc. Lung disease can cause spinal pain. Kidney disease can cause spinal pain and is related to blood pressure regulation.
    5. Have you ever been admitted to a hospital for an extended period of time? This is a general question aimed at identifying any severe / chronic conditions that might have long-lasting effects.
    6. When was your last visit to a doctor, other than in this office? What was the visit for? This question often helps identify concurrent conditions and treatment. It can also identify treatment the patient may be receiving for the condition they are being seen for in your office.
    7. How long have you been a chiropractic patient? Asking this can help determine if the patient have had successful chiropractic care in the past and is comfortable with chiropractic care. It can also identify a patient who is nervous about receiving chiropractic care.
      Family History
    8. Has any of your family members passed away before the age of 50? Accidental death must be excluded for this question. The intent is to identify serious disease that may be hereditary.3
      Occupational History
    9. What do you currently do for a living? Information about mental and physical work-related stress is obtained with this question. Occupational duties can influence the mechanism of injury and recovery rates.
    10. What type of work have you done in the past? Identifying previous occupations can be helpful for the same reasons as question #9, and for collecting information regarding wear and tear from patients who have retired.
      Present History
    11. Have you had any recent infections? Many forms of infections can cause musculoskeletal pain, whether they are located in musculoskeletal tissues or not.
    12. Are you experiencing any current bladder or bowel problems? This question is always stressed for back pain patients to rule out ominous conditions such as cauda equine syndrome.3 (To me, this is like the stroke issue in chiropractic; important but overemphasized. I have seen cauda equina once in 25 years.)
    13. Where are you currently experiencing symptoms? What symptoms have you had since your last visit?
    14. Is your visit today for the same condition(s) you were seen for last time?
    15. Have your symptoms changed in any way since your last visit? (better, worse or about the same)
    16. Have you developed any questions or concerns since your last visit?
      Questions #13-16 are questions a doctor should ask any patient on any routine, of course. They help confirm the patient’s present complaint, their progress and response to care, as well as the possibility of exacerbations.
    17. Does the doctor adjust your entire spine or limit care to specific regions?
    18. Are there any areas the doctor avoids when adjusting you or areas / ways you prefer not to be adjusted?
      Questions #17-18 are to familiarize the doctor further with the care the patient has been receiving and with precautions that have been taken in the past.
    19. Do any concerns come to mind for you, knowing you are being seen by a different doctor? Is there anything you want me to be aware of?
    20. Is it OK for me to treat you today?
      Questions #19-20 are especially important for the patient who is nervous about seeing a different doctor, especially if they were unaware that there would be a different doctor during their visit. Patients who show up knowing they will be seeing a substitute doctor are usually not nervous. As stated earlier, if there is any question, do not press the matter and reschedule the patient. Question #20 is a good idea in either case for consent to treat.

    Again, not every question necessarily needs to be posed to every patient. It would bog down the flow of the practice. And good notes may be available that answer some of your questions without needing to ask them. Additionally, the hiring doctor may have briefed the fill-in doctor or left specific instructions about patients with cases that are less than routine. Many of the questions could be asked while the doctor is performing the pre-adjustment assessment in order to make the process more efficient.

    Patients may have a few questions of their own for the fill-in doctor; one might be, “Why are you asking so many questions?” Patients often assume everything is in the file and/or that surely a summit was held between the two doctors regarding their case. The correct answer to the question is, “I am just being thorough.”

    With the progressive adoption of mandatory electronic records, the questions above will be of lesser consequence. The patient’s entire file will be available at the touch of a button. This feature has been available, but many have not utilized it because of affection for travel-card and other record-keeping systems.

    The questions here are recommendations based on my experience and observations. They are not sanctioned or set in stone. Every doctor must use their own experience, reasoning and discretion when it comes to clinical procedures.

