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Build Your Own Doctor’s Appointment.

In Providence, there’s a great burger place called Luxe Burger, and they have this menu where you can build your own burger.  Patrons can make use of a sheet of paper that helps you build a burger to your specific preferences.  Do you want the meat cooked medium, or medium well?  Tomatoes or no way?  Would slices of avocado do your burger right, or are you more the onion rings and chipotle aioli?

I love this place.  It gives great hamburger.  And it helps organize my thoughts around a moment that – let’s be honest – is not life or death.  It’s a frigging hamburger.

The things in my life that need to be streamlined into an effective and influential flow, like my endocrinologist appointments, are not as simple as ordering a hamburger.  But they should be.

This concept, about the ease of hamburgers versus the chaos of doctor’s appointments, came up in conversation with a design team I’m working with (part of theT1D Exchange Project – more on that soon).  “We should have the same sort of menu when it comes to making the most of our doctor’s appointments,” I said.  “I usually have to write down my questions before my appointment to remind me what needs to be asked, but even then I don’t always remember everything.  Having something that triggers me to think of potential discussion points would help me make the most of my appointments.”

Then I started picturing what my “menu” would look like.  As a patient at the Joslin Clinic in Boston, I see an educated and established endocrinologist.  She’s very smart, and I want to draw from her intelligence to help make positive changes in my health.  But, aside from labwork results, she can only work with what I disclose.

So what would my menu look like?  How would I build my own endo appointment?

  • My menu would be held on my phone, and would allow me to keep a running list of my medications and doses.  (I always forget the milligrams of medication I’m taking for blood pressure, despite taking the medication faithfully every day.)
  • It would have a list of possible discussion topics that I could tick off as needed, tied to my specific demographic:  exercise, pump therapy, CGM therapy, emotional health, travel questions, female-specific issues, etc.
  • Open fields to keep a running list of patient concerns would be helpful, giving people a place to jot down questions in one place (instead of a napkin note here, a question written on the back of an envelope there … what, just me?)
  • It would have a field for me to enter any blog posts/websites that I want to discuss with my doctor.  (Would also be awesome if I could email links to the menu, kind of like how I forward my travel emails to TripIt, and it automagically populates.)
  • The opportunity to add my labwork results would be great, too.  I wish the Joslin Patient Portal could be siphoned into an app of some kind, but then patient privacy concerns would crop up, and rightfully so.
  • But I keep coming back to the “menu” aspects of things.  Can I order my A1C before my appointment, so the results can be discussed during, and not after?  Can I ask for “the works” and have the rash on my CGM site inspected as well as my feet checked for nerve damage?  Can I ask for a side of dietician, or a follow up with a CDE as “dessert?”
  • And, thinking further out, what would my doctor have on my menu of expectations?  Would she want me to have my logbooks downloaded and ready to go?  Does she want to see my labwork ahead of time, too?  How can I help her help me?

For me, getting to the Joslin Clinic for my appointments is a complicated affair, since the drive to Boston takes a fair amount of time.  But I continue to go there for my diabetes care because I am confident that their expertise plus my dedication to taking care of myself produces the best outcomes.  I do want to make the most of my appointments, though, and being prepared contributes to doing just that.

What helps you become best prepared for your appointments?  If you could create a menu to build-your-own-endo-appointment, what would you include?

 

14 Comments Post a comment
  1. Love this. I am working on keeping all of my medical info on my iPad, which I carry around a lot. And I do occasionally e-mail someone’s blog post to my endo. But everything else here? I’d like that too. Thanks.

    02/2/15; 11:22 am
  2. Tim Steinert #

    Mostly I need an advanced pumping seminar or REALLY good CDE who is a pump guru. Pulling together advanced carb counting with on-the-fly bolus and basal adjustments is not easy to do.

    02/2/15; 11:29 am
  3. abby #

    I really appreciate that your CDE is dessert 😉

    02/2/15; 12:12 pm
  4. Melanie #

    I run my life from my electronic calendar, which, like most these days, syncs between my computer and my phone. When I have questions I want to ask my endo, I add them to my electronic calendar entry. Then the questions pop up with the reminder to go to the endo appointment.

    02/2/15; 12:49 pm
  5. I love that I have my lab work done a week before my endo appointment, if I’m lucky I’ve had time to call and get results before my appointment so I know what I’m going to hear about plus the data is relevant (not months old).

    However, my daughters’ lab work is done right there at the endo’s office. Quick a1c results but no prep time for mom. I wouldn’t want to make another trip for it so this works for us. We’re always forgetting ?s we wanted to ask.

