by Leslie Kernisan, MD MPH
Here’s a situation that comes up for many people: Your older mother — or father, or other older relative has or is moving to a new town.
Maybe it’s to an assisted-living facility near you. Maybe it’s to another location where she decided she’d like to age-in-place.
Such a move means that she’ll need to establish care with a new primary care doctor.
For most older adults, establishing a good working relationship with a new doctor is a challenge. If nothing else, it can take some time to feel that each party knows and understands the other.
But it’s also in many cases a terrific opportunity to review a person’s health and healthcare. Provided, of course, that everyone involved makes an effort, and has good information to work with.
Useful health information that you should bring to that first visit with the new primary care doctor.
Do you have to bring this information? Of course not. In my own experience, most people bring nothing more than a medication list, if that. And they leave it to the new doctors to request health information from the previous doctors, which often arrives well after that first new patient visit.
But this is a problem, because it makes it quite difficult for that first visit to be truly useful.
Sure, the doctor can interview your loved one, and do a physical exam. Yet for many older adults, that interview and exam is often much more productive if a doctor can combine it with a review of the most useful health information.
I myself used to see a fair number of new older patients, when I was a primary care geriatrician at the Over 60 Health Center. Those first visits often felt like fumbling around in a dark room, feeling the walls and furniture and trying to get a sense of the overall layout.
But occasionally, a new patient would come with useful health information in hand. This generally made a big difference in how quickly we could ensure that our new patient was getting the right medical care from us, and from other involved doctors.
So if you want to help your older loved one have the best start possible with a new doctor, you’ll need to do a little advance preparation. This often requires some time and energy. But it will pay off, by ensuring that the new doctor has the information he or she needs, to provide your loved one with good healthcare.
10 Useful Types of Medical Information to Bring to a New Doctor
Here’s my list of what I ask patients and families to bring to me, in order to make that new patient visit most useful.
This list is especially suited to the primary care of aging adults with chronic medical problems. But most of this information can come in handy for first visits with specialists. It can also be very useful to clinicians in the emergency room, or at urgent care.
Note: If you or your loved one have been maintaining a personal health record, this is the type of information that I hope you’ve been keeping in your personal health record!
- List of chronic health conditions. This would include any conditions that your loved one currently sees a doctor for. Bonus points if you include the year the condition was first diagnosed, or any other major milestones related to the disease. You can also include major past problems which are no longer being actively treated.
- Medication list. Be sure to list all prescribed medications, along with any over-the-counter medications and dietary supplements. Also helpful:
- Highlight any new or recently started medications;
- List any recently stopped medications (e.g. from the past 6 months);
- List any medications you believe have been problematic in the past.
- Laboratory results. Most commonly these are results from blood tests and urine tests. Any lab results from the past 1-2 years will be helpful.
- Specific tests that are likely to be useful include:
- Complete blood count (CBC)
- Electrolyte panel, which usually includes sodium, potassium, chloride, CO2
- Renal panel, which usually includes creatinine and blood urea nitrogen (BUN)
- Thyroid function tests, such as thyroid stimulating hormone (TSH) and/or free thyroxine (FT4)
- Do bring any lab results you have. It is useful to see what other doctors have ordered and checked.
- Do bring results from different dates if at all possible. Lab results are much more useful when a trend or context can be evaluated. In many cases, comparing the latest results to previous results is extremely useful.
- Radiology and imaging results. This includes x-ray reports, ultrasound reports, CT scans, MRIs, etc. Reports from the last 1-5 years are especially useful.
- Other medical diagnostic reports. These might include pulmonary function tests, EKGs, cardiac catherization reports, biopsy results, neuropsychology evaluations, and so forth. It’s especially useful to have reports that are related to the diagnosis or management of a current chronic condition.
- Hospital and emergency department reports. Try to get a copy of the narrative reports that clinicians create when a person comes the emergency room, or is hospitalized. Note: this is not same report as the patient discharge instructions that are always handed out.Usually you have to file a medical records request to obtain the narrative summaries that are most useful. Specific examples of useful reports include:
- Emergency room clinical note. This is the note dictated (or typed) by the emergency room doctor who managed your loved one’s visit.
- Hospital Admission History & Physical. This is the note dictated by the admitting doctor, when a person is initially admitted to the hospital.
- Hospital Discharge Summary. This is the note dictated by a discharging clinician, when a person is discharged to home or rehabilitation. It usually summarizes the patient’s hospital course.
- List of involved clinicians. List the doctors and healthcare providers who were previously involved in your loved one’s care. I often learn about important problems by finding out just why a person was seeing a given specialist! For each specialist, it’s helpful to know when your loved one established care, and how often he or she had been seeing each provider.
- Primary care provider
- Medical specialists, such as cardiologists, pulmonologists, urologists, neurologists, etc.
- Behavioral medicine clincians, such as psychologists, counselors, and therapists
- Skilled nursing facility doctors, if relevant (meaning, your loved one is currently at the facility, or recently was discharged)
- Other skilled medical therapists, such as for physical, occupational, or speech therapy
- Any other health professional who is significantly involved in your loved one’s care.
- Clinical visit notes. Visit notes written by the primary care doctor, and the medical specialists, can be useful. At a minimum, try to get a copy of the last note.
- I recommend starting by requesting notes from the last 3 visits, or the last year. If it’s easy to get more notes from each provider, you can do so as well.
- List of other providers of supportive or eldercare services. Have you or your loved one been getting help from a care manager? In-home aides? A patient navigator? A good primary care provider should be interested in knowing who has been involved, and what kind of help they’ve been providing.
- Advance care planning documents. These include any advance directives, living wills, pre-hospital DNRs, and/or POLST (Physician Orders for Life-Sustaining Treatment)forms.
How a Personal Health Record Can Help
That’s a long list, right! Well, you probably won’t be surprised to hear that so far, I’ve had very few patients arrive with most of this information.
But this is the medical information that we doctors should know, in order to provide your family with better care for your aging loved one.
The ideal process, of course, is to collect medical information into some kind of personal health record system as you go along, so that you have all the information handy if your loved one ever needs to switch doctors. So for instance, every time you or your loved one gets a blood draw, you would ask to get a copy of the results, and then you would file these results in your paper or digital personal health record. (For more on how to maintain a personal health record, see this post.)
But if you haven’t been maintaining a personal health record, an older loved one’s switch to a new doctor is the perfect time to start one.
So if you have the time, energy, and interest in being proactive, gather up this information and bring it to that new patient visit. Your new doctor will hopefully thank you, and your older loved one should be able to get better healthcare.