    1. McGuirk B, King W, Govind J, Lowry J, Bogduk N. Safety, efficacy and cost-effectiveness of evidence-based guidelines for the management of acute lower back pain in primary care. Spine, 2001; 26:2615-2622.
    2. Yochum TR, Rowe LJ. Essentials of Skeletal Radiology, 3rd Edition. Philadelphia, Lippincott, Williams and Wilkins, 2005.
    3. Bigos S, Bowyer O, Bren G, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline No. 14. Rockville MD, Agency for Health Care Policy and Research, 1994, AHCPR publication 95-0642.

    Click here for more information about K. Jeffrey Miller, DC, MBA.

    What Do I Need to Tell the Doctor?

    Talking about your health means sharing information about how you feel physically, emotionally, and mentally. Knowing how to describe your symptoms and bring up other concerns will help you become a partner in your health care. Discussing Your Concerns with the Doctor: Worksheet and Discussing Changes in Your Health: Worksheet can help.

    Share Any Symptoms

    A symptom is evidence of a disease or disorder in the body. Examples of symptoms include pain, fever, a lump or bump, unexplained weight loss or gain, or having a hard time sleeping.

    Be clear and concise when describing your symptoms. Your description helps the doctor identify the problem. A physical exam and medical tests provide valuable information, but your symptoms point the doctor in the right direction.

    Your doctor will ask when your symptoms started, what time of day they happen, how long they last (seconds? Days?), how often they occur, if they seem to be getting worse or better, and if they keep you from going out or doing your usual activities.

    Read and share this infographic for tips on how seniors can effectively communicate with their doctors.

    Take the time to make some notes about your symptoms before you call or visit the doctor. Worrying about your symptoms is not a sign of weakness. Being honest about what you are experiencing doesn’t mean that you are complaining. The doctor needs to know how you feel.

    Questions to ask yourself about your symptoms:

    • What exactly are my symptoms?
    • Are the symptoms constant? If not, when do I experience them?
    • Does anything I do make the symptoms better? Or worse?
    • Do the symptoms affect my daily activities? Which ones? How?

    Give Information About Your Medications

    It is possible for medicines to interact, causing unpleasant and sometimes dangerous side effects. Your doctor needs to know about ALL of the medicines you take, including over-the-counter (nonprescription) drugs and herbal remedies or supplements. Make a list or bring everything with you to your visit—don’t forget about eye drops, vitamins, and laxatives. Tell the doctor how often you take each. Describe any drug allergies or reactions you have had. Say which medications work best for you. Be sure your doctor has the phone number of the pharmacy you use. Tracking Your Medications: Worksheet can help.

    What questions should you ask your doctor about a new medication?

    Tell the Doctor About Your Habits

    To provide the best care, your doctor must understand you as a person and know what your life is like. The doctor may ask about where you live, what you eat, how you sleep, what you do each day, what activities you enjoy, what your sex life is like, and if you smoke or drink. Be open and honest with your doctor. It will help him or her to understand your medical conditions fully and recommend the best treatment choices for you.

    Voice Other Concerns

    Your doctor may ask you how your life is going. This isn’t being impolite or nosy. Information about what’s happening in your life may be useful medically. Let the doctor know about any major changes or stresses in your life, such as a divorce or the death of a loved one. You don’t have to go into detail; you may want to say something like: “It might be helpful for you to know that my sister passed away since my last visit with you,” or “I recently had to sell my home and move in with my daughter.”

    For More Information About What Information to Give the Doctor

    Centers for Medicare & Medicaid Services
    1-800-633-4227 (toll-free)
    1-877-486-2048 (TTY/toll-free)

    National Library of Medicine

    U.S. Food and Drug Administration
    1-888-463-6332 (toll-free)

    This content is provided by the National Institute on Aging (NIA), part of the National Institutes of Health. NIA scientists and other experts review this content to ensure that it is accurate, authoritative, and up to date.

    Content reviewed: May 18, 2017

    Annual Physical Exam: The Basics

    The physical exam is an essential part of any doctor’s visit. Surprisingly, though, there are no absolutes in a routine physical. A good doctor may be thorough or brief, but he or she will spend time listening to your concerns and providing counseling for your particular needs.

