Now We’re Talkin’: Patient Power Inside the Medical Appointment

Jul 9, 2024 | Aging Successfully, Conversations, Patient Advocacy

Would you rather listen instead?
Click here for the 23-minute audio recording.


You may wish to get your tools out because we’re goin’ into the weeds today. No, no swing blades, sickles nor pruning shears. Rather, you may wish to use your notetaking tools as we wade into the weeds of the medical appointment.

Doctor and Patient in DiscussionWe will dive deeper into weedy parts of your medical encounter, the

  • Prep
  • Arrival
  • Discussion
  • Departure
  • Debrief

Get ready.



First, let’s get our heads on straight about this appointment.

In the precursor article to this one, entitled The Power of Patient Participation, I discussed what it means to be an “activated patient’. A big part of becoming activated is to prepare for your appointments and to be active inside them. You see, there is a LOT of power – for the patient – and that is what we are delving into now.

In my previous segment, I went over some basics but consider these one or two additional angles now.

Use the rest of the team effectively.

It’s not just you and a doctor in the exam room. There are two, hopefully, three or four persons who will be working with you in your encounter. You have a job to do. The doctor has a job to do. The Care Partner may have multiple jobs to do. A nurse or medical assistant does also. The front desk staff, too. You will be interfacing with all of them, so keep that in mind.

Bring “all of you.”

Wear your glasses and hearing aids. Use the walker or rollator if you are supposed to (it may become part of the provider’s evaluation, or it may be or become the topic of discussion). 

Consider your appointment to be a business meeting

Some folks suggest that we consider medical appointments as business meetings. The average appointment lasts 15 minutes, so we have a designated time to get certain stuff discussed and handled. This is a 15-minute meeting where you and others must do their “job,” and everyone has a speaking part. In light of this, the appointment needs to be well-executed.

Bring a Care Partner

Your Care Partner is the person who is accompanying you and has a big role. Depending upon your needs, they can do things like take notes during the encounter. They should already be familiar with your list of concerns (you have prepped them, right?) and prepared to enter the discussion if need be. They can certainly help ensure the main topics are covered and that the answers are understood.



Arrive on time – it helps everyone. Think about it: you, staff, and others with their appointments. ‘Nuff said.

Try to relax. It’s natural to be nervous or anxious when visiting a healthcare provider, but try to relax as much as possible. It may be wise to avoid drinking caffeine within an hour of your visit. (You want your vitals readings to be “normal” and not enhanced, right?) Skip that dose of heavy cough syrup until you can describe your symptoms, and the provider can have a good look at you.

Did you know there is a thing called the White Coat Syndrome? A percentage of patients even suffer from white-coat hypertension, which means their blood pressure actually rises higher than normal when they are in the provider’s office.

When you arrive, take a few deep breaths. Remember that arriving early for your appointment will usually allow you to sit quietly for a few moments to center yourself or go over your prep for this “business” meeting.

Let the discussion begin

OK, they are calling your name. Here is where you may begin to employ the Use Your Team Effectively concept. 

A Medical Assistant (MA), nurse (RN, LPN) has escorted you toward the exam room and may begin with weighing you or taking vitals. You may wish to record those (or the Care Partner can). Ask them to repeat those numbers and demonstrate your “activation” and participation by writing them down.

Use your team

Here is where you are using your team. As the nurse or MA settles you into the exam room, announce why you are there. State that you brought your questions. They may enter such into the notes, which will set the stage for the provider. Also, it is likely that if there are questions after the appointment, this professional is the person with whom you will communicate. Build a little rapport, and make a friend here.

The RN, MA, or provider will most likely begin reviewing your medications with you. It’s time to show all of them: those prescribed, OTC (over-the-counter), supplements, and anything you have recently used, such as cough syrup. Know when.

This is also a time to bring up which doctor started or discontinued a medication. This a great way to make sure one provider knows what the other is doing; this provider may not know that another doctor had started you on a new medication. It all has bearing.

We have all seen the dangers of them not knowing, such as medications clashing, their side effects seemingly causing more “symptoms,” and may cause over-prescribing. There are two good ways you can prepare for this portion of your appointment:

  1. One way to convey this is to make a list that includes the names of the medications, the doses, who prescribed it, and the schedule of when you take those medications.
  2. A simple and certainly an effective way could be to simply put all of your pill bottles and other medications in a reclosable plastic bag. That’s easier for you because you don’t need to write down complicated names and doses.

