Why your new doctor asks a lot of questions

Last time I wrote, I reviewed some questions that a patient might consider at a first visit with a primary care provider. As health care providers, we also have questions and concerns when we first meet patients. Most of us are good at asking questions. We are not always so good at explaining why we‘re asking the questions.

We may ask some questions on a registration form before a new patient visit. These would include such as personal and family health history and health habits. A provider or assistant might review that with you at the visit to clarify details. It‘s okay if you don‘t have every detail: It‘s not a test, and we have time down the line to fill in gaps.

Then, there‘s that yes and no check-off sheet with everything from sniffles to chest pain, known as the Review of Systems. Again, we want you to be honest. If you checked “yes” on a lot of these, please know that we may only be able to address them a few at a time. We may have to spend part of your visit together making a priority list.

Many providers will also ask you about smoking history, use of alcohol and other substances, exercise, nutrition, religious or spiritual preferences, sexual orientation, safer sex, who lives in your home (including pets), and your recreational activities. We aren‘t just being nosy. In this era of health care, most providers practice from the holistic perspective that your health encompasses body, mind and spirit. Getting to know you as an overall person helps us to provide you with better care.

Remember that we are not here to judge you, and we are held to strict confidentiality laws. We genuinely want you to answer the difficult questions truthfully. One of our most important roles as providers is to coach you in making healthy lifestyle decisions. Pretty much everyone can make some improvements in their health habits; health care providers are no exception. We are often known for taking better care of our patients than ourselves.

We may also ask you about home safety. Having previously lived in Montreal, New York and Boston, I had been trained to ask about smoke detectors, fire extinguishers, seat belts and helmets, and then the question, “Do you have guns in your home?“ When I arrived in Maine I was naively surprised when the majority of patients looked at me like I had just grown a third ear. I had no idea that this question could sometimes make people feel annoyed and defensive.

Not to worry, after 19 years here, I get it. I don‘t hunt, but I do understand the importance of hunting for food, sport and tradition for many people. However, I will still ask the question about guns, because I also understand the high rates of domestic violence, depression and suicide, and I want guns to be kept safely. If I have a patient who is at risk, knowing this additional factor can sometimes be helpful.

Here are some other questions that I ask myself when I meet a new patient:

How invested are you in your health care? Are you here because a parent, son, daughter, spouse, partner, relative or friend talked you into it? Or do you really want to improve your health? It can be a challenge when I seem to care more about a patient‘s health than he or she does, but engaging a patient in his or her health care who wasn‘t all that interested before is one of the most satisfying aspects of being a provider.

Will you just expect me to tell you what to do, or will you want to be a true partner in your health care decisions? I have found that most people appreciate being empowered to advocate for their own health.

Do you learn better with written instructions, or would an Internet video or one-on-one teaching with a nurse work best? Many offices have a variety of options for patient teaching, or places we can refer patients for health education.

Do you have a basic understanding of your medications and illnesses? Can you afford your medications? Will you take them sporadically because of financial, memory, or other issues? Are there supportive people in your life who can help navigate this complicated health care system so we can manage your health safely? Will you need to involve care management?

Additional things I consider when anticipating a visit with a brand-new patient: Will you be someone who brings me thoughtfully researched information that we can review together, or do you trust questionable television or Internet sources over my opinions? Will you want to try something based on third-hand information from a neighbor‘s sister‘s daughter-in-law‘s uncle?

I do welcome thoughtful research and articles that patients bring in, and over the years I have learned a lot from my patients. It never ceases to amaze me how resourceful people can be when they or loved ones are faced with serious diseases or difficult-to-diagnose illnesses.

However, it is also easy for people who are in pain, desperate, or feeling betrayed or neglected by the medical profession to fall prey to slick marketing and Internet pseudoscience. We all have to use our sources wisely. Please trust us to help sort them out with you.

I am always excited when I meet a new patient for the first time — and a bit nervous, too. I want to make a good impression. I want the person to feel comfortable enough to answer questions honestly and safe enough to ask questions openly. When I enter the exam room, I try my best to put the chaos of the day and whatever else is going on in my life aside. Now it becomes about how we‘re going to take care of you — together.

Any questions?

Cindy Leiffer is an adult nurse practitioner at St. Joseph Internal Medicine.