    Annual exams usually check your:

    History. This is your chance to mention any complaints or concerns about your health. Your doctor will also likely quiz you about lifestyle behaviors like smoking, excessive alcohol use, sexual health, diet, and exercise. The doctor will also check on your vaccination status and update your personal and family medical history.

    Vital Signs. These are some vital signs checked by your doctor:

    • Blood pressure: Less than 120 over less than 80 is a normal blood pressure. Doctors define high blood pressure (hypertension) as 130 over 80 or higher.
    • Heart rate: Values between 60 and 100 are considered normal. Many healthy people have heart rates slower than 60, however.
    • Respiration rate: From 12 to 16 breaths per minute is normal for a healthy adult. Breathing more than 20 times per minute can suggest heart or lung problems.
    • Temperature: 98.6 degrees Fahrenheit is the average, but healthy people can have resting temperatures slightly higher or lower.

    General Appearance. Your doctor gathers a large amount of information about you and your health just by watching and talking to you. How is your memory and mental quickness? Does your skin appear healthy? Can you easily stand and walk?

    Heart Exam. Listening to your heart with a stethoscope, a doctor might detect an irregular heartbeat, a heart murmur, or other clues to heart disease.

    Lung Exam. Using a stethoscope, a doctor listens for crackles, wheezes, or decreased breath sounds. These and other sounds are clues to the presence of heart or lung disease.

    Head and Neck Exam. Opening up and saying “ah” shows off your throat and tonsils. The quality of your teeth and gums also provides information about your overall health. Ears, nose, sinuses, eyes, lymph nodes, thyroid, and carotid arteries may also be examined.

    • Breast exam. Your doctor will both visually and physically exam your breasts looking for any lumps, bumps, or skin abnormalities that could indicate breast cancer or non-threatening breast issues.
    • Mammogram. Mammograms typically begin after age 40 and involve placing your breasts between two radiographic breast plates which are gently pressed together, flattening your breast. This exam provides imaging of the breast tissue and is used to detect breast cancer.
    • Pelvic exam. Your doctor will both visually and physically examine your vagina, vulva, and cervix, checking for any abnormalities that may be indicative of cancer, sexually transmitted disease, or other benign condition. As part of the pelvic exam, your doctor will perform a bimanual exam. They will insert two gloved fingers of one hand into your vagina and feel both your uterus and ovaries, again checking for any abnormalities. While this exam may cause pressure and some discomfort, it should not be painful.
    • Pap and HPV tests. These screenings can indicate the presence of cervical cancer and help assess risk. Your doctor will insert a sterile swab in your vagina and gently scrape your cervix to obtain a cell sample for analysis. While this test may be uncomfortable to some, it is critical for assessing cervical health.

    While routine, annual medical exams many be an inconvenience, they are an important diagnostic tool that enables your doctor to keep track of any changes taking place in your body that may be indicative to an underlying disease or condition. Northwest Primary Care offers a variety of physical exams and preventative services and we look forward to keeping you happy, health, and well for many years to come.

    Physical Examination

    What should you bring to your doctor’s visit?

    Patients often ask what they should bring to their doctor visit. This is a very important question because bringing the right things helps your physician have as much information as possible when making a diagnosis and creating a treatment plan.

    Please bring the following with you to the appointment:

    1.) Current medication and allergy list (include vitamins and herbal supplements)

    2.) List of symptoms – what they are, when they occur, how long they last and what relieves them

    3.) Results from prior tests and lab work (include films and reports):

    – Actual heart catheterization film and report (if applicable)
    – Actual echocardiograph (echo) tape and report (if applicable)
    – Electrocardiogram (EKG) report, if performed within the last year
    – Reports and films (if applicable) from all other tests, such as Stress Test, MRI, CAT Scans and Carotid and Vascular Ultrasounds, if performed within the last year
    – **If you have had surgery related to your cardiovascular condition**, please bring:
    – Surgeon's operative report
    – Hospital discharge summary
    – **If you have had a device**, such as pacemaker or defibrillator, implanted, please bring a copy of the front and back of the device card.