Guess what? As many as one in three adults use some form of additional and alternative medicine, yet few mention it to their doctors. Do include vitamins, supplements (such as calcium), over-the-counter medicines (such as heartburn remedies cough syrup), eyedrops and ocular solutions, and ointments. In short, anything that you introduce into or onto your body. It all matters.



Got your list of concerns ready? Remember we mentioned jotting down your concerns and realistically knowing that you may only get to the top three in your appointment? More on how to handle this in a moment.

When the provider enters, make small talk quick. ‘Nuff said, clock’s ticking.

Let the provider know you have prepared for this time together. (They LOVE an active patient on nearly all occasions!). Tell them you have a list of concerns or questions.

It is important at this point to do a couple of things:

  • Do NOT show them a list of 11 topics to cover in your 15 minutes. It sends the wrong message that you are unrealistic in your expectations.
  • Let the provider know you have tried to prioritize your concerns and that you know that the two of you can only cover so much at this time. Convey your willingness to return as needed to cover the rest.

Here’s a good one: offer to let the provider see your list and ask them to decide what is important, or simply convey your readiness after letting them know – that YOU know – that the two of you can only cover so much in a short time.

Let’s take a pause here, step out into the proverbial hall, so to speak, for just a moment. Let’s remind ourselves about your goals and everyone’s jobs in this encounter.

Take charge of your healthcare

The goal here is to get your questions answered in this meeting. To be frank, and to be honest. Many a nervous or embarrassed patient has waited until the doctor reaches for the doorknob before blurting out the most important details. You are right there, so be ready to maximize!

A few words about honesty: Be honest with your doctor. Multiple studies show that 18%- 80% of patients are not—they may fudge or conceal relevant information that would have bearing on their outcome.  

What are people lying about? The survey of 500 people found:

  • 46% lied about smoking.
  • 43% lied about exercise.
  • 38% lied about drinking.
  • 29% lied about their sexual partners.

That doesn’t add up to 100% because some people said they lied about multiple subjects.

Why are patients lying? Patients who are not honest, admit they fear being judged or they are embarrassed. Believe me, providers have seen it all and heard it all. This is one of those confidential times in which you will need to “help them help you.” Help them do their job and get yourself some solid results.

We are back in the exam room now, back in the encounter to take charge of our healthcare.

As you enter into discussion, know what your doctor is listening for. It’s important to communicate two things: symptoms and what matters to you, not just “what is the matter with you.” Doctors have been trained to listen for symptoms, so describe your symptoms in detail.

I, too, am saying symptoms are not possible diagnoses from Dr. Google. Do NOT say: “I think I have such-and-such.”

Report what you have noticed:

  • When, what time of day, and how often does it happen?
  • When was the last time?
  • How long did symptoms last? What happened?
  • What were you doing when this happened?
  • How did this affect you, your activities, etc.

As the exam and discussion progress, you may become confused about the discussion, instructions, or jargon. Ask for clarification. This is a two-way street, and after all, it is YOUR appointment.  

For instance, you might say: 

“I want to make sure I understand. Could you explain that a little more?” or 

“I did not understand that word. What does it mean?”

If you don’t understand something, don’t hesitate to ask:

 “Can you explain that in simpler terms?” or “Can you give me more details about that?” 

Additional questions you might ask that encourage dialogue and education:

What is actually happening in my body right now?

Will this condition ever go away?

How will it affect my day-to-day life?

You may also ask for recommendations for a consult, another doctor to review your case. That is not rude.

For those times when the provider recommends additional testing, here are some questions for you to consider:

Of tests

  1. What is the test for?
  2. How the test is done.
  3. How it will feel.
  4. What you need to do to get ready for it.
  5. When will I (“we” is better, infers a team working) get the results?
  6. How will the results be delivered?

For times when treatment is recommended, here are some questions to consider:

Of treatment

  1. How do you spell the name of that drug?
  2. Are there any side effects?
  3. Will this medicine interact with medicines that I’m already taking?
  4. What’s the treatment?
  5. How does it work?
  6. How effective is it?
  7. Are there any alternatives?
  8. What are the possible complications?
  9. How many times have you done this procedure?

If referral to another provider, a specialist, is advised, then draw from the above, use the gist of, or modify. For example:

  1.   What will we learn from this referral? (Didja catch the “we”, to infer team approach?).
  2.   Will you refer me directly?
  3.   How long might it take to be seen?

For tests, treatment, or referrals – I have a personal fav that I employ a question as appropriate. It is good for almost any encounter, so weigh it – do you need to ask)

“And if we do nothing?” 

The patient needs to know this, too.

