The Savvy Chronic Pain Patient

I frequently hear patients and friends share stories about a disappointing experience they have had during an appointment with a physician, a hospitalization or a frustrating medication issue. Having chronic health problems sometimes can be exasperating. The complexities of your illness can complicate your experiences with health care providers, especially because of you may have varying symptoms, multiple medications and multiple treatment plans.

My goal is to educate you about communicating with health care providers and help you prepare for health care appointments. Gathering all of your health information in a concise and organized manner will save you an enormous amount of time when you need to respond to numerous questions on forms or in person. I find it easy to gather all of your health information in what I call a personalized health journal.

The following items are essential to include in this journal:

• Your name, address, and birth date
• Telephone numbers and emergency contact information
• Type of insurance
• Blood type
• Drug and other allergies
• Primary medical problems, including any medical events, surgeries, hospitalizations or procedures in chronological order, with the most recent problem/incident listed first.

List the names of all of your physicians, their addresses and phone and fax numbers. I have found it enormously helpful to have the name of the contact person at each physician’s office. This person may be the office manager, medical assistant or nurse. This contact person often can often answer your questions or help you with issues more quickly than your physician.

Below is an example of one kind of format to be used for your health journal.

HEALTH JOURNAL

Name:
Address:
Date of birth:
Social security number:
Insurance Plan: (Policy number and contact information)
Blood Type:
Your Phone Numbers: (Home, work and cell)
Emergency Contact: ( Name, relationship and phone numbers: home, work and cell)
Any allergies/negative reactions: (i.e., medications, latex…)
Current Primary Care Physician: (Address and contact information)
OB/GYN: (Address and contact information)
Specialists: (Address and contact information)

Based on your chronic disease:

List all physical limitations or mobility issues you have and assistive devices you use (e.g., a cane, hearing aide).

List any chronic diseases – you can use the example below as a guide.

Date diagnosed	Disease	Treatment plan
01/08/07	Migraine headaches	Guided imagery, ibuprofen as needed
04/07/05	Fibromyalgia	Venlafaxine 50 mg daily, Nabumetone 500 mg twice daily
02/06/04	Cervical strain	Muscle relaxant ofr 6 months, pilates mat exercises

List significant family health history information (e.g., cancer, heart disease, stroke).

List any surgeries and/or procedures in chronological order starting with the most recent. For example:

Date	Surgery/Procedure	Result
05/07/08	Colonoscopy	Negative, follow up in 5 years
03/05/06	Spinal epidural injection	Pain relief for 6 months
09/02/02	Right knee arthroscopy	Physical therapy for 6 weeks

Having a document with detailed information about prescription and non-prescription medications you are currently taking can be very helpful when meeting with a health care provider. It’s better to be accurate than rely on your memory. It is easy to forget all the details for each medication and it is extremely important to provide accurate information to your health care provider.

Below is an example of how you can list prescription medications, over-the-counter drugs and any vitamin and herbal supplements you take. Place a copy of this list in your health care journal and have a copy ready to bring to an appointment whenever it is needed. A medication list should include

• Name of the medication
• Dosage and frequency
• Reason you are taking the medication
• The date you started taking the medication
• The prescribing physician’s name and contact information
• Any special instructions about the medication

Name of medication	Dosage and frequency	Reason for taking medication	Date started	Physician information	Any special instructions
Example Zocor	10 mg at bedtime	Reduce cholesterol	5/05/07	Dr. Smith 5 Pilgrim Lane Ph: Fax:	Avoid grapefruit while taking this medication

However you choose to keep track of your medications, you should:

• Educate yourself about your medications and their desired effects
• Be familiar with the instructions on how to take the medication, possible side effects and drug interactions
• Know how to store your medication, with any special instructions that should be implemented when you travel

It can be very helpful to develop a relationship with one of the pharmacist’s where you pick up your medications. Pharmacists are well trained and can answer your questions about possible drug interactions, side effects and contraindications that your health care provider may not tell you.

Now that you are armed with all your important medical information, it’s time to get prepared for your appointment. This should be much easier with your personalized health journal by you side. Remembering and retrieving all the information you are supposed to fill out on forms for each health care provider can be an energy drain. You will be “miles ahead” with your personalized health journal. Reviewing the information in your journal and bringing it with you for reference will help you give your health care provider up-to-date information on your health condition. This will help your health care provider gain a better understanding of your symtomology and health condition.

I have divided the physician appointment into three sections that I believe are the most helpful for a satisfying and helpful medical visit.

• Before your appointment - Make a list of relevant questions, note your symptoms as they relate to your activities of daily living and diet and bring any relevant journal article/research that you may want to review with your health care provider. Keep the information short and to the point. Bring along your personalized health journal and paper and a pen so you can take notes.

• During your appointment - Take some notes of tests, medications or special instructions. Ask your health care provider for information/reading material that they may have prepared.

• After your appointment - Sit down in the waiting room to review your notes and fill in any additional information you may have left out. The sooner you review your notes, the more likely you are to understand and remember what was said during your appointment.

Advance planning helps you become a “savvy patient” who presents him or herself in the best manner possible and now only needs to find the health care provider who provides your health care needs in a manner that suits your style, with grace and dignity.

Linda Winkler Garvin, RN, MSN
Nurse Practitioner
Director, Health Management Associates
www.healthmanagerbayarea.com

More information

http://medicalcenter.osu.edu/patientcare/healthcare_services/womens_health/prevention/medication/Pages/index.aspx
http://cancer.about.com/od/treatmentoptions/tp/managemeds.htm
http://www2.mdanderson.org/depts/oncolog/articles/06/9-sep/9-06-hc.html
http://www.ahrq.gov/consumer/