Good for you-you show up for the appointment on time. Sitting in the waiting room, you can’t help but wonder what lies ahead in this medical and emotional evaluation.
Every doctor has his or her own preferred style and procedures. Here, however, is the general process of evaluation used by one of the authors, Dr. Gardner, in his own practice. It suggests the various aspects of your health that your doctor will review in making an eventual diagnosis and recommending treatment for your situation.
The evaluation begins by establishing a comfort level so information and feelings can be shared openly. You will provide the doctor with information about your medical and psychological history either in written form or by conversation. Included in this information gathering will probably be questions about your age, job, education, and marital status. The doctor will ask about your main complaints and ask you to describe in detail the symptoms you’re experiencing. The doctor will want to know about past or present medical problems along the way, such as surgeries, medications, hormone therapies, supplements, allergies, adverse reactions to medications, family history of illness, habits involving alcohol, tobacco, drugs, over-the-counter stimulants or herbs, date of the last physical exam and any abnormal results, and names of other physicians or professionals who have been consulted.
Next will come a group of questions known as the “review of systems.” These questions are designed to elicit any problems the patient may have forgotten to mention, including weight changes, sleeping problems, heart symptoms, difficulty breathing, stomach or bowel problems, muscle or skeletal pain, and neurological conditions (numbness, tingling, weakness, pain, memory and cognitive difficulties, headaches, and so on).
Often patients have already made a diagnosis and come to the doctor simply for confirmation of what they have already concluded, have heard from a friend, or have learned from books or the Internet. And sometimes patients are right in their diagnosis. But just as often, they are wrong in part or in the whole, with serious implications for their health.
To get a clearer picture of the patient’s condition, the doctor may ask them to fill out a psychological questionnaire or inventory such as the HAM or BDI forms shown in this chapter. Toward the end of the initial evaluation, the doctor will probably explain his initial thoughts and may schedule appropriate laboratory or screening tests. The doctor will also ask for a copy of the patient’s past medical records. A prescription for specific medical treatment may be given on this initial visit, especially if the patient is acutely suffering with panic attacks or is clinically depressed. Or the doctor may prioritize treatment of symptoms beginning with the most threatening or uncomfortable, such as insomnia or headaches.
A complete physical may be scheduled as soon as possible after the initial visit. By this time, laboratory tests from the first visit will have been carefully reviewed. The doctor will explain the results of these tests to the patient and probably give a copy of the laboratory results to the patient to take home. The physical examination itself begins with observation of vital signs (weight, blood pressure, height, breathing rate, heart rate, and temperature) and then proceeds “top to bottom,” looking at the eyes, ears, nose, throat, neck thyroid, heart, lungs, abdomen, back, arms and legs, skin, neurological system, circulatory system, lymphatic system, and, if indicated, the genital and urinary systems.
After the physical, doctor and patient together review what has been learned by putting together all the pertinent information from the health history, questionnaire(s), lab tests, and physical examination. Often, the doctor has sufficient information at this point to make a clear diagnosis and discuss treatment options. However, additional tests may be necessary, such as a heart rhythm monitor, a treadmill test, chest X-ray, abdominal ultrasound, or stomach or bowel imaging studies, just to name a few. The patient may be asked to take time to get an evaluation by a psychologist or psychiatrist. This additional point of professional view can be extremely helpful to the doctor in accurately identifying the problem and clarifying the diagnosis and treatment options.
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