Guest Author - Heather C. Guidone

We´ve all been there: draped in a tiny, paper gown with our clothes (and our dignity) in a little pile on the chair next to the cold, uncomfortable table we wait (and wait - and wait) for the doctor on.

When the doctor finally arrives for your allotted 15 minute visit, you try to cram as much information into one sentence as you can - all while enduring invasions from cold speculums and other instruments of torture. When the pelvic exam is over, the doc stands up and announces cheerily, "everything looks great! See you in 6 months!" You get dressed and wonder if he actually heard any of your questions, concerns or complaints of pelvic pain, irregular bleeding, medication intolerance, etc. You go home feeling worse than you did before you got there, wondering if you will ever get help from the medical establishment.

So how do we become partners in our healthcare, choose the right physicians - and get them to listen? Believe it or not, it is possible!

First, Select a Doctor
OB/GYN is the discipline that treats reproductive health issues. The best doctor referrals seem to come from word of mouth. Talk to other patients and find out who their doctor is, what they think of him/her and if they would feel comfortable recommending you. If you are going for specific concerns such as fibroids, Endometriosis or other illness, consider contacting Support Groups in your community, search internet message board communities for positive references, call your local hospital, state medical board and even the AMA if you need to. Seek and ye shall find a practitioner to suit your needs.

Get to Know Your Doctor´s Capabilities
It is important when selecting an OB/GYN that you are aware of his/her capabilities. Some questions you may want to bring along with you to the appointment include:

How much of your practice is dedicated to obstetrics? How much to gynecology? This can be helpful in determining whether or not your doctor will be sent off to the delivery ward during your appointment time!
If you are there for a specific illness, ask your healthcare provider how familiar s/he is with your disease. How many similar patients do they have? Do they keep up on the latest information surrounding the disease?
Also ask if you have access to all of your medical records at any time you wish.

Other things to consider
Do you feel comfortable talking with the doctor? Do you think that you will be able to be an active partner in your healthcare with that particular provider, or do you feel as though "they are in charge?" There is a long-standing joke in many patient circles: "what´s the difference between God and a doctor? God doesn´t think he´s a doctor." If your physician gives the impression that you will have no say in your treatment, then they are probably not the doctor for you.

If you have medical concerns outside of a well-woman check-up and you´re not already diagnosed... ...tell your doctor what you are feeling. Take a list of your symptoms and even a pain journal with you to the visit. Make sure all of your concerns are addressed.

Remember that you are both human beings; don´t place any unreasonable expectations on yourself or the doctor. By working together, you can successfully manage your health.

As outlined above, it is helpful if you go to your appointment with a prepared set of questions to ask, a pain journal or diary of any symptoms you may be experiencing. Following are some examples of questions to consider when meeting with your doctor for the first time, questions to ask regarding surgery or other procedures, and a sample pain journal which you may want to adapt for your own usage.

When Meeting for the first time
Do you have medical records from previous physicians throughout your treatment? Bring them.

Explain why you are there. What are your symptoms, concerns, fears? How long have you been experiencing these problems? Be specific.

Don´t be afraid to ask questions
Indicate that your wishes to be a partner in any treatment plans. When discussing options, always ask what else is open to you and choose the option you feel most comfortable with.

Gyn Surgery Questions

What is the reason for my surgery?
What exactly will be done during the surgery? For instance, if the surgery is a hysterectomy, will it be total or partial? Stress your wishes prior to surgery and put in writing what your understanding is...if you are going for a diagnostic laparoscopy and do not wish to wake up with a hysterectomy done without your permission, let them know that!
What pre-op procedures will be done? Do I need to store some of my blood? What type(s) of incision(s) will be made?
What type of anesthesia is being used?
Am I at high risk for any complications? If so, why, and what are they?
How do you expect to deal with any unforeseen complications, should they arise?
How much pain can I expect to be in post-operatively? How can I lessen the pain? What are my post-op restrictions?
Will I have bowel or bladder problems afterwards?
Who will be in the operating room to assist? What specific capabilities will they bring to the surgery?
When can I expect to return to work?
When can I expect to engage in intercourse?
When can I expect to return to my exercise regimen?
Are there post-op food or liquid restrictions?
Will you be provided with a prescription for painkillers prior to surgery, so you don´t have to fill it on your way home from the hospital?
How can I help to prepare my body and myself for the surgery?
Remember, you will get basic answers to all of these questions and the others you think of...no two patients are alike and so the answers cannot be assumed to be the standard for everyone.

Medical Therapy Questions

What is the reason for placing me on this drug?
What exactly will this drug therapy accomplish? For instance; is it for pain relief, or is it therapeutic?
What side affects am I at risk for? i.e. fatigue, weight gain/loss, loss of libido, mood swings, physical changes, etc.
Are there any food, liquid or other drug interactions? Any other contraindications?
How long is the course of therapy? Can I stop anytime?
Will this therapy be followed up by therapeutic surgery or other method of disease maintenance?
Again, you will get basic answers to all of these questions and the others you think of...no two patients are alike and so the answers cannot be assumed to be the standard for everyone.

Keeping a Pain Journal
This might be helpful in documenting your pain and being able to relay your situation to your doctor.

Some words to describe pain:

dull ache
itching
cramping
constricting
burning
stabbing
nagging
pinching
shooting
throbbing
Think about how much pain affects your daily activities.

How much pain do you have on an average day?
How often do you have the pain?
Is there any time of day that the pain is worse?
Do any activities set your pain off?
Does the pain come and go?
What helps alleviate the pain?
How upsetting and disrupting is the pain to you?
Does pain interfere with your personal routine? i.e.. brushing your hair, eating, getting dressed
In your pain journal, try keeping track of when you experienced the pain and the level of pain experienced. For instance:

Use the following ratings to gauge your pain: 1-mild, 2-moderate, 3-distressing, 4-horrible, 5-unbearable EXAMPLE:

TIME OF DAY PAIN OCCURRED: 4 p.m.
PAIN RATING: 3
WHERE WAS THE PAIN: lower right quadrant
WHAT WERE YOU DOING? reaching for something
DID YOU TAKE PAIN MEDS? HOW MUCH: none
WHAT WAS THE PAIN RATING AN HOUR LATER? 2
Hopefully, some of the above guidelines and examples will assist you in finding a great Gynecologist, who will partner with you to successfully manage your reproductive health!


Note: Portions of the above "Pain Journal" are adapted from St. Vincent´s Medical Center Patient Guide. (c) copyright 1997 by St. Vincent´s Medical Center.

By Heather C. Guidone © All Rights Reserved.