Setting the Agenda
Under ideal circumstances, I always take 5 minutes before I meet with a patient to review their chart and recent lab results. This is not only to refresh my memory about patients I may not have seen for many months, but also to see if I need to make any recommendations to the patient. If their MRI looks like it is active, for example, I might suggest that the person change medications. Obviously, my first job is to listen to the patient and respond to their concerns and feelings, but assuming I am not significantly backed up, I try to go into every meeting with an agenda of some sort. Hopefully, I will say that everything seems fine and nothing new needs to be done. But if I do have a concern about some aspect of a patient’s treatment, I like to be prepared.
How a Patient Can Prepare
As much as a possible, I suggest that patients also prepare in advance for their visit and what they would most like to accomplish. My advice to patients is not to simply list everything that is bothering them, but rather to pick one or two things that they feel are the most significant disruptions to their lives. The range of possible symptoms experienced by patients with MS is quite large. It includes fatigue, pain, weakness, stiffness, depression, anxiety, bowel and bladder problems, vision problems, trouble walking, and many others. Unfortunately, even if I had two hours to spend with each patient, it would not be reasonable to try to solve all of these problems in one visit. It is the practice of most doctors I know not to prescribe more than one or two new medications at every visit so as to not overwhelm patients with new medications. Otherwise, if a patient had a side effect from a new medication, it would be impossible to tell which of the medications was causing it.
So while I do feel that patients should mention all of their concerns, they should do in as clear a manner as possible, communicating to the doctor which one or two problems bothers them the most. This allows the doctor to focus on the problems that are most significant to the patient and suggest an intervention that will hopefully lead to the greatest improvement in their lives.