Partner with Your Doctors for Better Care

Collaboration, communication, and coordination are the keys to successfully working with all of your health care providers. This only possible when patient-physician communication is open, honest, and as often as needed.

When communication between a doctor and a patient breaks down the outcomes for the patient are not as good. If for any reason you are not comfortable talking with your doctor and your health providers, please find someone that you trust to help you.   The rest of this section helps you understand and speak with your doctors and health care providers.

Communicating and Working with Your Doctor

Communicating with your doctors and health providers is a cornerstone of good health. This requires learning and using basic communication skills, including; preparation, asking questions, listening to answers, answering questions honestly and directly, and taking enough time to think about what you want. Unfortunately, talking with your doctor is not always easy. It takes time and effort on your part as well as your doctor. If either person does not do their part the communication may break down.

Find the Right Primary Doctor First

Get started by trying to find a primary doctor who you are comfortable with. Your primary doctor should get to know you, and what your health is normally like. Your doctor should help you make decisions that suit your values and lifestyle, and keep in touch with other medical specialists and health care providers when you need them.

Tip: We know that one of the biggest problems is that primary care doctors have a very limited time to gain a deep understanding of each patient. Today, if you want to get the best care you must help your primary doctor by notifying him/her when you have appointments with other health care professionals, and when you are considering taking any other action to treat or care for yourself.

If you don’t have a primary doctor or you are not at ease with the one you currently see, you want to find a new doctor. Under any circumstances it is worthwhile to spend time finding a primary doctor who you trust and feel comfortable with.

Primary care doctors frequently are family practitioners, internists, or geriatricians. A geriatrician is a doctor who specializes in older people. Family practitioners and internists may also have a lot of experience with older patients. In most cases, a primary doctor should be your main health care provider in non-emergency situations. Your primary doctor’s role is to:

• Provide preventive care and teach healthy lifestyle choices.
• Identify and treat common medical conditions.
• Assess the urgency of your medical problems and direct you to the best place for that care.
• Make referrals to medical specialists when necessary.

Primary care is usually provided in an outpatient setting. However, if you are admitted to the hospital, your primary physician may assist in or direct your care, depending on the circumstances. Having a primary care provider can give you a trusting, ongoing relationship with one medical professional over time. You can choose from several different types of primary doctors.

Tip: Be extra careful if you are admitted to a hospital with an emergency. You are likely to be treated by doctors and healthcare professionals who know very little about you, and may not be in your insurance network.

Types of Primary Care Clinicians

Family Practitioners are doctors who have completed a family practice residency and are Board Certified or board eligible for the specialty. The scope of their practice includes children and adults of all ages, and it may include obstetrics and minor surgery.

Pediatricians are doctors who have completed a pediatric residency and are Board Certified or board eligible in this specialty. The scope of their practice includes the care of newborns, infants, children, and adolescents.

Internists are doctors who have completed a residency in internal medicine and are Board Certified or board eligible in this specialty. The scope of their practice includes the care of adults of all ages for many different medical problems.

Obstetricians / Gynecologists are doctors who have completed a residency and are Board Certified or board eligible in this specialty. They often serve as a primary doctor for women, particularly those of childbearing age.

Nurse Practitioners (NPs) and Physician Assistants (PAs) are practitioners who go through a different training and certification process than doctors. They are often referred to as “physician extenders.” They may be your key contact in some practices. All PAs and NPs consult with physicians.

Many insurance plans limit the providers you can choose from or they provide financial incentives for you to select from a specific list of providers. Make sure you know what your insurance covers before starting to narrow down your options. Decide what qualities you are looking for in a doctor.

A good first step is to make a list of qualities that matter to you. Do you care if your doctor is a man or a woman? Is it important that your doctor has evening office hours, is associated with a specific hospital or medical center, or speaks your language? Do you prefer a doctor who has an individual practice, or one who is part of a group? After you have made your list, go back over it, and decide which qualities are the most important and which are nice, but not essential.

Once you have a general sense of what you’re looking for, ask friends, relatives, medical specialists, and other health professionals for the names of doctors with whom they have had good experiences. Rather than just getting a name, ask about the person’s experiences. For example: say, “What do you like about Dr. Smith?” and “Does this doctor take time to answer questions?” A doctor whose name comes up often may be a strong possibility.

