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 framework. Read the first blog post of the series, “A” for Anticipation: Tips to prepare for your doctor’s visit.
- a brief statement or account of the main points of something.
My last post explored the importance of Anticipation, the preparation for a medical visit. This post considers the first moments of the visit, as patient and provider come together, and we begin to create a shared story of what is happening and why.
There are two key areas where the patient and provider must come into alignment to set the stage for a meaningful visit: the goal of the visit itself, and the relevant background information needed to discuss the issues at hand. More than small talk, the introductions and opening questions should summarize the basics of who we are, where we’ve been, and what we hope for in the conversation and any medical treatment.
The goal of the visit
Start with a clear introduction. Beginning the visit with a connection through a handshake, good eye contact, and letting the provider what you prefer to be called, ensures your provider can be focused on you as an individual, not a diagnosis. If you feel unclear about what role a provider plays in your care, how much time you will have in the visit, or what the purpose is, ask at the beginning so that you know what to focus on. This is especially important when the provider is new to you.
Focus the visit. There may be assumptions about what will need to be discussed, so if you have a specific issue to raise, or have multiple issues, speak up. Rather than diving into each issue sequentially, use a summary statement. For example, “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?”
Note critical forms and refills. Be sure to mention any forms that might need to be filled out, and refills you might need. Keeping these “must-do” items until the end creates stress for everyone involved, and increases the risk that you will forget to ask.
Match expectations. Hearing your expectations for the visit helps your provider mentally map out how much time he or she can spend on each issue, and prioritize worrisome issues at the beginning of the visit.
Relevant background information
As we delve into an individual topic, such as a procedure being considered or a new medical problem, you and your provider will also want to summarize relevant background information as a foundation for the discussion. This can mean telling your provider about the timeline of your new symptoms, or how you have been managing a chronic condition.
Bring helpful notes. If you have difficulty remembering details like when things started and how they evolved, bring notes or practice ahead of time so that you can optimize your time with the provider. For people with multiple chronic illnesses, you may want to include a one-page health summary for background. Learn how to make your own one-page health summary here.
Clarity matters. Avoid jumping between topics or time frames. Sometimes a metaphor can help create an image in your listener’s mind, and paints a clearer picture than a long list of adjectives. Patients are never obligated to be interesting, entertaining, or even polite, but our ability to articulate our symptoms and history is the foundation of the care we receive.
Ask for a summary. In a hospital setting, where events are happening hour by hour, you may want to ask the provider for a summary of what has been happening before considering new treatments or making choices. You can ask, “Before we talk about _____, could you summarize what brought us to this point in my specific situation?” Paraphrase in your own words to make sure you understand.
The simple act of summarizing where we have been, before talking about where we might be going, is critical to your safety and your ability to engage the treatment plan. In my work with seriously ill patients, it is often this simple act of describing our journey that helps us heal and gain perspective. Claiming the emotions and events of our past is consistently the first step to a better future.
Coming up next: “C” for Concerns.
Learn how to make your own one-page health summary here.