Thursday, April 17, 2014

Five Questions for Your Doctor

by Larry Creswell, M.D.

Readers here at Endurance Corner will know that I’m a fan of a periodic visit to the doctor for a check-up. In a previous column I discussed the rationale and the value in athletes having a doctor and on my blog I’ve offered suggestions about how to find a good primary care doctor. Today I’m sharing five important questions for your doctor that will help you get the most out of an annual visit.

Most primary care doctors will set aside a fairly short amount of time to visit with their patients in the office. For new patients, this might be 30 minutes or so. For established patients, this can be even less. If you’re healthy, the doctor will see you only infrequently, so each visit may seem like the first time you’ve met. In order to get the most out of your visit, you need to prepare. I’d encourage you to sit down with pen and paper and jot down any health-related issues that are on your mind. Take the list with you to the visit and make sure that you and your doctor address each item. Most doctors I know would prefer to see patients who’ve prepared for their visit.

Here are five questions athletes should put on their lists:

  1. If I have any medical problems, how do they affect my athletic pursuits?
    Almost any chronic medical problem (such as high blood pressure, diabetes, thyroid disease, asthma, osteoporosis and arthritis) will impact an athlete. The list of potential medical problems and particular circumstances is virtually endless. Regardless, though, your doctor is apt to be very capable about dealing with the medical issues or finding appropriate help when needed. He or she is also probably very able to work through the implications for an athlete. But you should ask specifically about this. He or she will need to know exactly what your athletic pursuits include. Saying simply that you’re “a runner” might send a different message than explaining that you run five to seven hours per week. Saying simply that you’re “a triathlete” might send an inaccurate message if you don’t explain that you do 15-20 hours of endurance training per week. If you do resistance training, let your doctor know. There are different medical implications for endurance and resistance training.

  2. Which preventive services or screening tests are useful for me?
    There is increasing awareness about the value of wellness, or preventive, care -- the care provided to even completely healthy folks. The Affordable Care Act may help to make wellness care more readily available and, for many, at more reasonable cost. In addition to a general physical exam, this includes items such as specific exams or diagnostic screening tests for various forms of cancer (such as breast, prostate, testicular, skin and thyroid), immunizations and screening laboratory tests such as blood lipid profile. Two resources that will be helpful in preparing for your visit are the American Academy of Family Practice (AAFP) online Health Maintenance and Counseling resources and its summary of Adult Health Maintenance Guidelines. You’ll see that the guidelines are age-specific. These recommendations are a starting point for discussion. Be sure to ask your doctor about what’s right for you.

  3. What is your assessment of my heart health?
    Even very fit and seemingly healthy athletes can have unrecognized heart and vascular disease. You should ask your doctor about your heart health and any potential risk for participating in your sport(s). The American Heart Association (AHA) has outlined a 12-step approach to the evaluation of athletes, focusing on the elements of personal medical history, family history of heart disease, and a careful physical exam that concentrates on the heart and vascular systems. You should also have a discussion with your doctor about any additional screening tests and ongoing preventive health assessments that may be useful. The AHA offers a set of recommendations about risk factors and screenings that might serve as a starting point for discussion with your doctor.

  4. Can we talk about the benefits/risks of any drugs or supplements I plan to take?
    An annual visit is an opportunity to have a discussion about the benefits -- and risks -- of any drugs or supplements that you might want to use. Some typical examples might include multivitamins or specific vitamins, iron or other minerals, aspirin, creatine, fish oil, and glucosamine/chondroitin. But the list is probably endless. Come prepared for this discussion. Read up on the particular drug or supplement that’s important to you. Your doctor will be in a good position to help you work through the plusses and minuses.

  5. How can we communicate between now and my next visit?
    If you have ongoing medical problems, you will likely be returning to see your doctor with some frequency. If you’re totally healthy, it might be a year or more until your next visit. You should ask about how you can communicate with your doctor between now and the next scheduled visit. Ask if your doctor or somebody from her office will talk with you on the telephone if a problem comes up. Ask about email. There are certainly issues with health providers and the use of email communication, particularly related to privacy concerns, but this can obviously be a convenient way to reach the doctor with questions. Whatever the conclusions might be, you should work this out in person during your visit.

Larry Creswell, M.D., is a cardiac surgeon and Associate Professor of Surgery at the University of Mississippi Medical Center in Jackson, Mississippi. In addition to his regular column on Endurance Corner, he maintains The Athlete's Heart blog to offer information about athletes and heart disease in an informal way and to encourage exchange and discussion that will help athletes build a heart-healthier lifestyle. You can contact him at lcreswell@umc.edu.
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