If you have health insurance make sure you find out if the doctor you would like to use accepts your insurance, and if they are in your insurance provider network. If the doctor you choose is not in your insurance provider network you are likely to pay extra if you choose to choose them. Most managed care plans will provide information on their doctors’ backgrounds and credentials. Some plans have web sites with lists of participating doctors from which you can choose.

Tip: It is helpful to develop a list of a few doctors you can choose from. As you find out more about the doctors on this list, you may rule out some of them. In some cases, a doctor may not be taking new patients, and you may have to make another choice.

Consult Reference Resources to Check Credentials

The Directory of Physicians in the United States and the Official American Board of Medical Specialties Directory of Board Certified Medical Specialists are available at many libraries. These books don’t recommend individual doctors but they do provide a list of doctors you may want to consider. MedlinePlus, a website from the National Library of Medicine, has a comprehensive list of directories that may also be helpful. The web site is at www.nlm.nih.gov/medlineplus/directories.html.

There are plenty of other Internet resources too. For example, you can find doctors through the American Medical Association’s website at www.ama-assn.org; (click on “Doctor Finder”). A list of doctors participating in Medicare can be found at http://www.medicare.gov; (click on “Search Tools” then “Find a Doctor”). The WebMD web site also provides a list of doctors at www.webmd.com; (click “Find a Doctor”).

Tip: Don’t forget to call your local or State medical society to check if complaints have been filed against any of the doctors you are considering.

Learn more about the doctors you are considering. Once you have narrowed your list to two or three doctors, call their offices. The office staff is a good source of information about the doctor’s education and qualifications, as well as the office policies and payment procedures. Pay attention to the office staff. You will have to deal with them often if you choose the practice. You may want to set up an appointment to meet and talk with a doctor you are considering. Ask what you will be charged you for such a visit. Then contact your insurance provider and see if they will cover the cost.

After your initial appointment, ask yourself whether this doctor is a person with whom you could work well. If you are not satisfied, schedule a visit with one of your other candidates.

When learning about a doctor, consider asking questions like:

• Do you have many patients like me?
• How do you feel about involving my family in care decisions?
• Can I call or email you or your staff when I have questions? Do you charge for telephone or email time?
• What are your thoughts about complementary or alternative treatments?

When making a decision about which doctor to choose, you might want to ask yourself questions like:

• Did the doctor give me a chance to ask questions?
• Was the doctor really listening to me?
• Could I understand what the doctor was saying? Was I comfortable asking him or her to say it again?

The First Appointment

Once you’ve chosen a doctor make an appointment. This visit will likely include providing a medical history and a physical exam. Be sure to bring your medical records or have them sent from your former doctor. Bring a list of your current medicines or put the medicines in a bag and take them with you. If you haven’t already met the doctor, ask for extra time during this visit to ask any questions you have about the doctor or the practice.

Tips: Your first meeting is a good time to talk with the doctor and the office staff about some communication basics.

When you see the doctor and office staff, introduce yourself and let them know by what name you like to be called. For example: “Hello, my name is Mrs. Jones.” or “Good morning, my name is Bob Smith. Please call me Bob.”

Ask how the office runs. Learn what days are busiest and what times are best to call. Ask what to do if there is an emergency, or if you need a doctor when the office is closed. Share your medical history. Tell the doctor about your illnesses, operations, medical conditions, and other doctors you see.

You may want to ask the doctor to send you a copy of the medical history form before your visit so you can fill it out at home where you have the time and information you need to complete it. If you have problems understanding how to fill out any of the forms, ask for help. Some community organizations provide this kind of help. Give your new doctor all of your old doctors’ names and addresses, especially if they are in a different city. This is to help your new doctor get copies of your medical records. Your doctor will ask you to sign a medical release form giving him or her permission to request your records.

How to Talk to Your Doctor

How do you talk to your doctor? Does he or she do all the talking while you do all the listening? Are you afraid to ask questions? Do you leave the office feeling like you just sat through a foreign language class?

A good relationship is based on you and your doctor openly sharing information and working together to make the best decisions about your health. Practicing open communication with a doctor that you trust may also help increase your confidence that you have chosen the right treatment, and in achieving a positive outcome. Doctors are busy people and their offices are often a buzz with activity, like ringing telephones and crowded waiting rooms. When you actually see your doctor, your visit may not last more than fifteen minutes.

Tip: Be prepared for your doctor’s appointment.