    4.) Any measurements your doctor has asked you to keep track of, such as blood pressure, blood sugar or daily weight readings

    5.) Medical and surgical history (a record of your past diagnoses, treatments and procedures)

    6.) Report from a physical exam done within the last year

    7.) Questions you would like answered

    8.) A list of your current doctors, including their names, addresses, phone numbers and fax numbers. Please let us know if you would like reports sent to those physicians.

    The exam is the first step in evaluating your heart.

    During the visit: Tell me what’s bothering you

    The physical exam always begins with you telling the doctor, in your words, how you are feeling, what is bothering you and what symptoms you are having. Symptoms vary from person to person. Start by telling the doctor why you made the appointment. What kinds of symptoms are you having? It’s important that you describe your symptoms and when they occur.

    Some things the doctor needs to know are:

    • Do you feel any unusual discomfort?
    • Where is the discomfort/pain located?
    • What does the pain feel like? Is it dull, achy, pressure or sharp?
    • How long does the pain last? Does it come and go? Does it stay for a long time?
    • Do you notice that anything causes the discomfort? Do you feel it after eating, after exercise or at night?
    • What relieves the discomfort? Rest, medications, position?

    Pain from coronary artery disease is usually felt in the chest, but may also be felt in the arms, shoulders, back or jaw. It may range from a slight discomfort or feeling of pressure to a feeling of heaviness or unbearable pain. Sweating, nausea, vomiting, lightheadedness, anxiety and shortness of breath occur along with the discomfort.

    Angina, a symptom of coronary artery disease, occurs when the heart muscle is not getting enough oxygen-rich blood to meet its needs. Angina lasts for a short period of time and is often happens after eating, exertion (activity), emotional stress or exposure to cold weather. These are known as the four Es. Angina is relieved by rest and, in some cases, medication.

    Other symptoms of heart disease include:

    • Palpitations (a fluttering or flip-flop feeling in the chest)
    • Shortness of breath
    • Edema (swelling in the ankles, feet or stomach)
    • Weakness or feeling overtired
    • Dizziness or faintness
    • Varying degrees of chest pain or tightness

    Learn more about symptoms of:

    • Peripheral arterial disease
    • Carotid artery disease

    The physical exam ….trained eyes, ears and touch

    The doctor will look at your skin for good color, which shows that your body is getting a good supply of oxygen-rich blood. Your doctor will also feel your skin for warmth and feel your pulse to check your heart’s rate, rhythm and regularity. Each pulse matches up with a heartbeat that pumps blood into the arteries. The force of the pulse also helps evaluate the amount (strength) of blood flow to different areas of your body and problems with circulation. Your doctor will check for swelling, which is a sign that your heart is not pumping efficiently.

    Your doctor will use a stethoscope to listen closely to the sounds the heart makes with each heartbeat. The doctor can evaluate your heart and valve function and hear your heart’s rate and rhythm by listening to your heart sounds.

    Abnormal sounds include:

    • Murmur: An abnormal whooshing sound made by blood flowing abnormally through the heart. This may indicate a leaky heart valve.
    • Click: An abnormal sound made by a valve that is stiff or stenotic (narrowed).

    Blood Pressure

    The doctor will measure your blood pressure (sometimes referred to as BP). High blood pressure (hypertension) is a common problem that often leads to heart disease.

    Blood pressure is the force (pressure) exerted in the arteries by the blood as it is pumped around the body by the heart.

    Blood pressure is a measurement of two types of pressure that are recorded as mm Hg (millimeters of mercury):

    • Systolic pressure: This is the amount of pressure in the arteries when the heart contracts. This is the higher of the two numbers.
    • Diastolic pressure: This is the amount of pressure in the arteries when the heart is relaxed between heartbeats. This is the lower of the two numbers.

    The normal blood pressure for an adult who is relaxed at rest is less than 140/90 mm Hg.

    Blood pressure may go up or down, depending on your age, heart condition, emotions, activity and the medications you take.