    I think it *always* helps to keep a list of medications and a ready list of ?s for the doctor. 🙂

    02/2/15; 2:54 pm
  6. I love the menu idea. I’m close to having my first appointment with a new endo and I really don’t know what to expect from her. The “system” is set up so that half of my appointment is spent with a “gatekeeper’ nurse who runs through a laundry list of questions that are far from tailored for my specific concerns.
    My labs are scheduled to comply with what [and when] my insurance will allow and that rarely permits an in person response from an MD.
    The lab results appear on my electronic medical records chart without any comments. If I have questions about the results I can send them via the electronic records and the gatekeeper nurse either answers or sends them on to the MD.
    My spouse pays a hefty price for this employee offered insurance.
    I think I’m going to come to my endo appointment with a list in hand (yes, an actual written list) and hope that I get some in person answers.

    02/2/15; 9:02 pm
  7. Hi Kerri,
    Great ideas. There are some online tools to help with this–some better than others. Tamara and I developed an iteration of the menu idea for a talk we’ve given before. The tool is only available for download to print and use with traditional pen/pencil, but it’s a start. Making an e-version would be a nice thing to work toward, as would refining it to make it more what people really want. Right now it’s a mix of what the patient wants to address and the fairly predictable things that the healthcare team will want you to be able to provide to them. The faster you can give them that information, the more time is left for them to address what you want. We’ve found it very helpful to make it explicit that each visit has to balance the patient’s agenda with the HCP’s agenda–both are important, and the more that both patient and HCP realize that, the better the communication and the interaction can be. The tool, if anyone is interested, can be downloaded here:
    https://docs.google.com/file/d/0B5EpVjLtWTJIMmNsckFBOEw3SU0

    02/2/15; 10:49 pm
  8. Lauren #

    I would definitely suggest asking your doc if you could get lab work done before the appt. – I’ve been doing it that way for a few years now & I’ve found that it does help. My doc just gives me the necessary ppwk at my current appt for the next time’s lab work so that I have it; granted, that means I have to keep track of it for 3 months, but that’s not usually a problem. And once they have the results, I know they look at them, as there have been a few times I’ve received calls before my appt. if there are any glaring concerns.

    As for my log book info – my endo’s office downloads my CGM data & meter data as soon as I step into the room (I’m not on the pump, but I’m sure they’d look at that too if I was). I’m not sure where they download it to (I believe it’s put directly into my electronic file, which has been called up on the computer in the exam room), but all I know is that as soon as my doc comes in, he’s got the info at his fingertips & we’re able to review & discuss things right away.

    I do tend to forget questions & have not yet figured out a way to remember to ask them, but I can usually call in later if need be. However, I know I’m very fortunate in this, since my endo is a T1 diabetic himself (& has been since he was a kid), so he understands. I am so very thankful for that!

    02/2/15; 11:28 pm
  9. I’m always surprised that all endo offices DON’T order labwork before your appointments??!!! Mine has done that for the past 20 years. I mean, it’s one thing to talk about your blood sugar logs (or lack thereof) and what not, but having some concrete numbers to look at (a1c, thyroid numbers, cholesterol, etc) is WAY more beneficial. Start the movement everyone! Demand your endo schedule a lab appointment for you the week before your appointment. You’ll be happy you did 🙂

    02/3/15; 10:38 am
    • Tim Steinert #

      I have to remember to come in a few days before my appointment to get my blood drawn for my a1C. However, sometimes the doctors forget to have the order in for it, which causes no end of problems to the lab. For the first time ever, they LOST my blood sample.

      I guess what I need to do is call a week before and ASK them to put in a blood work request so when I come in, there’s no hassle. That’s an awful lot of work for ME that should really be coordinated by the doctor.

      02/3/15; 1:25 pm
  10. I’ve always had my lab work done before the appt, but it’s up to the doctor to release it to my accessible electronic chart before the visit. Which he does not do because he knows I’ll come in in a tizz with all sorts of erroneous interpretations. But at least it’s all there so we can talk about it at the moment. Ahem…..Mr. Scott Karl Johnson is currently going to the same clinic and he gets to see his ahead of time – boooooooooo. I guess that’s what you get when you turn on the charm.

    02/4/15; 11:03 pm
  11. This is a great post! At My Diabetes Home we are working to streamline doctor appointments for patients through our visit optimizer tool. It is meant to help patients gather all of the needed information for an appointment easily so their doctor appointments go smoothly and on the course they prefer. These are some really great points that will help us develop our visit optimizer tool even further. Thank you for being such a great voice for the diabetes community!

    03/1/15; 7:15 pm

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