You can prepare by writing down all the questions you have for the doctor in advance and bring a pen and paper to jot down answers and take notes. Here are some questions you might want to ask:

• What do think might be wrong with me? How do you know?
• What are the common causes of this problem?
• Will I need any tests?
• Which tests might I need?
• What does each test involve?
• How do I prepare for each test?
• Will my insurance pay for the tests?
• What are my treatment choices?
• What are the benefits and risks of each treatment?
• What are the side effects?
• How are the likely outcomes of each treatment?
• Which treatment is the most common for my condition?
• What would be the “next steps” if treatment fails?
• What kind of medication(s) must I take? For how long?
• What does the drug do? Will there be any side effects?
• What should I do if I have side effects?
• Can I take a generic version of the drug?
• Will the medicine interact with any I am already taking?
• Should I avoid any kind of food or activity while taking this medicine?
• Will I need to see a specialist?
• Should I get a second opinion?
• Do I need a follow-up visit?

Additional preparation includes:

• Bring a list of the symptoms that you’re experiencing with you to your appointment.
• Bringing a list of all the medicines you take. Write down the doses and how often you take them. Include vitamins and other supplements.
• Arrive early enough to fill out forms.
• Have your insurance card ready.
• Bringing your medical records with you, or have them sent in advance if you’re seeing the doctor for the first time.
• Dress and present yourself as a successful, confident person.

Speak Up During the Appointment

Don’t be put off by big words, or a doctor’s impatient manner. If you don’t understand what the doctor is telling you ask him or her to explain it again using different words, or a drawing if needed. Don’t leave the office without understanding everything the doctor told you. If there are issues you want to discuss that the doctor does not mention, bring them up yourself. Doctors often are so focused on making sick people better, or so rushed, that they may forget to talk about important health matters like diet, weight, exercise, stress, sleep, tobacco use, alcohol use, sexual practices, vaccines, etc. Ask your doctor what tests you might need for your age, such as a mammogram or colonoscopy, and ask your doctor about getting them. Don’t be embarrassed or ashamed to bring up sensitive topics.

Don’t Withhold Information

Speaking up also means telling your doctor everything you know about your body and health, including all your symptoms and problems. The more information you share the better your doctor will be able to figure out what’s wrong and how to treat you. Don’t make the doctor guess. Be sure to mention any and all medicines, vitamins, and herbs you are taking, and anyone else you are seeing about your health; both physical and mental.

Bring Someone with You

Sometimes, people like to bring a friend or family member to a doctor appointment for moral support. A companion might also help you relax, remind you of questions you forgot to ask, and help you remember what the doctor said. If you need personal time with the doctor, the person can sit in the waiting room. Having someone join you is especially helpful if you feel too ill to get around easily on your own.

Follow Up with Questions

If you feel nervous, rushed, or just plain overwhelmed you might forget to ask a question, even if you wrote it down. If this happens or if you think of a new question, call the office right away. Be patient but firm if you want to speak directly with the doctor. Although they may not be able to take your call at that moment certainly they will get back with you. If the doctor wants you to come back for a follow up visit be sure to set and keep the appointment

Building a successful partnership with your doctor takes time and effort. It’s not uncommon to have a frustrating doctor visit now and then. But overall, your relationship with your doctor should be positive and comfortable. You should have confidence and trust in his or her medical ability and judgment.

Tip: Let your doctor know when there’s a problem. If you can’t resolve things together, you might need to entrust your care to someone else.

Talking about Your Health

Talking about your health means sharing information about how you feel physically, emotionally, and mentally. Your doctor may ask when your symptoms started, what time of day they happen, how long they last, 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. Knowing how to describe your symptoms and bringing up other concerns will help you become a partner in your health care.

A symptom is evidence of a disease or disorder in your body. Examples of symptoms include pain, fever, a lump or bump, unexplained weight loss or gain, having a hard time sleeping, or anything that seems different that what you know as normal. Be clear and concise when describing your symptoms. Your description helps your doctor identify the problem. A physical exam and medical tests provide valuable information, but it is your symptoms that point the doctor in the right direction.

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?
• Are there ways to keep my condition from getting worse?
• How will making a change in my habits help me?
• Are there any risks in making this change?
• Are there support groups or community services that might help me?

Tip: 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.

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. Bring everything with you to your appointment if you have not written it down, or can access the information electronically. Do not forget about eye drops, vitamins, and laxatives. Tell the doctor how often you take each. Describe any drug allergies or reactions you have had. Tell your doctor which medications work best for you, and be sure your doctor has the phone number of the pharmacy you use.

