The Good Neighbor Journal

You wait three weeks for the appointment, forty minutes in the waiting room, and then you are in the chair for about as long as it takes to boil a kettle twice. You come out holding a piece of paper and the distinct feeling that you forgot to say the thing you went in for.

The length of the visit is not going to change, and complaining about it has never yet added a minute to one. What can change is what walks in with you. A page of notes and a proper list of your medicines will do more for that twelve minutes than anything else available to you, and both are free.

This is not about being a difficult patient. It is about not spending a third of a short visit reconstructing, from memory, facts you already had at home.

The one page

The evening before, sit down with a sheet of paper and write four things. Not a diary. One side, large enough to read across a desk.

• What has changed, and when it started. A date matters far more than an adjective. "Since about the middle of June" is worth more than "for a while now", and considerably more than "lately".
• What makes it better or worse. Time of day, standing up, after eating, after walking, at night. This is often the sentence that decides the whole appointment.
• What you have already tried, including anything bought off a shelf without a prescription.
• Your questions, in order, worst first. Three at most. A list of nine gets triaged by whoever is looking at the clock, and it will not be triaged in your order.

Bring any numbers you have been keeping — home blood pressure readings, a weight, a blood sugar log. The notebook itself, not a summary from memory. A fortnight of honest readings is a piece of evidence; a recollection of roughly what they said is not.

The medication list, which matters more than the rest

If you do only one thing from this article, do this one.

Write down, or photograph, everything you take. Not the prescriptions you think are relevant. Everything.

• Every prescription, with the dose and how often — the label on the bottle has all of it.
• Anything bought over the counter: painkillers, antacids, sleep aids, cold and flu remedies, laxatives, allergy tablets.
• Every vitamin, mineral, herbal preparation, tonic and supplement, including the ones a friend recommended and the ones that arrived in the post.
• Eye drops, creams, patches, sprays and inhalers. People leave these off constantly, because they do not feel like medicines.
• Anything prescribed by a different doctor, at a hospital visit, or by a specialist. Nobody's records are as joined-up as you would hope.

The reason this is the most valuable page you can carry is that the interactions between things are exactly what a doctor cannot guess at. Plenty of ordinary shelf products — some common painkillers among them — interact with prescriptions people are already taking, and several popular herbal preparations do too. None of that is exotic and none of it is cause for alarm. It simply cannot be checked if it is not on the table.

The easiest version of this, if writing is a nuisance: put every bottle and box in a carrier bag and take the bag. Any practice in the country has seen it before, and it is faster than a list.

Say the important thing first

There is a well-documented habit in medical consultations of the patient raising their real concern at the very end, with a hand already on the door. The worry that actually drove them to book the appointment comes out when there is no time left to deal with it, and the visit has to be repeated.

It happens for understandable reasons. The frightening thing is hard to say. It feels like an imposition, or foolish, or like something that ought to be worked up to. So the visit fills with the ankle and the repeat prescription, and the thing that has been keeping you awake gets nine seconds at the threshold.

So say it first. Not artfully — the first sentence, in ordinary words: "The thing I'm most worried about is this." A doctor hearing that in the opening seconds can shape the whole appointment around it. A doctor hearing it at the door can only book you another one.

Questions worth asking about a prescription

If something new is prescribed, or something existing is changed, these four are worth asking every time. They are not a challenge to anybody's judgement; they are the information you need in order to take the thing properly.

• What is this for, in plain words? "For your pressure" is enough. Knowing why you are taking something is the strongest predictor there is of still taking it correctly in six months.
• What should I expect in the first fortnight, and what would be a reason to telephone rather than wait?
• Does it change anything else on my list — including anything I buy over the counter, or any food?
• How long am I on it, and when do we look at it again? Some things are for a season and some are indefinite, and it is very easy to end up on something for years because nobody ever revisited it.

And one that is not about a prescription at all, but is the most useful question in the room: "What would you like me to watch for at home?" It turns a monologue into a plan, and it gives you something specific to report at the next visit instead of an impression.

Small things that make the visit longer than it is

• Take somebody with you if the appointment matters. Two people remember roughly twice as much, and the second one can ask the question you decided not to.
• Write the answers down in the room. Not afterwards in the car. Almost everybody overestimates how much of a consultation they will carry out of the building intact.
• Ask for it in writing if the plan is complicated. Most practices can print a summary, and most are glad to be asked.
• Repeat it back. "So I stop the one, halve the other, and come back in six weeks." Thirty seconds, and it catches the misunderstanding while somebody is still there to correct it.
• Ask who to ring, and when. Knowing which number to use out of hours, and what counts as worth using it for, prevents both the unnecessary panic and the dangerous wait.
• Do not stop anything on your own because it seems to be disagreeing with you. Say that it is disagreeing with you. There is usually an alternative, and stopping unannounced is how a small problem becomes a real one.

What is not an appointment matter

All of the above assumes there is time to prepare. Some things do not wait for a Tuesday.

Sudden severe chest pain. A face or arm that droops. Speech that comes out wrong. Sudden weakness or numbness down one side. A sudden crushing headache unlike any before it. Sudden breathlessness, or fainting. Those are not things to write on a page for next week. In the United States that is 911, immediately, and it is always better to call and be wrong. Nobody in an emergency department has ever been annoyed by a false alarm; they are annoyed by the person who waited until morning.

A word about what you read

There is a great deal published for people our age suggesting that doctors are not to be trusted, that the short appointment proves it, and that the answer lies somewhere else — usually somewhere that takes a payment.

I do not believe a word of it, and this Journal will never print it. The appointment is short because the system is stretched, not because the person in the chair opposite is indifferent. Twelve minutes with somebody who has your history in front of them and a licence to lose is worth more than any amount of reading, mine included.

All this article is for is making sure you get all twelve.

— Margaret Hayes