You’re at the doctor’s office, the visit is just about over, and you completely forgot why you’re there in the first place. Trust me, I’ve been there before too. But fear not! Getting ready for a routine visit is as easy as walking the dog or minting an NFT.

You can prepare yourself well for a regular physical before you even set foot in the exam room. Besides reviewing everything I’ve noticed from my own experience running a clinic, I checked out a few sources including the government’s Agency for Healthcare Research and Quality (AHRQ), the New York Times, and comments from Aetna’s chief medical officer talking about how to get ready for a routine visit.

Let’s start with the thing you should get done even if you forget everything else I’m going to say. It’s astonishingly simple: just write down two or three items or major questions you want to cover at the visit. This checklist of your mission-critical concerns focuses your visit and helps the doctor guide you through what you need to know. One example of a list would be: 1) discuss how to keep my blood pressure down, 2) what lab tests are best to run at this point in my life, and 3) can you or a specialist help me with condition X? This is not homework for you to turn in—this prep is just for yourself and for communicating with the clinic staff at the appropriate time. Making the checklist is easier when you nail down what your aims for the visit really are. Are you just wanting to check the boxes for making sure you are doing well? Are you having a new health issue that you need treatment for? Or do you want to focus on preventative care due to upcoming life transitions? These are the broad categories I’ve found useful for thinking of visit goals.

Now let’s approach your prep from the other side of the exam room: what do physicians wish for patients to bring to the clinic? If you are joining a clinic as a new patient, bringing your complete medication, vitamin, and supplement list is a must that is easily overlooked. You should leave no stone unturned for spelling out what you put in your body. Your doctor will also appreciate you explaining a rough timeline of your symptoms whenever a new health issue comes up. Of course, if you know what your symptoms are suggesting and you already have a treatment in mind, then you would not be going to the clinic in the first place. That being said, you can still be in tune with your well-being to make the doctor’s job easier which makes the visit better.

If you’ve been seen by another provider already, you should bring records of previous visits, especially when you switch between health systems and clinics using medical record data that cannot talk to each other. Once you have your shortlist of visit goals and basic history in order, more than half the battle of having a great visit is done.

Before we keep going though, let’s back up for a second. The reason why I am talking about all this preparation is because the length your actual visit itself is painfully short. According a retroactive study by the American Public Health Association’s Journal of Medical Care, the average length of a primary care visit was 18 minutes. This conclusion was drawn from data covering over 21 million primary care appointments. The study’s authors, who originally got the data from the IT company Athenahealth, also noted the average excess visit run time as 1.2 minutes. Put yourself in your provider’s shoes for a moment. Imagine trying to get someone’s history, perform an exam, suggest treatment, and answer questions in 18 minutes. And the doctor has to document all that in a chart note, then see another 50 patients after you. This is why you need to take advantage of every second in the clinic. You may not even be meeting with the doctor the entire time during the exam room, which is why you should communicate your visit goals and major questions to the medical assistant or nurse bringing you to the exam room and taking the initial history.

Asking why primary care visits are this compressed is not too different from asking why we use quarters and halves for sports games. There are a variety of reasons, some of which are arbitrary, for why medical visits are like this, but that is missing the point for now when we have the ability to make the most of the time we do have.

Now we can talk more about things to consider during the performance of your visit. You’ll want to balance going with the flow of the exam while also circling back to your primary concerns when needed. Depending on how the exam is going so far, you should not hesitate to put in a clarifying question or two like “how is X procedure done, can you define XYZ condition, or what should my expectations be for results.” Just avoid breaking your provider’s rhythm by asking something every two seconds.

If you are legitimately worried about some particular health condition, it does not hurt to ask point-blank how concerned you should be. Then you can gauge your provider’s reaction, assurances, and comments on treatment. When you get to the point where the doctor seems to be giving you clean bill of health so far, it would also be in your best interest to get feedback on what preventative care to get depending on where you are in life right now. This could take form in asking something like: do I need to get any screening tests within in the next few years?