Research shows that doctors can be influenced by pharmaceutical company promotions. One of the most effective promotions seems to be free samples.  Eventually free samples run out and a prescription needs to be written. It is not uncommon for the doctor to simply write the prescription for the same drug even though the doctor may have actually considered a different drug. Direct-to-consumer advertising by the pharmaceutical companies tries to get the patient to ask the doctor about a drug.  No matter what tactics the pharmaceutical companies use the point to remember is that there are often lower cost alternatives that work just as well as the more expensive, heavily promoted brand name drugs.

You might want to ask your doctor to consider the cost and effectiveness when choosing a drug to prescribe. You can also ask both your doctor and pharmacist about the availability of a generic substitution for the drug prescribed. That said, there is nothing wrong with asking for a highly advertised drug. Just remember that there are often alternatives.

Don’t forget to tell the doctor about your lifestyle habits. To provide the best care your doctor needs to 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, the death of a loved one, or the loss of a job. 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.”

Tips for Making Good Use of Your Time 

• Be honest. It is tempting to say what you think the doctor wants to hear. For example, saying that you smoke less or eat a more balanced diet than you really do. While this is natural, it’s not in your best interest. Your doctor can suggest the best treatment only if you say what is really going on. For instance, you might say: “I have been trying to exercise more, but I it is not working out as well as I had hoped.”
• Decide what questions are most important. Pick several questions or concerns that you most want to talk about with the doctor. Tell your doctor what they are at the beginning of the appointment, and then discuss them each in turn. If you have time, you can then go on to other questions.
• Stay focused. Although your doctor might like to talk with you at length, each patient is given a limited amount of time. Make the best use of your time by keeping the conversation focused on your questions.
• Ask your doctor about prevention, and if there are ways to prevent conditions you are likely to encounter based on your family and personal history.

Share your point of view about the visit. Tell the doctor if you feel rushed, worried, or uncomfortable. If necessary, you can offer to return for a second visit to discuss your concerns. Try to voice your feelings in a positive way. For example, you could say something like “I know you have many patients to see, but I’m really worried about this. I’d feel much better if we could talk about it a little more.”

Remember, the doctor may not be able to answer all your questions. Even the best doctors may be unable to answer some questions. Most doctors will tell you when they don’t have answers, and they will help you find the information you need, or refer you to a specialist. If a doctor regularly brushes off your questions or symptoms as simply a part of aging or unimportant think about looking for another doctor.

Talking to Specialists and Surgeons

If you need or want to see a specialist, your insurance provider may require you to have a referral from your primary doctor. Appointments with specialist can at times be short. In most cases, the specialist has already reviewed your medical records or test results, and has some knowledge about your circumstances.

As with your primary doctor, if you are unclear about what the specialist tells you ask questions. For example, if the specialist says that you have a medical condition that you are not familiar with, ask the doctor to explain what it is, and how it might affect you. You also may ask the specialist for written materials to read, Internet sources you can trust, and the specialty medical organizations for the condition.

Tip: Don’t hesitate to ask the specialist to send information about any further diagnosis or treatment to your primary doctor. This allows your primary doctor to keep track of your medical care. You also should let your primary doctor know about your appointment, and discuss with them how well any treatments or medications the specialist recommended are working.

Questions to ask a specialist:

• What is your diagnosis?
• What treatment do you recommend? How soon do I need to begin the new treatment?
• Will you discuss my care with my primary doctor?
• What is the medical and common name of each treatment option?
• How will each treatment recommended help my situation?
• What is involved with each treatment?
• How will each treatment affect my lifestyle?
• Is the treatment commonly covered by insurance?
• How many patients have you treated successfully with each treatment?
• What is the expected outcome of each treatment?
• What are the risks associated with each treatment?
• How soon should treatment start? How long will it last?
• What would happen if I choose not to have any treatment?

Surgery

If you need surgery, Section 6 in this book discusses how to find and select a surgeon. This will involve checking with your insurance provider to see which surgeons are included in your network, checking each surgeon’s credentials, considering referrals, learning about the surgery, and ultimately choosing a surgeon.

Once you have selected a surgeon, you will schedule an appointment. You will want to prepare for that appointment the same way you prepared for your appointment with your primary doctor.

