The Joys of Taking Notes on an Exam Table

I appreciate the great tips in how to get a handle on medical visits, from Monday’s post, especially the suggestions about advance preparation and using email. Anna’s description of how she makes sure she has something hard to write on while taking notes in her hospital gown sounds something like a description of a newspaper reporter covering a fire, making sure not to let the smoke or water or wind interfere with her taking notes so she can write her story later. I think this is in line with what one of the doctors at my short-story session was getting at when he advised asking tough follow-on questions. What he was really saying is what Anna is doing—showing persistence and doggedness in an unwelcoming environment.

I was also reminded by her comment of a pet peeve of mine—the failure of practitioners to review a patient’s records before a visit. Just as patients should come in with a list of questions, practitioners should also have some questions based on a patient’s record.

I was struck when I visited my internist a couple weeks ago and she asked me about whether I was still under as much stress as when I last saw her in February. I had forgotten that I had mentioned it, but I realized the question was driven by her concerns that my blood pressure had been up a little then.

Unfortunately, such followup was the first time something like that had happened in a long time. Anna’s account of how she found entries for another patient in her records only confirms fears I have long had that our medical records are not only under-used, but misused, whether intentionally or unintentionally.

Two issues that stand out in all this:

1. On medical records, there is a move afoot to give patients greater control of their data. I wrote some months ago about the efforts of AOL founder Steve Case to launch a company based on giving patients direct and regular control of their records by providing an online database tool.

2. I sense there are wide disparities in how the patient-physician communication problems play out within the conventional system and the complementary/holistic systems. Even allowing for the problems Linda Diane Feldt sees in her practice, I suspect they pale next to the problems that play out in most MD’s offices. And a lot of that has to do both with patient and physician motivations over payment. Not only are insured patients not paying directly for each service, but MD’s feel under-compensated for each service. For holistic providers, the scenario is much closer to fee for service, giving each party much more motivation to succeed.

Yes, there’s a huge education task ahead. It’s just much more of an uphill battle within the context of managed care.

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Pete Kennedy, a lawyer with the Weston A. Price Foundation, reports that a proposal before a dairy industry trade group to outlaw herd share programs has been tabled, making it moot for at least a few years.

And if you thought the U.S. and Canada were alone in their paranoia about raw milk, fear not. Saudi Arabia is cracking down on raw camel’s milk. Thanks to Don Neeper for the link.