How to Make Your Visit to the Physician Successful? - Juniper Publishers

Juniper Publishers- Open Access Journal of Case Studies

How to Make Your Visit to the Physician Successful?

Authored by Ahmed Nouri

Opinion

A doctor’s visit is known as a meeting between the patient and the doctor for medical advice or treatment for a patient’s illness. In fact, there are many reasons that require a patient to visit a doctor, such as visits to follow a chronic illness, to conduct routine tests, visit for the first time because of an emergency health problem, or many other reasons.

The continuous increase in the number of patients relative to the number of doctors requires doctors to reduce the length of visit available to each patient. According to a study conducted in the United States of America, it was found that one doctor meets between 50-100 patients per week and may vary from one specialist to another. A survey in the United States showed that the doctors see patients for 13-16 minutes, and anesthesiologists, neurologists and radiologists spend more time with patients at a rate of 25 minutes or more. In contrast, the general physician spends 15 minutes with each patient, while the dermatologists and ophthalmologists have the lowest share, where the patient spends an average of only 9-12 minutes. The study also showed that female doctors had higher length of visits compared to male doctors.

This limited the time available to each patient to spend with his doctor and time must be invested in the best way possible to obtain the necessary health care. Therefore, the patient must prepare for this visit to get the benefit without wasting time. Although the patient will not be at his best in the doctor’s office, we will show you how to succeed in your visit to the doctor and prepare for her without having to go back again.

First: How do you prepare to visit a doctor?

If you are suffering from a certain condition for the first time, do not assume a specific medical specialty and go to it, such as an orthopedic specialist or kidney specialist, but go to a general practitioner or family doctor and he will examine the situation and do referral to the appropriate specialist if necessary, this will save the patient from choosing the wrong jurisdiction which will reduce the required cost.

If your visit to the doctor is to follow a previous medical condition, the patient should prepare to present a summary of his/her condition in the period following the last visit with the doctor. This summary should include the extent of the condition of the disease and the appearance of any new symptoms, severity and time and association with any activity or action, the extent to which the patient is satisfied with the treatment plan and its results. On the other hand, if the patient is monitoring a particular test at home, such as blood pressure, sugar level or other, the patient should record the results and times and bring the record with him when visiting the doctor.

It is also important to take a trusted companion with you. A person accompanying you during the visit will help and support you, especially if you are experiencing a complicated diagnosis or bad news, or if you are uncomfortable with doctor visits in general, and help you describe your condition. On the other hand, this person is an additional ear and eye that helps you to remember what the doctor says. Some studies see that the patients do not remember more than three things the doctor said during the visit, and many doctors confirm this, especially if the doctor tells the patient a bad diagnosis. This is why many doctors ask patients to bring someone else with them to visit while receiving such news. Conversely, having a person with you during a meeting with your doctor may cause embarrassment and negatively affect your communication with your doctor, and may prevent you from disclosing uncomfortable or personal matters, so you should choose the right situation for you.

Second: What do you do during a doctor interview?

When you visit your doctor, you will be asked several questions about your health condition, and then you will have a clinical examination and a laboratory examination if necessary to reach a possible diagnosis, after which the patient will be given appropriate treatment. It is important during this process that the doctor to educate the patient about his condition, and its causes, complications, and how to treat and follow up and prevent recurrence. Here are some questions that the doctor may ask the patient and how to provide an appropriate answer:

The doctor will first ask about the reason for the visit: “Why are you here?"

Talk about your situation and provide a basic description of it in a sentence or two sentences as much as possible. Then talk about the symptoms, when and how often they start, whether there is more or worse, and whether a member of your family has similar symptoms or the same problem. To better describe your situation, consider several things:

a) Description: Do not say "I suffer from pain" but use specific words, such as: light, sharp, or pulse, to describe the nature of pain more precisely, or use a scale of one to ten to determine the degree of pain intensity. Describe where you are experiencing, mention the area, point to the area, or take a picture of rash or other.

b) Describe the effect of symptoms on your daily life. Instead of saying "I do not do things as I did before", describe things from the reality you live. "I sleep for 3 hours a day!" Or "I cannot walk to the next shop "Or" I cannot stand for more than ten minutes".

c) Patronize the truth without hiding any information. Although the patient is the one who came to visit the doctor himself, honesty is one of the most important barriers between the patient and the doctor, so if you smoke, drink alcohol or other harmful behaviors, tell your doctor. Remember that your dialogue with the doctor is a private and reliable dialogue that is aimed at your health, so it is important that your doctor is fully aware of your condition from all sides to reflect this on your benefit.

Do you suffer from other diseases?

Here you should mention your medical history, which means any cases or diseases you have previously suffered and treated, such as: asthma, diabetes, high blood pressure and others. You should also indicate whether you are allergic to a particular food, medicine or substance. If you visit several doctors, tell information from a doctor to another about your condition, so that they take care of those things during your diagnosis and treatment.

Does one of your relatives have a similar condition, or what is the family history?

The doctor here means your first-degree relatives, the father, the mother, the brother, the sister, the children, and the diseases they suffer from, such as heart disease, diabetes, cancer, and other diseases that may be associated with your condition.

What medications do you take?

The answer to this question should include medically prescribed medicines, non-prescribed medicines, dietary supplements, and herbal medicines taken by the patient. It is best to bring the patient all the drugs used by each visit to the doctor, so that the doctor can know the doses and names of medicines and pharmaceutical forms, where it is difficult for the patient to remember this amount of information. This also includes medicines that you have previously taken in the late period of your visit to the doctor.

Do you have any questions?

