A healthcare appointment can hold a surprising amount of pressure. You may have waited weeks or months to be seen. You may be experiencing multiple symptoms, have a variety of questions, and be looking for space to express your concerns. Once you’re finally in the exam room, you feel the pressure of limited time to address all you had hoped to.
Preparation cannot bypass every limitation of the healthcare system. It is not entirely the patient’s responsibility to make an appointment productive. However, a little preparation may help you use the time you get more intentionally, communicate your priorities, and leave with a clearer understanding of next steps.
How a woman prepares for an appointment with me is likely different from how she might prepare for an appointment with a conventional practitioner. By the time a woman finishes completing the approximately 14 forms that are my new patient paperwork, she has a sense of what to expect, and I have a good foundation of information to work with.
In a shorter conventional appointment, you may need to arrive ready to tell the most important parts of your story first. Here is how I recommend doing that.
Begin with a three-point priority list
Before your appointment, write down the three things you most want to discuss.
Not ten things. Not every concern you have ever had. Start with three priorities that will help you and your practitioner quickly understand why you are there and what you hope to accomplish.
Your list might include:
The symptom that is affecting your daily life the most
A change or pattern you have noticed
A question about testing, treatment, or next steps
This list is helpful whether you are seeing a conventional practitioner or coming to see me. It is also useful to bring any test results you have from the current year, especially if they were ordered by another practitioner or completed through a different health system. Bring an up-to-date list of medications and supplements as well.
You may not be able to resolve all three concerns in one visit. It may mean you and your practitioner decide what to address first and what can be addressed at subsequent appointments.
Track the story of your symptoms
Pattern recognition is everything in functional medicine. We are trained to consider the antecedents, triggers, and mediators of symptoms.
Antecedents are what happened before the symptoms started.
Triggers are what seems to stimulate the symptoms.
Mediators are the things that make the symptoms better or worse.
Timelines are often helpful, too. It is common for a woman to come into the clinic and say, “I haven’t been the same since…” Sometimes there is more than one such occurrence.
Perhaps the change began after an illness, pregnancy, loss, injury, medication change, surgery, period of intense stress, or major life transition. Perhaps it did not begin all at once, but you can identify the snowball that accumulated during a particular time of life.
Before your appointment, consider writing down:
When the symptom began and whether the onset was sudden or gradual
How often the symptom happens and how long it lasts
What the symptom feels like and how severe it is
What makes the symptom better or worse
Whether the symptom changes with your menstrual cycle, sleep, stress, meals, movement, or medication
What you have already tried to address the symptoms and how your body responded
Any other symptoms that tend to occur at the same time
A short, clear timeline can be useful in identifying the antecedents, triggers, and mediators for symptoms.
Ask open-ended questions that stimulate conversation
Asking “Why?” can help you understand the basis for a clinical recommendation.
If a practitioner recommends a medication, test, procedure, or change in behavior, you can ask:
Why are you recommending this?
What are you hoping it will tell us or help us change?
Are there alternative options?
What are the benefits and risks of each option?
What should I expect next?
What should we do if this does not help?
“Are there alternative options?” is an especially useful question because it can help you understand the full range of ways an issue might be addressed, rather than hearing only one.
Asking these questions is not the same as challenging your practitioner. Asking questions is part of shared decision-making, when you and your practitioner work together to discern what is the best choice for you.
"Normal" is not always "Optimal"
Test results are one part of the clinical picture. They are not the entire picture.
A reference range is based on results gathered from a group of people. Oftentimes, reference ranges vary from lab to lab. A normal result, or a result within the reference range provided by any particular lab, may be reassuring, but also may not be optimal for you. Lab results are best understood in context, within a system that includes your symptoms, health history, family history, physical exam, and changes over time.
For example, a fasting blood sugar of 98 mg/dL falls within the standard reference range. I may still want to look at it in the context of a woman’s previous results, family history, symptoms, hemoglobin A1C, and other metabolic markers. The number does not automatically mean something is wrong, but “normal” does not necessarily mean there is not a conversation to be had.
Thyroid testing offers another example of how normal may not be optimal for an individual. If a woman’s test results fall within the reference range but her symptoms seem thyroid-driven, I consider the larger clinical picture. Sometimes intervention is warranted, even when test results are normal.
When reviewing test results with your practitioner, consider asking:
What does this result mean in the context of my symptoms?
How does this result compare with my previous results?
Is there a trend worth tracking?
Could anything else have affected the result?
Do we need to repeat the test or look at other markers?
The goal is not to interpret every number on your own. It is to have a conversation about what the results mean for you.
Leave with a clear next step
Before the appointment ends, make sure you understand - and are in agreement with! - the plan.
You might ask:
What am I doing next?
When should I expect test results?
Who will contact me about them?
When do you recommend I follow up?
What changes should indicate the need for emergent care?
If the plan feels complicated, repeat it back in your own words: “I want to make sure I understand. First I will do this, then we will review the results, and after that we will decide whether to do that. Is that right?”
You can also take notes or bring a trusted person who can listen, ask questions, and help you remember what was discussed.
If you leave feeling unheard
Sometimes, even when you prepare carefully and communicate clearly, you may leave an appointment feeling dismissed, disrespected, or unsure what to do next.
If something is unclear, you can contact the office and ask for clarification. But if you were not listened to or treated with respect, document what happened. Write a letter to the practice manager detailing the experience and share it. If this is an ongoing problem, find a new practitioner.
The patient-provider relationship is integral to good outcomes. Working with someone who listens, whom you trust, and who meets you where you are creates an environment for change and growth.
Bring realistic expectations—and expect a real relationship
One of the most important things you can do is have realistic expectations of the practitioner you are seeing and what can be addressed in the allotted time.
None of us can do it all. Good healthcare often requires a team and ample time to address multiple concerns. One appointment may be the beginning of a process rather than the moment when every question is answered.
Remember, too, that most practitioners enter healthcare because they care and want to help. The healthcare system often precludes the delivery of what might actually feel like health care.
You do not need to arrive with the right diagnosis or a perfectly organized medical history. Your role is to bring the clearest version of your experience that you can: what matters most, what you have noticed, what you want to understand, and what you need help deciding.
Be an active participant in your care.
A Simple Appointment Checklist
Before
Choose your three priorities.
Write a short symptom timeline.
Gather recent test results.
Update your medication and supplement list.
Write down the questions you most want answered.
Consider bringing a trusted person for support.
During
Lead with your three priorities.
Describe antecedents, triggers, and mediators.
Ask “Why?” and “Are there alternative options?”
Take notes.
Clarify what happens next.
After
Review the plan and complete the next steps.
Follow up if results or instructions are unclear.
Document an experience in which you felt dismissed or disrespected.
Seek a second opinion when you do not feel heard, respected, or confident in the plan.
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As with all of my articles, blogs, social media posts, etc, this article is educational and not a substitute for medical care. Please check with your clinician before changing your routine.