Every question and prompt we have talked about so far got us through the meat and potatoes of the visit. With that done we can move to the appointment’s endgame or two-minute drill. You should not leave the clinic without getting a visit summary from your PCP. Usually, a visit summary would include your documented meds/symptoms, the doctor’s comments, and most importantly the assessment and plan for what you need to do next. The office can print this for you or have the summary forwarded to your electronic medical record. This is also a great time to check if your doc wants you back at the clinic in a year or another time. Since your health priorities will be fresh in your mind right after the appointment, or at least until you start looking at your emails and social media again, you should put any necessary calendar events on your phone to confirm any future appointments, prescription pick-up, and lab orders. If for whatever reason the visit is winding down and you have not had your main visit goals addressed, it is worth politely redirecting the conversation with your PCP to talk about those aims.

All that appointment prep we spent this episode talking about so far sets you up for healthcare success, but now let’s recap the two essential things to do even if you forgot everything else. Writing a couple visit goals before the visit and making sure to get a written summary after the visit greatly enhances the value of even a routine physical.

“We have the ability to make the most of the time we do have.”

You will realize that in the coming weeks after the visit you will probably get a strange letter from your insurance that claims not to be a bill but has a lot of distressing dollar signs and funny terms on it. In the next episode we’ll talk about how to translate those explanations and other medical codes into plain English. Subscribe to Friendly Neighborhood Patient for more healthcare tips and tricks. I’ll catch you at the next episode.

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit rushinagalla.substack.com

What is a primary care provider, why do I need one, and how the hell do I find one?

Contacting a primary care provider (PCP) or a primary medical doctor (PMD) is a great first move when you need a new health issue addressed or if you want preventative care and guidance. These are the professionals you want to have a great relationship with. You should not settle for seeing an absolute jerk of a doctor, regardless of how great he or she may be. Getting effective medical care from a professional should not be like a fast-food drive thru or vending machine. You cannot hit a button related to your problem and expect a bag of magic pills, at least most of the time. So why should you invest in your relationship with a PCP? The answer would be continuity! Just like how your social media apps get better at reading your mind based on your activity, your medical care tends to improve when a professional follows you for enough time.

So what kinds of primary care providers are out there? Internists usually see patients above 18 y/o and pediatricians below 18 y/o. Family medicine docs see patients of all ages and are the true jack-of-all-trades in the medical field. Ladies can designate a gynecologist as a PCP, but in some cases insurance plans may place restrictions on doing that. Check if your health plan makes you pick an internist or other traditional PCP instead. Older patients with chronic and/or several complex issues may also consider a geriatrician as a PMD.

Even though you will hear me say that you need a doc for this and a doc for that, the patients considering themselves to be perfectly healthy may find a better match with a different healthcare professional like an FNP instead where the patient can have various primary needs addressed but can still get referred to a specialist when needed. It is more important to strike a balance: make sure to have a medical provider who has both expertise and professional courtesy.

According the Kaiser Family Foundation, there are around 495k active PMDs in the US as of September 2021. In our country of over 330 million people, it should be no surprise that low supply makes it hard to get scheduled with any doctor, let alone a good one. About 25% of those PMDs are in CA, NY, and TX alone.

So how can you find a reasonable PMD? Most websites and forums will tell you to seek out friends/family or use your insurance plan’s directory. While these sources are nice, not everyone is fortunate to have family in good medical hands already and health plan directories themselves may not be up to date (plug BCBS, UHC, Healthline source here).

Let me make this easy: crack open google maps and type ‘internist/pediatrician near me’ or write ‘internist/pediatrician in [insert your town here].’ Convenience to medical care should matter just as much as how solid a professional’s advice may be. Even when your insurance company requires you to designate a PCP, you can seek out whatever prospects are reachable. Go check out the map listings, scroll past the ads, and certainly read some reviews. But don’t stop there! If you want another sophisticated tool to complement your impeccable google search, see Medicare’s physician comparison site, which is also linked on my Substack’s resource page (at rushinagalla.substack.com).