Usually the last question the doctor asks the patient, and the most important question in the interview because the conclusion of the interview. Do not hesitate to ask for clarification of anything you did not understand. There is no place to be embarrassed when it comes to your health so ask and ask for advice without any hesitation! If you feel that you need to reject something, do not hesitate to contact your doctor, so that you do not give up the treatment later. Because this may lead to a relapse or worsening of your condition. If you refuse a treatment, the doctor will clarify this; review the reasons for rejection and talk about it and how to make it easier for you.

The pharmacist is the last person you meet with your health care professional before your visit. He dispenses medicines and provides advice and instructions for each treatment you have been prescribed. He will review each drug compared to your medical history, check for interactions and dosing. Also, he may ask you about your nutrition, do not wonder why the pharmacist is asking me questions. Therefore, cooperate with the pharmacist as much as possible as the knowledge he will deliver is of high value regarding your medicines. And remember, your medicines are tool for the relief of your condition. If you feel that you have forgotten anything, do not hesitate to consult your pharmacist directly.

Finally, always remember that treatment and a successful medical visit may not require all the information you have prepared, but it will be easier if you prepare this information. Your relationship with your doctor is the key to making your visit a success. The success of the visit is the key to your treatment.

 

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To Medical Oncologists: Can We Safely Trust and Recommend the Robot Assisted Radical Prostatectomy? - Juniper Publishers

 Juniper Publishers- Open Access Journal of Case Studies

To Medical Oncologists: Can We Safely Trust and Recommend the Robot Assisted Radical Prostatectomy?

Authored by Georges El Hachem

Opinion

Widespread screening using serum prostate specific antigen (PSA) and digital rectal exam (DRE) resulted in an increased incidence of early diagnosis of prostate cancer. The surgery remains the mainstay treatment of early localized prostate adenocarcinoma, especially in young population. Radical prostatectomy can be performed via an open surgery requiring a large vertical incision or via a minimally invasive technique consisting of laparoscopic radical prostatectomy (LRP) or robot assisted radical prostatectomy (RARP). The main risks and complications of any radical surgical procedure are the bleeding and infectious risks, the post-operative recovery (pain, hospital stay) and most importantly the oncologic outcomes (to have negative margins and complete radical excision of the tumor, to avoid recurrence, to improve survival). Besides, radical prostatectomy has other specific complications related to the anatomic localization of the prostate gland: erectile dysfunction, urinary incontinence, urethral strictures and impotence. Thus, the least debilitating surgical procedure associated with an excellent oncologic control without affecting the quality of life remained a challenge for many years especially that the results of the minimally invasive LRP weren't so promising at the beginning.

In this perspective, the United States (US) was the first to develop the computer-assisted technology, initially used in military battlefield applications then adapted for civilian use. This technique consists of inserting the "robotic-assisted instruments" through several small abdominal incisions. The surgeon will control these devices assisted by a computer system, which is a sophisticated device allowing a high dexterity and intuitive movements, as well as an excellent 3-D vision with increased precision due to filtration of the hands' tremors. So, the procedure is performed by a surgeon, not a robot, using a computer-assisted device. The term robotic surgery is only used in place of "computer assisted". Initially, the publications concerning RARP were limited, until it has become a well-known technique and gained a higher acceptance in the US and Europe [1]. When it is performed by a well-experienced and trained surgeon, RARP has many advantages over radical prostatectomy that are similar to LRP: smaller incisions, faster healing time, less pain and less risk of infections. However, the robotic surgery has also advantages over the laparoscopic intervention: more precise, more comfortable for the surgeon, less intra-operative time, shorter hospital stay, less bleeding and transfusion requirements, better functional outcomes including a better recuperation of the continence and erectile functions [2-5]. Novara et al. underwent a systematic review and meta-analysis of studies reporting the oncologic outcomes after robot assisted radical prostatectomy: the positive margins rate (PMR) was similar following open radical prostatectomy, LRP and RARP [6]. The PMR was identical between LRP and RARP in a study done by Rozet et al. [7]. The problem is that the studies directly comparing LRP vs RARP are few in the literature because it is difficult to perform a prospective randomized trial for minimally invasive prostatectomy. Although most studies were designed as case-matched control studies, the RARP showed promising results concerning the biochemical recurrence free survival (BCR). Porpiglia et al. [8] published in 2013 their randomized controlled trial comparing laparoscopic and robot assisted radical prostatectomy revealing a better potency and continence control in the RARP group [8]. Thereafter, they reported the 5-year outcome of their prospective trial confirming the better functional control and patient satisfaction with RARP with similar survival results: no difference in terms of survival and BCR [9]. All the previously reported benefits were once more seen in the results of the large systemic analysis done by Basiri A et al. [10] Nevertheless, the main disadvantages of the robotic surgery are the high costs of the procedure itself and of the computer devices maintenance. Moreover, it remains operator dependent and is being only available in high volume centers with multidisciplinary robotic usage. This problem was well addressed by Peter Albertsen [11] when he published a manuscript entitled "Robot-assisted Radical Prostatectomy-Fake Innovation or the Real Deal?", emphasizing on the new healthcare costs and the new practice changing economies [11].

In conclusion, the robotic - computer assisted radical prostatectomy is becoming more and more popular. It is a promising technique with excellent functional results and excellent oncologic outcomes. Further trials and prospective studies are essential to confirm its survival equivalence-benefits. Despite its rapid propagation, it is still a highly expensive procedure where the successful results depend on the surgeon's skills in large volume centers. As oncologists, I think we can approve the RARP indication during the multidisciplinary team discussion in tumor boards. If the patient is a candidate for mini invasive procedure, two other main conditions should be fulfilled to undergo "a safe” robotic surgery: to have a skilled well trained colleagues' urologist and to be able to afford the procedure financially.

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