    One high blood pressure reading does not mean you have high blood pressure. You may have to have your blood pressure measured at different times to find out what your typical reading is.

    More information to help you prepare for your appointment

    Your physical exam is the first step to diagnosis and treatment of cardiovascular disease. In addition to bringing the items already mentioned to your appointment, you can also prepare by learning more about cardiovascular disease.


    • You and Your Cardiologist – A Cleveland Clinic Guide, by Curtis Rimmerman, MD, © January 1, 2008, Cleveland Clinic Press.
    • How To Prepare for Medical Visits*, American Heart Association
    • MyChart, a secure, online tool that connects you to personalized health information. Please confirm with your doctor what information is stored in the MyChart account.

    * Opens a new browser window

    This information is about testing and procedures and may include instructions specific to Cleveland Clinic. Please consult your physician for information pertaining to your testing.

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    The simple, powerful question doctors should ask their patients


    As physicians, we are used to asking our patients lots and lots of questions. It’s our job to elicit information, listen, and then come up with a management plan. There’s a standard script every doctor goes through, based on the science of medicine, and we usually have this memorized to a tee. And that’s all very well and good. However, as with many things in life — especially those that involve human beings and an emotional (and dare I say, spiritual) component — it’s always more than just the science.

    There’s one great question, however, that doctors utilize to a lesser degree than almost any other. And that’s a simple: “What are your goals?” This can come in a variety of different ways, such as: “What are you hoping for?” or “Where do you see yourself in one month?” It can be used at different points, depending on the circumstances — at the beginning of a discussion, before tests are ordered, or in the case of a hospital attending physician (which I am involved in most) — right upon discharge.

    Asking this question has a number of positive effects:

    1. It elicits extremely useful information

    On a rudimentary level, this is obviously important information to know, for anyone involved in the patient’s care. Where are they coming from, and what are their goals? Do they expect to be pain-free in 1 week and back at work? Do they have to be up on their feet for their daughter’s wedding next month? This expectation level can then either be tempered, reinforced, or made even more optimistic!

    2. It shows you care

    Asking this basic question will immediately show that a doctor is curious and has a genuine interest in the patient. You are not just a “point-of-contact” person, but have taken the time to probe deeper. You are asking a question that helps foster empathy and compassion, the core of a better clinical interaction. Even in a social situation, anyone who is asked a question like this, responds positively because everyone likes and appreciates being able to articulate something that is important to them. And few things are more important than anybody’s health.

    3. It gives the patient something to think about

    Life is nothing without having goals and things to look forward to. Even if a patient struggles with this answer (rare), they will have something to ponder over. Hopefully, we are dealing with a reversible illness with light at the end of the tunnel. Even the thought of attending a Yankees game (sorry to anyone who is reading this not in New York, and hates this line), can motivate the patient immensely.

    Time is a precious commodity in health care. It’s not something that any doctor has in abundance, or can afford to spend on random conversations (even if they really want to). But the above question may only take 2 or 3 minutes, and can have an immense effect, especially when a doctor is meeting a patient for the first time. And as with anything to do with communication, this does not mean asking a question in a robotic way! It has to come with the right level of emotional intelligence, and done with sincerity. If you are a doctor and already have this question in your repertoire, then well done. But as someone who coaches and teaches physicians communication skills, I am certain that very few ever make use of the simple “What are your goals?” question. Those goals or aspirations, may or may not otherwise come out organically during the discussion, but that’s left to chance.

    So if you’re a doctor reading this, try it next time, even just once a day. You may be surprised with how much it’s appreciated. It’s one example of a small step that a physician (or any health care professional) can take, to improve their everyday communication skills. And there are dozens of more techniques like this that can help, many of which do not even involve asking questions, or take even a minute of extra time. All of these little things that help maintain the fast eroding doctor-patient human interaction, are healthy things to cultivate. Because they not only help make patients happier and more likely to have a better outcome, but also make the work of a doctor, a lot happier too.

    Suneel Dhand is an internal medicine physician and author. He is the founder, DocSpeak Communications and co-founder, DocsDox. He blogs at his self-titled site, Suneel Dhand.