Now for the good part: it is better to hear things from the horse’s mouth and actually contact the prospective medical offices you see on your computer screen. Good offices want to have nice conversations with new patients and are usually willing to go over all the nuances with you. There is no reason to be shy. Let me give you a few basic questions to ask for improving your screening process.

Here’s the first thing to open up with: do you take new patients? If you get a ‘yes’ then you should follow up with asking what to expect with the first consultation. Given that you are new, there is more history for the PCP to collect. Some physicians give new patients more time for the opening visit or change the overall structure of the appointment. The office’s response to describing how new patients are treated should matter in your screening process.

The next thing to cover is this: does your physician have experience treating the condition I have? Your expectations here would vary based on your social, personal, and family history, but understanding if a prospective doc has been treating patients with certain conditions for X number of years is a great thing to know regardless. We know already that PCPs treat you for a wide variety of conditions—that being said, we all know what an iPhone does but we still check what the features and specialties are for each new generation. This is why it is helpful to know what kind of tilt a prospective doctor has.

Now it would be reasonable to ask another necessary question now rather than later: does your doctor and facility take my insurance? Although you should expect a yes or no answer to this, you should remember that there are a gazillion variations of plans under each insurance network. This is why it is best to have your insurance card handy when you ask that question to clarify what specific health plan you have. You are now making the office staff’s job and your screening process easier.

The last effective question to ask, which tends to be overlooked, is: Can I get labs and tests performed at the clinic itself? When your new PCP gives you some orders to fill you do not want to realize right then that you need to go to another facility to get additional medical care taken care of. Some primary care facilities are fully equipped to have a test drawn on site but it is easy to know for sure when you ask about their setup over the phone. If all of the aforementioned questions are answered to your satisfaction, it is worth scheduling a visit. Now you have made it through the first major hoop in screening your PMD prospects. It is important to do your research here because you are, ideally, going to see your PCP once a year to stay on top of things. If you wait until a busy season like the end of the year to squeeze in a physical, you will not get to the clinic in a timely manner. Leaving a 6-month calendar reminder on your phone to schedule a visit later makes this part easier.

Let’s say you make it to the clinic in a reasonable time frame, like within a month or two of your initial phone call, for a regular physical and you are chilling in the waiting room. At this moment you are more likely to check your crypto wallet or social media newsfeed than to think up some questions for your doc. In the next episode, I’ll fill you in on simple tips and tricks to get the most of your routine visit even if you’re fit as a fiddle.

Stay tuned and subscribe to Friendly Neighborhood Patient for more wonderful and practical guidance!

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit rushinagalla.substack.com

Calling all patients,

Think of your healthcare like your bike. A bike suiting someone who’s 6’3” and 280lbs wouldn’t work for someone who’s 5’5” and 140. The purpose of a bike or a car of course is to take you from point a to b—that doesn’t change. But not everyone should ride the same bike, the same car, or have one-size-fits-all medical care. The problem is that various companies and governments are trying to replace and reinvent healthcare when the equivalent of applying some WD-40 and switching the chains is a better solution for most people.

Patients need guidance, straight facts, and brutally honest truths about the medical field. This is a direct, incremental solution rather than having a knight in shining armor swoop in and innovate everything for us in a timely manner. There are many issues with our current medical infrastructure to talk about but I’m here to teach patients all the tools and tricks to pedal through our healthcare system with ease. My experience with running a medical clinic and telemedicine platform is going to help us cover practical things like how to find a new primary doctor, learning how to be prepared for any kind of medical visit, understanding your health insurance, and knowing why you should care about big-picture developments like genetic therapies and CRISPR, for example.

As a patient, you deserve to be an advocate for your well-being; you have much more power than you realize. Knowing simple tips and lingo is the grease making all the gears of our evolving healthcare ecosystem turn well. Subscribe to Friendly Neighborhood Patient and learn how to be healthcare savvy in 2022 and beyond!

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit rushinagalla.substack.com