Most of us end up in the doctor’s office because of something specific: Something hurts. Something feels funky. Some new symptom is worrisome. So what do we do? During our visit, we talk to our doctor to talk about this one specific thing. But what about the bigger picture?
For Jonathan Vinson, M.D., a family physician with Providence Medical Group-The Plaza, the big picture is the one he wants – and needs – to see. “In family medicine, we try to treat the whole person and take the entire context into account,” he says. “Some things may seem irrelevant, but they may have a lot to do with the trouble at hand.” Everything that is happening outside the exam room – your lifestyle habits, the medications you’re taking, the struggles you’re facing in your workplace or at home – is part of this context. It’s not that your doctor finds the details of your personal life titillating, Dr. Vinson says. It’s that more information helps connect the dots.
Dr. Vinson encourages his patients to put it all out there. He wants you to tell him, for example, that your toenail fell off inexplicably and that you started on a new medication a month ago, or that you’ve begun experiencing intense headaches daily and you’re in the midst of a divorce. “I’m trying to get a better feel for what’s going on, trying to rule out scary stuff,” Dr. Vinson says. Following are six types of information to share with your doctor the next time you have an appointment. You may find some of the topics difficult to discuss; that’s OK. Just consider the benefits of being upfront before you decide to withhold something while in the exam room.
- You’re seeing someone else. If you have more than one health care professional in your life, be sure to tell the doctor you’re seeing now. While Dr. Vinson’s goal is to treat 95 percent of what a patient is dealing with before he refers to a specialist for this or that, he has learned that many individuals rely on a host of specialists to treat their skin issues, their sinus infections, their gastrointestinal troubles, etc. Some see a naturopath or physical therapist. A lot of health challenges are being addressed outside the primary care doctor’s office. Dr. Vinson’s point? If you’ve got health issues, let the doctor know what they are, who’s treating you and what treatment course you’ve been following. “These other people may prescribe medicine or duplicate tests – we can actually hurt you more than help you if we don’t know what your other doctors are doing,” he says. “It’s good to be in the loop, and then we’re all working together as a team.”
- You’ve lost your job. How stressed are you if you’ve lost your job? Probably pretty stressed. That stress can affect your physical health and the health of those around you – your spouse, partner, children and others. So look for ways you can cut stress – and costs, Dr. Vinson says. If you’re on medication, ask your doctor about a generic equivalent. If you’ve lost your insurance along with your job, Dr. Vinson suggests talking to your provider about how to get what you need in fewer visits. “Patients really appreciate when their doctors can be flexible and help save them money,” he says. “It’s a reasonable option for people who are between jobs.” Beyond being good stewards of your financial resources, Dr. Vinson says, physicians want to help protect your physical and emotional reserves, too. Job loss can trigger all sorts of behaviors that lead to worse health, such as smoking, drinking more, eating poorly and exercising less. Telling your doctor that you’ve lost your job may be humbling, but it’s the right thing to do for your health.
- You smoke. Compared with 30 or 40 years ago, when smoking was much more common, today’s tobacco users are an often maligned minority, Dr. Vinson says. “Some people really struggle with the fact that they’re continuing to smoke when they know it’s not good for them.” Being sensitive to this fact, Dr. Vinson works hard to tread somewhat delicately, and not to shame his patients: “My point is not to give them a guilt trip. My job is to be a reality check – to pull back the curtains and shine a light on the patterns of behavior that perpetuate risk.” For Dr. Vinson, it’s not about emphasizing the detrimental (and obvious) health effects of smoking or using tobacco; it’s about letting the patient know that help is available – and effective. Telling your doctor you’re a tobacco user doesn’t have to feel like you’re being pulled into the principal’s office for a lecture, he says. It’s a two-way conversation in which you can be frank about your fears and reservations, and become better educated about making a different choice.
- You drink too much. “People underestimate the way too much alcohol affects them,” Dr. Vinson says. “It’s good for us in small amounts. But anything more than those small amounts is bad for us. It interacts with medication. It affects sleep. It affects mood.” Patients should be up front with their doctor about how much alcohol they consume daily and weekly, he says, especially given the risk involved if drinking while taking medication. Having said that, however, he knows that he may get a nuanced version of the truth – particularly from those who have identified themselves already as having trouble with alcohol. As with smoking, people also feel shame about drinking too much. “People tell themselves stories all the time to make it sound OK,” he says. But before you withhold this information at your next appointment, ask yourself: Who are you helping and who are you hurting? “Your doctor is not your parent, pastor or friend,” Dr. Vinson says. “Your doctor is here to keep you safe and give you good guidance.”
- Your sex drive is suffering. Did this one make you blush? Well, you’re in good company. Many folks are embarrassed to bring this one up with their doctor. If this is a touchy subject for you, listen up: It’s not just about sex. As Dr. Vinson points out, “Couples mainly fight about two things – sex and money. And mismatched libidos can really wreak havoc on a relationship.” Medication can affect libido, and Dr. Vinson is willing to look at other medication options that have fewer sexual side effects. But what he really worries about is how the absence or infrequency of sex in your relationship plays out in what he calls
second- and third-order effects. If you’re a man with a low libido, is your wife now spending more time with her girlfriends – and therefore less time with you? If you’re a woman with a low libido, are you stressing out when your partner spends more time at work than home? Or maybe you’re struggling with the notion that you don’t really need an active libido – an idea that Dr. Vinson says is still pervasive among women. These concerns run deep and can have ill-effects on your health that are separate from the root problem. Sex, or lack of, can affect your happiness, the quality of your relationships, and even your performance at work.
- You’re more forgetful. This is a major hot-button issue for people – especially those who are creeping toward retirement age and beyond. Forgetting, for some, can signal the beginning of the end of independence. An admission of forgetfulness may translate into major life changes: where you live, how you get around, who pays your bills and who manages your medications. It’s not always age-specific; some people in their 30s and 40s might experience cognitive deficits while a person in her 90s is still razor sharp. “Is there such a thing as normal forgetfulness? Yes. Some people in the prime of their lives are more forgetful,” Dr. Vinson says. “But if it’s a change, it’s important to bring it up.” Many people in an effort to protect their last bit of independence wait to mention increasing forgetfulness until something bad happens. That’s why Dr. Vinson finds it so important to share this type of change with your doctor as soon as you notice it. There are steps you can take with your doctor’s help to combat loss of cognition without having to give up life as you know it.
Throughout the past 20 years, technology and the ready availability of information, has dramatically changed the way care is given and received, Dr. Vinson says. But as a family physician, he believes strongly in the power of the doctor-patient relationship. If you don’t have a primary care doctor in your life, Dr. Vinson recommends you get one. Today’s relationship between doctor and patient, Dr. Vinson says, is “much more of a shared decision-making model and much more of a partnership.” (If yours doesn’t work like this, maybe it’s time for a new doctor.) As health care consumers, we may be tempted to use information we gather from the Internet, books and TV to make medical decisions. Dr. Vinson admits there is value in doing your research, but he points out that none of these resources knows you personally. In addition, it’s difficult for the average person to distill so much information and determine the next best step to take. “Medicine isn’t simple – it’s extraordinarily complex,” Dr. Vinson says. “There’s still real value to that primary care relationship.”
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