by Karen Knops, MD
Each meeting with a physician or other healthcare professional is a shared journey. It can be healing and affirming, or a source of confusion and mistrust. There is increasing evidence that communication often falls short in healthcare. A few thoughtful steps can help: preparing for the visit, having a concise summary ready to share, prioritizing your concerns to make sure they are discussed, exploring anything you don’t understand, getting the clear next steps, and writing or recording the visit. Those steps can be summarized in A-S-C-E-N-D.
An introduction post shares what inspired the ASCEND. This post shares the first step: “A” for Anticipation.
We will begin with our mindset – mental preparation helps us be at our best for any task. While we naturally hope that a clinician visit will help us with a specific problem, sometimes focusing on the need to “fix” things can create a subtle (or not so subtle) anxiety and tension. Shifting slightly to appreciate that we and our loved ones are doing the best we can, and to remember how much is beyond our control can help release some of that tension. Remembering a time where we were able to speak effectively, or when we were able to listen deeply and understand reminds us what we are capable of.
In times of loss, physical pain, and grief, we often strain to find anything to be grateful for, but if we can read this document or have it read to us, it means a powerful tool is still at our fingertips – the power to change our thinking and construct stories. We will be using that power now.
Briefly imagining the details of the “where, when, who, what and how” of the interaction is the essential task of preparation.
Feeling confident that you understand When and Where we expect to meet with the clinician sets the stage for what might happen, as this often determines who or what you will bring to the appointment. Often you can get detailed information about the visit, such as how much time it is expected to take, by asking when you arrange the appointment or meeting with the clinician. Time of day can make a difference, for us and for the clinicians caring for us, so asking about flexibility in timing can be an important part of preparation.
Who is expected to be in this interaction? Are we new to this clinician and needing an introduction, or do we remember them from a previous visit? If the person’s job title is unfamiliar to us, what role do they play in our care? Do we need to bring a friend or family member with us to this visit, or put someone on speakerphone to help take in all of the information? For concerns about what role the clinician plays or who should participate, it can ease anxiety to ask ahead of time rather than coming in with false expectations.
What are the top priorities for this visit? Writing them down in order of importance helps clarify what matters most in case there is only time for one or two topics, depending on what the clinician needs to add and how complex the topics may be. Some clinicians use the patient portal or suggest websites or smartphone apps to use in preparation. Medical decision aides are tools, such as diagrams or questionnaires, designed to help us anticipate or explore information related to a specific medical decision.
How we speak about our needs influences whether we can access help, for better or worse. It is helpful to be able to summarize in a concise way what we hope to gain from the visit, and any details about what our issues are and how they impact our function. Some people like to practice in advance so they feel a sense of clarity and confidence in the visit itself. Some of us do better with pictures or models — drawing out a picture or timeline can be worth a thousand words. However we tell our story, the goal is not to be the “perfect” patient or caregiver, but to give clear information about what matters to us. Naming our emotions (afraid, embarrassed, etc.) helps prevent them from overwhelming us.
Many of us have challenges with hearing or vision, or prefer a language other than English. Mentioning these needs is often best done in advance of the visit. Often accomodations can be made, such as an interpreter, large print or language-specific learning materials, or use of a hand-held device that amplifies sound.
In addition to mental preparation, physically preparing eases your entire visit as well. Some clinicians mail or use electronic services such as “patient portals” to share information with us before our visit, and it is best to have a look at that well in advance. Writing a checklist of things to remember for the day of the visit- medication lists or bottles, a list of priorities or questions, forms to be filled out, medical records or a one-page summary if you have complex health or social needs. Our memories often fail us in emotional situations, so bringing notepaper or asking ahead of time if the clinician allows visits to be recorded lowers anxiety and ensures we aren’t fumbling or interrupting our visit to try to document it in some way.
Wearing clothing that is easy to change out of if needed, bringing a snack and water, and bringing something to keep us busy if there is a wait are actions we can take to make ourselves feel more at ease and empowered to handle what comes.
Anticipation begins before the visit and extends into the first moments when we first meet with the clinician:
Introductions: Confirming what the clinician likes to be called, letting the clinician know what we prefer to be called, and acknowledging the roles of other people present, be they family members or other clinicians, allows the visit to get off to a clear start. This is our chance to confirm who we are meeting with, what role they play in care, and get a sense of the time available to deal with our priorities. If it hasn’t been conveyed beforehand, this is also a time to mention any challenges with hearing, vision, memory, or language, and to mention a desire to include a family member or caregiver in the conversation.
Get comfortable and get ready. If possible, sit where it is easy to see and hear the clinician. Now is the time to bring out a notepad and/or confirm that visits can be recorded.
Get a sense of what might be covered in the visit. There may be assumptions about what will be discussed, so rather than diving into each issue on our list sequentially, we can use a summary statement to help set a shared agenda: “There are actually several problems on my mind. Can I tell you what they are so we can see which ones can be addressed today?”
Mention critical forms and refills. Keeping these “must-do” items until the end creates stress for everyone involved, and increases the risk that we will forget them completely.
This process can take less than two minutes, but this “shared anticipation” for what is to come can create the foundation for therapeutic partnership.
Read the next post in the A-S-C-E-N-D series: “S” for Summarize.
Go back to the previous post in the A-S-C-E-N-D series: Introduction.