You may wish to inquire if insurance will cover that testing, treatment, or referral. Find out who answers your insurance questions, if not the provider. It’s okay to lodge your concern that someone be In Network, that the referral be made to someone – and for something – your insurance will cover. The office may have a navigator who will be the one coordinating that referral, and that’s key information for them to know. Do you know how your provider’s office is structured for this kind of situation? 

Speaking of understanding, the Care Partner can play a vital role by interjecting a need for more information or clarification. They can ask for a translation into simpler terms or restatement. They, too, must understand the patient’s main talking points and be able to record any next steps that come from this appointment. Both the patient and the Care Partner should be clear before the provider leaves about what to do if you do have a question later.



But wait a minute. You are still not happy, you say?

Share your point of view about the visit with your doctor

Tell the provider if you feel rushed, worried, or uncomfortable. If necessary, you can offer to return for a second visit to discuss your concerns. Try to voice your feelings in a positive way. For example, you could say something like: “I know you have many patients to see, but I’m really worried about this. I’d feel much better if we could talk about it a little more.”


Take time to recap before exiting. At the end of the appointment, review what you’ve heard: “We discussed my lower back pain, and you recommended that I try a heating pad and these specific exercises. Am I hearing what you said correctly?” When you use a phrase like “What I’m hearing you say is…,” it should cue your provider to pause to make sure you understand the problem and what the next steps are

It is absolutely okay and essential to ask your provider if you can come back soon to handle the rest of the list.

Finally, be sure you know how to contact your doctor’s office if you have further questions. How are you supposed to let them know if the treatment is – or isn’t – working? How do you get in touch with someone?

Debrief with your Care partner and advise any others

Using the After Visit Summary (“AVS”, the paperwork provided to you at your departure), the patient and Care Partner can later debrief. A debrief again ensures understanding and allows for a plan (for example, pick up the prescription, make the next appointment, arrange transportation for it, or expect a call regarding testing, etc.).

Long-distance caregivers also need to be in the loop. Who, patient or Care Partner, will let your VIPs (Very Important Persons) know what transpired and what’s next?

Before I conclude today, I wish to speak to another medical elephant in the room: Bias in Healthcare.

Like anywhere else, there is a lot of bias in healthcare. We know of documented concerns of gender bias, racial bias, insurance bias, bias against obesity, and LGBTQ+ community. For the purposes of our own appointments, let’s just make sure we do all we can do to be that activated patient by doing all the things we are talking about today.

Even without any kind of bias, there are some providers with whom we simply will not easily gel – for whatever reasons. Many people lament that they did not “feel heard” by their provider or felt their concerns were dismissed. You have options.

If you’ve tried all of the activated patient communication tips we have covered thus far and still feel like your doctor isn’t listening to you or solving your problem, then it may be best to find another. Consider finding a new provider or asking for a referral for a specialist who “deals more with your symptoms.” Sometimes, just telling your doctor you’re thinking about switching out of their care can make them take you more seriously.

It is not only helpful to speak up about what you’ve experienced, but doing so could inspire change. I read the remarks of a doctor who recalled a time, 25 years previously when one of her patients complained that she wasn’t paying enough attention. “I remember what she looks like, decades later,” said that doctor. “And from that time on, I made an effort to do better.”

Our recap

You and I now have a recap, and it is as follows:

  • Prepare, for this will be your 15-minute business meeting, during which everyone must do their “job” and have a speaking part.
  • Think about and prepare your top three concerns for discussion, including how the symptoms affect your daily life. Know what makes it worse or better, when they began, etc.
  • The information you should take includes your insurance information, your meds, and any vitamins, supplements, or OTC items you may have recently introduced to your body.
  • Reread this blog. (Just kidding. No, maybe I wasn’t).

Whew, you made it through the weeds with me! I welcome your commentary (Y’all are so good about writing to me and telling me your experiences), and I invite any questions.

Refer someone who may benefit from my Single Consultation model: one hour of work with results and recommendations and no obligation for “ongoing or invoicing,” as I like to say. It’s just one really good hour of work. No one has ever let me know that they did not feel heard. I can tell you that. May I help someone you know?

I hope that something I shared today helps you to move more comfortably forward.

Thanks, Everyone!


Nancy Ruffner is a patient advocate whose focuses include aging strategy, healthcare navigation, and solo aging. Nancy consults with clients in a triage fashion, offering one-hour consultations to find a path, gain a deeper understanding of “how stuff works” in eldercare, or specifically problem-solve. Schedule your Power Hour now, without obligation of commitment or continuing costs.