During your appointment you will want to ask:

• What will be done during the operation?
• What reading material, videotapes, or websites you can look at before the operation to learn about the procedure?
• If you will have to stay overnight in the hospital, or if the surgery can be done on an outpatient basis?
• Will you need someone to drive you home? Minor surgeries that don’t require an overnight stay can sometimes be done at medical centers called ambulatory surgical centers.
• What is the success rate of the operation? How many of these operations have you done successfully?
• What problems occur with this surgery?
• What kind of pain or discomfort can I expect?
• What kind of anesthesia will I have?
• Are there any risks associated with it for older people?
• Will I have to stay in the hospital overnight?
• How long is recovery expected to take?
• What does it involve?
• When can I get back to my normal routine?

In the Hospital

Staying in the hospital is difficult and stressful for many patients. It’s almost like going to a foreign country where they talk about you behind your back, and don’t speak your language. Not to mention, that it’s likely that you’re not feeling so well.

One of the best things that you can do before you get to the hospital is to choose someone to help you during your stay. When you get to the hospital, make sure that the staff knows who this person is, and their contact information. Many hospitals also have patient representatives, advocates, or helpers. Find out if your hospital has such a person, and get their name and contact information.

Usually the admitting doctor coordinates your care while you are in the hospital. However, it’s not always possible for hospital staff to get in touch with your admitting doctor. Find out who is responsible for your care when your admitting doctor is not available, and get their contact information. Although it sounds silly, check your wristband to make sure that the information about you is accurate.

Tip: One of the “Must Do’s” to get safe care when you are going to a hospital is to bring a list of your current medications and dosages.   

Hospital patients often receive a lot of drugs. Consumer Reports notes that the average is 10 different drugs. Pay attention to what you are being given, why you are being given each drug, and what the proper dosage should be. The Institute of Medicine reported that there is one medication mistake for every admitted patient. Being vigilant about your medications can help avoid some of these mistakes.

Tip: If you bring your cell phone and charger to the hospital it will be much easier for you to stay in touch with family and friends, and find resources and help when needed.    

It may seem a bit excessive and even uncomfortable, but asking every person who touches you to wash your hands will help you avoid one of the biggest problems within hospitals; hospital acquired infections. Remember, people are in a hospital because they are sick. Infections are not uncommon.

During your stay it’s possible that things will happen that confuse or annoy you. If you bring a small notepad and pen you can write them down, along with any questions or concerns that you have. This will help you keep track of what’s important when you have an opportunity to speak with your doctor(s) and nurse(s). Other things that you may want to bring include:

• A robe for when you able to walk around.
• Your own pillow.
• Some music.
• Earplugs
• A reading light.
• Reading material.
• Your own toiletries.

Most hospitals have a daily schedule. Doctors generally visit patients during specific times each day. Find out when the doctor is likely to visit so you can have your questions ready. Knowing the hospital routine can make your stay more comfortable. Find out how much choice you have about your daily routine and express any preferences you have about your schedule.

Tip: Many doctors start their rounds on the top floors. If you request the highest floor possible, you may get to see the doctor a little earlier.

In the hospital your primary doctor and various medical specialists, as well as nurses and other health professionals, may examine you. If you are in a teaching hospital doctors-in-training known as medical students, interns, residents, or fellows, also may examine you. Many of these doctors-in-training already have a lot of knowledge and experience. They may be able to take more time to talk with you than the other staff. Nurses also can be an important source of information, especially since you will see them often.

It’s not a bad idea to ask your admitting doctor to provide “standing orders” regarding pain and sleep medication. This way, the hospital staff will not have to call your doctor to get authorization if you need them.

There are many different situations that you might encounter during your interaction with your doctors and health providers. Some questions for a few of the more common situations, medications and tests, are outlined below:

About Prescription Medications

• What is the medicine for?
• Is there a generic version available?
• How will the new drug affect my current treatment plan?
• What is the name of the medicine?
• How do you spell the name?
• How am I supposed to take it?
• When should I take my medicine?
• How much medicine should I take?
• How long do I need to take the medicine?
• When will the medicine start working?
• Can I stop taking my medicine if I feel better?
• Can I get a refill?
• Are there any side effects?
• When should I tell someone about a side effect?
• Do I need to avoid any food, drinks, or activities?
• Does this new prescription mean I should stop taking any other medicines I’m taking now?
• Can I take vitamins with my prescription?
• What should I do if I forget to take my medicine?
• What should I do if I accidentally take more than the recommended dose?
• Is there any written information I can take home with me?
• Are there any tests I need to take while I’m on this medicine?

