"No questions are silly questions in doctor visits"
It is a good idea to prepare for your doctor visits, maybe by writing notes over time. These are rheumatologist Lotta Ljung's tips on what patients can do to get what they need from each visit. An idea might be to use the Elsa app to log your everyday life. It makes it easier to remember what you want to discuss, check and mention when you meet your health care provider.
Who are you?
My name is Lotta Ljung and I have worked in rheumatology for almost 25 years. I work with the Swedish Rheumatology Quality Register, SRQ, with quality and digitization issues and have my clinical operations in Örnsköldsvik as a rheumatologist at a surgery. I have always felt it is especially interesting to work with patients with chronic diagnoses. We can build relationships with patients and we follow up with them over time. Rheumatology affects a wide spread of ages and includes both common and unusual diseases. Finding the right diagnosis and treatment can be a detective job. And that all attracts and motivates me!
What does a day at your clinic look like?
A large part of my mornings in the clinic consists of patient visits. The afternoon is more focused on telephone contacts, emergency visits and administration. It can be easy to forget that the administrative time is also all about helping the patients. I go through referral responses, write certificates, go through X-rays or test results and respond to letters or emails from patients. Sometimes you may need to discuss with colleagues when there are issues that concern other areas.
What is your focus during a consultation?
The main focus for me as a rheumatologist is overall to find out the answer to the question “How are you?”. It then depends on what kind of consultation it is. It could be a new visit, a scheduled return visit or a visit that has been scheduled at short notice because the patient is not feeling well and maybe considering changing their medication or needing a joint injection.
My primary role as a rheumatologist is to be responsible for the patient's drug treatment and to ensure that it gets the best possible results. So if the patient has an ongoing drug treatment, we always talk about how the medication is working. How does it feel, are there any side effects or any other concerns about the drugs? The things that come up during visits can be very varied. It usually depends on the situation. I will ask an open question like "is there anything you have thought of that you want to raise with me?" or "is there anything else you would like to know?"
It’s important to ask questions
It is so important to have a concrete dialogue about what is important to you as a patient. Try to be open, ask questions and share your thoughts. No questions are silly questions. For example, you might have concerns about your treatment. Maybe you have read something about a drug, heard from acquaintances or someone else. It is important to say what’s on your mind! Then you can have an open, trusting relationship and talk about it in a good atmosphere. There may be things that gnaw at you, and worry is not good for anyone. It’s best not to let worries affect your life, so let’s sort things out together.
In addition to the drug treatment, conversations during consultations can also touch on life at large. How is everything going, and is the condition affecting anything?. I often talk to my patients about smoking and physical activity and can, if necessary, direct a patient to my co-workers. You might need help getting your everyday life to work; things like managing fatigue, sleep and stress.
How can I, as a patient, get the most out of my doctor visits?
Ideally all patients would think about what they would like to talk about before seeing the doctor. It creates the conditions for a good meeting where the patient truly gets what they want. A good tip is to write down thoughts, questions or things you would like to happen or know.
What does my everyday life look like?
How is it going with my job? Daily activities? Exercise? Travel?
Is your condition something my family is talking about?
What can I handle and is there anything I can't do?
Do I have any concerns about my treatment?
Is there anything the doctor can help me with?
Do I want to get in touch with an occupational therapist, orthopedic technician, counselor or physiotherapist?
Do I need a referral or a certificate?
A good tip is to prepare for each meeting. Write down thoughts, questions or requests. Prepare your notes and share them at the beginning of the session so we can deal with your questions and thoughts first, or at least plan the meeting according to what is important to you. It is important that you as a patient feel you receive the information and help you need to live the life you want.
It can be hard to be sick, be on medication and feel limited and then have to "obey” the advice you’re given. It is important for the patient to be their own boss and be able to decide things for themself. As a doctor, I am becoming more and more of a consultant in my patient relationships. The longer a person has had the disease, the more their own knowledge increases, and the more I as a physician becoùe more like someone they can check things with.