Communication: Making Sure You Have Success
Robert Cowan, MD
Make Sure You:
- Write down what you want to talk about BEFORE you go into the office; come with a plan.
- Leave with a Written Treatment Plan and be sure you Understand:
- What to do WHEN you get a headache and if that doesn't work
- How and when to take acute and preventive medicines and their most common side effects
- Know the ground rules with your provider
- What is an emergency and what to do when there is one
- Whether to call or email to ask and get questions answered
- Keep a headache log to help you talk to your provider
The Appointment
Many patients feel like a deer in the headlights when they go in to see their healthcare provider. Often there is a lot going on and too little time. As a result, sometimes patients leave the doctor’s office more confused than when they came in. This article should help you avoid that lost feeling and to help ensure that you get the most out of your appointment.
Come to your Appointment with a Plan
Studies have shown that most doctors will interrupt a patient in less than a minute or two of the time they start speaking. Sometimes, you have to be a bit firm to make yourself “heard”. It is best if your appointment begins BEFORE you step foot in your provider’s office. Jot down notes on the things you want to talk about. If you are having trouble keeping up on your headache log, make some notes about what the problem is. If you have any headache more than once a week, ask what changes are needed to help prevent them. If your headaches seem to be worse in the morning and you don’t know why, make a note to ask. If one of the rescue medicines you’re taking is making you feel sleepy or shaky, tell your provider. If not asked, volunteer that you have a few questions; do this at the beginning, not the end of the meeting.
Leave with a Written Treatment Plan
Studies report that patients remember only a small part of what they are told during an visit with their provider. It is a good idea to write down information or ask for a written treatment plan. What should a treatment plan include? Every treatment plan will be different, but most should include:
- What to do when a headache starts.
- Should you take the medicine right away or wait and see how it goes? It can be useful to score how bad the pain is. In other words, if my headache is a 3/10 (different people will have a different idea about what a “3” is, but you should know what yours is), and that’s when you take medicine, you should discuss that with your provider.
- How long should it take for your medicine to work? What should you do if your treatment is not helping (What is your rescue plan).
- Could a dark quiet area for when you have a headache or removing bad smells, flickering lights or loud noises help manage your headaches?
- If a trip to the Emergency Room or Urgent Care is part of your treatment plan, what medicines would be best (and what medicines should be avoided)? It is always good to have something in hand from your provider when you go to the ER.
- What are your prevention strategies?
- Are there changes in behavior that will help improve headaches, such as regular sleep and eating schedules, daily aerobic exercise, etc? Do you have a behavioral plan you are excited about and can "just do it". See the ABCs of Headache Trigger Management for workable ideas for behaviors and triggers.
- If you know of definite triggers, what is the best way to address them? Get an answer. Should you avoid a particular trigger or “cope with it”? Can you modify it or take preventive measures before exposure to a trigger?
- If you have been given a medicine to take on a daily basis to help prevent your headaches, how often should you take it? What are the most common side effects? What should you do when you have side effects?
- Are there situations that might require special instructions from your doctor, such as travel, stressful events, pregnancy?
- Are you keeping a headache log to help monitor how often, how painful, and how long your headaches are and whether your rescue strategies are working? You could also list changes in your treatment plan and possible triggering events you notice.
Know the Ground Rules
Ask your provider what is the best way to communicate with him/her. Is the method the same for both routine questions and in an emergency? It is best to find out early in the relationship to avoid misunderstandings.
- What To Do in an Emergency
Most healthcare providers have a system set up to help in emergencies. But sometimes providers and patients have different ideas about what is an emergency. Most would agree that a headache unlike any headache you have ever had in your life is an emergency worthy of a call to 911. This is very true for a sudden onset, severe and more than momentary pain.
- What is not an Emergency
Most would agree that refills should be during office hours addressed with a phone call to the pharmacy or the office
- Ongoing Communication
Have a clear sense of what to do when you need advice and how best to communicate with your healthcare provider. Some providers are using e-mail for routine non-emergency questions and communications. This method may have a 24, 48, or 72 hour turn-around response time. Others prefer a phone call to the office and a call back.
Keep a headache log as the bedrock of communication.
By keeping a headache log and bringing it to each appointment, you are better able to communicate the real impact of your headaches on your life. The headache log helps your provider understand:
- how often you are getting headaches and how bad they are
- how well your medications are working
- patterns that might help you prevent and control your headaches
Conclusion
Having an open and effective relationship with your healthcare provider is essential for good headache care. Like all relationships, it often comes down to good communication. Make sure that your provider knows what you want to get out of your visit. Make sure that you have a clear plan when you leave the office. These simple but important actions will help insure that you get the most out of your relationship with your provider.
Robert P Cowan, MD, FAAN, Stanford University Headache Center, Palo Alto, CA.