Here’s how to make the most of your appointment
February 2010
After more than 16 years as a practicing cardiologist at Cleveland Clinic, Curtis Rimmerman, MD, MBA, knows well how important it is for patients to arrive at their initial cardiology appointment with a health history and list of medications in hand. That’s one of the reasons why he wrote The Cleveland Clinic Guide to Speaking with Your Cardiologist (Kaplan Publishing, 2010): to help patients overcome anxiety and establish a good relationship with their physician.
“As with any life challenge, preparation increases the odds of a successful outcome,” says Dr. Rimmerman, who holds the Gus P. Karos Endowed Chair in Clinical Cardiovascular Medicine.
In the following excerpt from his new book, Dr. Rimmerman discusses what to bring to the first appointment and what to expect when you get there.
What Is Your Chief Complaint?
The first subject you and your doctor will discuss is your chief complaint. This includes your reason for making the appointment and a description of what is bothering you. (Even if you tell your story in sweet and even tones, doctors still call this the “complaint.”)
The chief complaint is a brief description of why you’re seeking medical attention. The physician will usually start with an open-ended question such as “Why are you here?” or “What prompted you to make this appointment?” to elicit this important initial information. From here, the physician can quickly raise additional questions whose answers will help him delve more deeply into your health concern.
It is an unfortunate but necessary fact of life that appointment time is finite. Anything you can do in advance to speed the exchange of information during your visit will pay dividends because it will allow the physician more time to ask the insightful questions that home in on what your symptoms might mean and more time for the physical examination. It will also allow more time for discussion of your treatment plan, medications, and any testing that is planned.
Knowing your chief complaint may seem simple—after all, you know why you made your appointment—but it’s often easier to know how you feel than to state it.
For example, I recently saw a patient named Rick, whose chief complaint was “not feeling well.” When I asked why he was seeing me, he reiterated, “I just don’t feel well.” I followed up, asking him, “What do you mean?” He repeated the same answer.
This is an example of a chief complaint that hasn’t been well thought out. It required additional questioning on my part to extract information. Many patients reply with one-word answers, creating a time-intensive process of information transfer. I am happy to spend time with a patient, but I would rather spend it getting through the preliminaries quickly so that there is more time for serious discussion of the condition and possible treatment plan.
Eventually, I was able to put the pieces of Rick’s puzzle together. He had been experiencing fatigue, shortness of breath during physical activity, and central chest pressure for the past three months, increasing in both severity and ease of provocation. Getting to the root of his chief complaint took about 10 minutes of valuable appointment time.
Had Rick been able to communicate his chief complaint succinctly, we would have accomplished much more during the visit. Such a summary might have gone: “For the past three months, I have been fatigued, short of breath with activity, and have been noticing pressure in my chest when I walk my dog. These symptoms have been getting worse over time.”
With the time saved, we could have delved more deeply into eating habits and a weight-loss strategy and discussed approaches that would help him quit smoking.
Be Sure You “Complain” Succinctly!
Here are a few examples of a concise chief complaint:
- I’ve had shortness of breath for the past three months.
- For three weeks I’ve had chest pressure when I exert myself, with a simultaneous pain in my left arm.
- I’ve noticed central chest pressure that travels to my throat and left shoulder each time I take my dog for a walk. This has been occurring over the past month and has been increasing in both severity and frequency.
- Over the past two weeks, I’ve noticed an extremely rapid heartbeat occurring out of the blue, along with light-headedness and near fainting.
- I can’t breathe the way I used to, and I’ve gained 20 pounds over the past few weeks. My ankles and feet are twice their previous size.
- Over the past year, I’ve noticed progressive shortness of breath and reduced ability to perform my daily activities, such as grocery shopping and climbing stairs. My waist size has increased by four inches, but I don’t think my calories have increased significantly.
Excerpted with permission from The Cleveland Clinic Guide to Speaking with Your Cardiologist by Curtis Rimmerman, MD, MBA. Published by Kaplan Publishing, © 2010 Curtis Mark Rimmerman.
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