Questions about Tests

• What is the test for?
• What will the test show you?
• What will happen if I don’t have the test?
• How is the test done?
• Where is the test done?
• How much pain will I be in during and after the test?
• How accurate are the test results?
• Are there any alternatives to the test?
• What are the benefits and risks of having this test?
• What do I need to do to prepare for the test?
• How many times have you performed the test?
• When will I get the results?
• What will the results tell me?
• What are the next steps after the test?

Questions about a Recent Diagnosis

• What is my diagnosis?
• What is the technical name of my disease or condition?
• What does the diagnosis mean to me and my life in plain English?
• What is my prognosis (outlook for the future)?
• What changes will I need to make?
• Will I need special help at home for my condition?
• Is there any treatment?
• What are my treatment options?
• How soon do I need to make a decision about treatment?
• What are the benefits and risks associated with my treatment options?
• Is there a clinical trial (research study) that is right for me?
• Will I need any additional tests?
• What organizations and resources do you recommend for support and information?

If you sense that something may be wrong, speak up. Your health care team needs your input to ensure the highest quality care.

Leaving the Hospital

For starters, if you do not feel that you are ready to leave the hospital, say something. If you fee faint, dizzy, groggy, unclear, or in excessive pain, you should probably not be leaving the hospital. Other conditions to be concerned about include:

• Not being able to urinate or go to the bathroom with minimal assistance.
• Not being able to keep food or drink down.

If you don’t feel that your concerns are being heard, you can appeal to your doctor, the hospital discharge planner, the hospital’s patient representative or advocate, and even the state health board.

Do not wait until you are being wheeled out of the hospital to discuss your care after you have left. Make sure that you completely understand your condition, the follow up that’s needed, the medications that you need to take, any warning signs that things are not right, and what to do if you experience any problems. You can accomplish this by speaking with your doctor(s) and your discharge planner, and reviewing your post discharge care plans with your primary caregiver.

If you do not have someone to help you at home or in your new care setting, find someone. It’s not in your interest to try and do everything alone. There is a great deal of inconsistency in the processes used and quality of discharge planning in America’s hospitals. The problem is that research shows that the way your transition to your new care setting is a critical factor on your healthy recovery.

The basics of discharge planning are;

1. An evaluation of your condition by a qualified professional.
2. A discussion with that health professional, and the patient and/or the patient’s primary caregiver.
3. Planning for care in whatever your new care setting will be.
4. Determination of what training and support will be needed in the new care setting, and in the future.
5. Referrals to appropriate services in your local area.
6. Arrangements for follow up appointments.
7. Transference of all medical records from your stay in the hospital, or in any facility, to the patient and their doctors.
8. Communication with your doctors and health care providers of all relevant information pertaining to your transfer of settings and your condition.

Tip: Remember, the discharge staff at the hospital is probably not familiar with all of the aspects of your life outside of the hospital.   

If you are being transferred to a nursing home or rehabilitation facility, you may not have a lot of time to choose which one is right for you. Safety, quality, affordability, and convenience should be the primary factors that drive your decision.

Tip: Your health insurance, Medicare, or Medicaid may not pay for all of the services that you need after you are discharged. Make sure to discuss this with your discharge planner, and a representative from your health insurance provider, or Medicare/Medicaid.

Some basic questions to ask when being discharged to another facility are;

• How long do you expect that I will need to stay in the facility?
• Who will choose the facility?
• Does the facility have experience working with people like me; my condition and my culture?
• How is the facility rated by the Centers for Medicare and Medicaid, and other oversight groups?
• Does the food support the diet that I like and need?
• Has the facility had any safety or quality issues in the last year?
• Is the location convenient for my family and caregiver?
• What is the nurse to patient ratio?
• Is there a social worker on staff?
• How easy is it for my family and friends to visit?
• What plans have been made to ensure that medical records are available to the clinical staff?

Tip: Make sure to ask if follow-up appointments have been made with your doctor(s) and/or other health professionals. If they have not been made, find out who to call, get their phone number, and make an appointment as soon as possible.

Make sure that you and your admitting doctor have possession of a “discharge summary.” This is a clear written document detailing what you should and can do in your new care setting. It should include a list of medications that were given to you in the hospital, and that you should continue to take.

It is also important to insure that you and any doctors and health care professionals who will be treating you access to your medical records; both before you went in to the hospital, and during your stay. You can even ask for a copy of your medical records, including doctor and nurse notes and all test results, as you are being admitted to the hospital. This way, the hospital is on notice that you want copies as soon as it’s possible.