    Image credit: .com


    Questions to Ask Your Doctor


    • What stage is my cancer?
    • Can you tell if this is a fast-growing type of cancer, or a slow-growing type?


    • What tests will I have?
    • When should I expect the results from these tests?
    • What will these tests tell me about my cancer?
    • How long after I have these tests will I know the results?
    • Who will call me with the results of these tests? Or, whom should I call to get the results?
    • If I need to get copies of my records, scans, X-rays, whom do I contact?
    • Do I have to do anything special to prepare for the tests?
    • Do these tests have any side effects?


    • How many doctors will be involved in my care? Who are they? What are their roles?
    • Who will be the doctor in charge of coordinating my care and the rest of the doctors?
    • What other health care professionals can I expect to be involved in my care?


    • What is the standard treatment for my type of cancer?
    • How many patients have you treated with this treatment? What have been the results?
    • How does this compare to other institutions?
    • What is the future outlook (prognosis) for my type of cancer with standard treatment?
    • Are there any other treatments that might be appropriate for my type of cancer?
    • What treatment do you recommend? On what do you base your recommendation?
    • What are the risks or benefits of the treatment you are recommending?
    • Who would you recommend that I talk to for a second opinion?
    • What percentage of patients usually respond to this treatment?
    • How long does each treatment last?
    • How long is the entire course of therapy?
    • How often will I be treated?
    • What type of results should I expect to see with the treatment?
    • Will there be tests during my treatment to determine if it is working?
    • What will it feel like to get treated?
    • Can someone accompany me to my treatment?
    • Can I drive to and from my appointments? Is parking available?
    • Can I stay alone after my treatments, or do I need to have someone stay with me?
    • Will I have to be in the hospital to receive my treatments?
    • Who will administer my treatments?
    • How often, during treatment, will I see a doctor? The nurse?
    • Will a reduction in or delay of the recommended therapy reduce my chances of being cured?
    • Are there foods or medications or activities that I should avoid while I am going through treatment?
    • How soon after treatment can I go back to work?

    Clinical Trials

    • Are there any clinical trials or research being done on my type of cancer?
    • Are there any clinical trials that you particularly recommend?
    • Am I a candidate for any of the clinical trials that you recommend?
    • Where can I find related research information?
    • Is there anyone else in the area that is involved in research that I might contact to discuss my cancer?
    • How much time do I have to make a decision about my treatment options?

    Financial Issues

    • Will the required treatment require out of pocket expenses?
    • Is there someone in your office (or facility) who assists patients with questions about insurance? Who would that be?
    • If my insurance doesn’t pay for a particular treatment or medication, will you recommend an alternative treatment? What if it is less effective?
    • Who can I talk to about getting treatment if I don’t have insurance?
    • Who can I talk to about pharmacy assistance programs if my insurance doesn’t cover a particular medication?


    • Where can I get literature about my illness?
    • Are you willing to speak to my spouse or other family members about my illness and my treatments?
    • Where can I find out about support groups?
    • Can I speak to someone who has undergone this type of treatment?
    • Is there a social worker that I could talk with?
    • Is there a dietitian on staff if I have nutritional concerns or difficulties?
    • Do I need to be on a special diet?
    • Are there any lifestyle changes you would recommend?
    • Who do I call if I have an emergency medical situation during my treatment, or shortly afterwards?
    • What are the telephone numbers I should have in order to reach you? The nurse? The hospital?

    Side Effects

    • Should I watch for any particular symptoms?
    • How likely are they to occur?
    • What should I do if I have side effects?
    • Who should I call if I experience severe side effects?
    • What can be done to prevent these side effects or reduce their severity?
    • When might these side effects occur?
    • Could these side effects be life threatening?
    • How long will the side effects last?
    • What treatments are available to manage these side effects?

    More Information:

    For additional information or resources, please visit:

    Patient and Family Cancer Support Center
    1600 Divisadero St., First Floor
    San Francisco, CA 94115
    (415) 885-3693

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