Alternative & Complimentary Medicine (CAM)

Some medical professionals have begun to integrate these two approaches to medicine into their practices. They typically make it known that they integrate what they consider to be the best of traditional and CAM approaches into their practice.

There are also doctors who want nothing to do with complementary or alternative medicine. One of the challenges with CAM therapies is that there has not been a large amount of clinical research into the effectiveness of many of the treatments. If you want to consider how CAM therapies might help, you need to ask what type of medicine the doctors’ practice. Just as important, you need to be absolutely certain that the doctors or health providers have a great deal of successful experience treating your condition.

If you have a good relationship with your current doctor you may want to discuss your interest in possible CAM treatments with them to see if they might be willing to investigate those options with you.

You can accomplish that with following steps:

• Tell your doctor about your interest.
• Ask if they would be willing to explore options with you.

If your doctor is comfortable looking at CAM treatments, learn everything you can about alternative or complementary therapies appropriate to your medical problem.

Be very careful to use authoritative and trustworthy sources during your research. Many CAM books, websites, and businesses really focus on selling something that may not be very credible. One reason why many doctors don’t recommend CAM to their patients is because evidence is lacking to prove its success. Do enough research to find CAM therapies that are published in peer-reviewed research. Without that evidence, your doctor probably won’t be supportive and your insurance company is very unlikely to pay for the treatment.

Once you have found a therapy that you believe will help you, and you have reviewed the evidence to support it, record your source or copy the information to take to your next appointment. During your appointment discuss your findings with your doctor summarize what you have learned. Do not hand your research to your doctor unless he or she asks for it. Together the two of you can determine next steps. Using this approach will strengthen patient-doctor communication and your partnership, and created a win-win situation where both of you have learned something new about a possibility for improving your health.

Finding a Mental Health Doctor

It is critical to find a provider that you can talk openly with and feel comfortable with. Any factors, such as, age, religion, or culture that would help you feel comfortable should be addressed. You should not feel guilty limiting your choices to those that you are most at ease with.

Where Do You Begin?

Start with your primary physician. Many illnesses cause symptoms similar to those experienced with a mental illness. Mental, physical, and emotional well-being are all important to your overall health. Other people you might ask for help with emotional issues are ministers, friends, local support groups, or relatives. The key is that it is someone that you trust to respect your choices and privacy. Second, try getting help from your health insurance provider. Ask for phone numbers of local professionals who are covered by your health plan. Try to get at least three names. At the same time, ask about your benefits. Make sure that you understand what costs that your insurance will cover, and what you will have to pay for.

The National Alliance on Mental Illness suggests the following steps when looking for a mental health professional:

1. Think about what you want. Is it someone to give you medication, someone to talk to, or someone to help you find other treatment options?
2. Call for help. Don’t do nothing. If you’re too nervous to make the call yourself, have a trusted family member or friend help you.
3. Make an appointment. Even if you are told that it will be weeks before you can be seen. You can always call other professionals and try to get an earlier appointment.
4. Go to your appointment. Get a friend to go with you if you are afraid or uncertain.
5. Write down your questions before you go to your appointment. It’s very common for people to get nervous when they are with a health care professionals. Having your questions prepared in advance help will ensure that you get the answers that you want.
6. If you’re not comfortable with the person who you speak with, try and find someone else.

What Type of Mental Health Provider Do You Need?

The type of mental health professional that you choose should be based on your individual needs. If you desire or need medication to help with symptoms, you will require a medical doctor or psychiatrist, as they are able to prescribe medication. If you are looking for talk therapy or help in cognitive skills, you might choose a therapist, a social worker or a psychologist. Many people will have more than one mental health provider, one to discuss medication issues and one to help with life and coping skills.

How Will You Pay For Services

Another consideration would be your ability to pay for services. Do you have insurance? Be sure that the provider you choose accepts your insurance plan. Know in advance what the health insurance company will pay and what your co-payment will be. If you do not have health insurance, find out exactly what the fees will be, and if the provider works on a sliding scale. Mental health services have been terribly under-funded for many years. Recent attention is to this problem is resulting in increased access to mental health services in local communities.

The U.S. National Institutes of Health states that the doctor-patient relationship has been and still is a cornerstone of good patient care. Patients can strengthen that relationship by collaborating, communicating, and coordinating with the doctors.