Questions and Tips for Talking to Your Doctor

We're doing a little cleaning around the office, and I found a nice list of questions to ask a doctor. The list came from ucomparehealthcare.com, but the list is no longer on that site. So, I'm reprinting it here:

Key subjects for the patient to consider

1. Remember, you are the one most interested in your health.
2. You, the patient, are the most important source of communication with doctors.
3. Before your visit, take the time to get your medical facts in order so that you can explain what you know to the doctor. This should include any medications that you take and their dosages; any other doctors that you have recently seen; their addresses and phone numbers; and the reasons why you went to see them.
4. It is important that you listen closely to your doctor and understand what he or she is explaining to you.
5. If you have trouble understanding the medical terminology, see if a family member can go with you to assist you in understanding or to take notes for you.
6. Hand washing is a very effective way of reducing the transmission of various kinds of illnesses. Each healthcare worker who has direct contact with you should wash their hands prior to any examination or treatment.
7. Family members and friends can be great advocates for patients. See if you can bring a family member or friend with you when you see a health care professional.
8. If the doctor does not communicate the results of your test(s) to you, do not assume that no news is good news. Calf and ask the doctor for your results.
9. Learn as much as you can about your condition. Ask your doctor or nurse to explain it to you and make sure you use reliable sources for all information that you seek.

What you should know about your doctor

1. In which field has the doctor been trained?
2. Is the doctor "Board Certified"?
3. Does the physician participate in your health insurance plan?
4. What hospitals does the physician refer patients to?
5. Does the doctor have an emergency number and can he or she be reached in times of emergencies?
6. What are the doctor's office hours?
7. What is the doctor's policy for returning phone calls?
8. Whom should you speak with if the doctor is not available?
9. Where is the office located, including street address and phone number?
10. Is access to the doctor's office easy for patients with reduced mobility?

What you should tell your doctor when you visit

1. Previous hospitalizations and for what reason.
2. List of all medications you are taking, their dosages, and when you last took them.
3. Last time you saw a physician and for what reason.
4. Names and phone numbers of any specialists you have seen.
5. Health habits, which may include smoking, alcohol, and/or drug use, exercise, bladder control, and memory.
6. Any type of problems or changes in your health status.
7. Your family health history.
8. Any supplements that you may be taking and when you last took them.

Questions you might ask relating to Illness or symptom(s)

1. What's wrong with me?
2. Can you draw a picture or show me what is wrong?
3. What causes this kind of problem?
4. Can l give this illness to someone else, and if so, how and for what period of time can I pass this on?
5. Are there any activities or foods which I should avoid?
6. When can I return to work or school?
7. What is the long~term prognosis of my condition?
8. How can I prevent this from happening again?
9. How will this problem affect me in the future?
10. What will happen if I don't treat my condition right away?
11. What treatment should I follow, including dietary, medical treatment, and lifestyle changes?
12. When do I need to see the doctor again?
13. Where can I get more information on my condition?

Questions you might ask about medications that are prescribed to you

1. What is the name of the medication?
2. Why do I need this particular medication?
3. How and when should I take this medication?
4. How long should I take the medication?
5. Whet are the possible side effects of this medication?
6. Is this medication safe to take with other medications I am taking?
7. What do I do if side effects occur?
8. How often will I need to get the medication refilled?
9. How will I know if the medication is working?
10. What are the risks of not taking the medication?
11. Is this a brand name or generic name?
12. Are there less expensive medications for my condition?

Questions you might ask about surgery or a procedure

1. When do I check in to the hospital and where?
2. What can I exped to happen before the surgery or procedure?
3. How long will the procedure take?
4. Can my family go with me?
5. What effects will the procedure have on me in the short and long term?
6. What is the doctor's experience in perfonning the procedure?
7. What medications will be given to me?
8. How long will I have to rest at home after the procedure?

Questions you might ask about diagnostic tests or procedures

1. Why is this test necessary?
2. What will happen if I do not have the test?
3. Are there any risks involved?
4. Will it hurt? If so is there anything I can do to lessen the pain?
5. Can the doctor perfonn the test in the office or will I have to go to the hospital or the laboratory?
6. Is there any preparation for the test?
7. What are the side effects of the test?
8. What changes or effects should I report to the doctor?
9. Who will call me with the results of this test?
10. How long will it take for me to get the results?

Questions you might ask about a hospital

1. Is the hospital a teaching hospital?
2. How many patients have this procedure in this hospital each year?
3. Is the hospital accredited and by what organization?
4. Where do I check in? When? What will 1 need?
5. Do l need a pre-operative visit to the hospital?
6. What services does the hospital offer that are specifically helpful to the type of procedure that l am going to have?
7. What is the hospital's policy on family members staying overnight with the patient?

 

Banish the Paper Blizzard, Part 5: How do I go paperless?

Redundancy, redundancy, redundancy.  Did I mention backups?

The most important factor to consider when implementing a paperless office is redundancy.  Redundancy is important at many steps in the paperless office workflow.  For instance, it is important to have multiple backups of your data across at least two locations to ensure against loss in a fire or other catastrophic event.  Redundancy is also important with respect to ensuring that electronic documents are correctly entered into your system.  Your network administrator will be able to identify a redundancy solution that works for you.

Security

As stated above, a competent network administrator is already necessary to your practice in order to comply with ethical and practical requirements.  In connection with implementing a paperless office, your network administrator should perform a security audit to confirm that your systems are secure.

Equipment and workflows

In implementing a paperless office, you will need to identify your current software and hardware configurations and evaluate whether you need to add additional scanning equipment, practice management software, or paper capture software.  You will need equipment having enough monthly duty cycles to handle your firm’s paper usage, and the software should be configurable to minimize user interaction beyond scanning, naming, and saving documents in the appropriate file.  Your network administrator will be able to assist you with designing a hardware, software, and workflow configuration for implementing your own paperless office according to your specific needs.

The purpose of this series is not to peddle specific gadgets or software, which is why no recommendations about specific products are made in these materials.  Rather, this course aims to teach the concepts underlying a framework upon which a less paper-reliant practice may be built.  Modern practice management demands something very different than technological snake-oil requiring minimal user input from your practice.  For most law firms, effective paper management necessitates a change in philosophy about when paper is truly necessary.

Depending on your current configuration, you will need to consider whether moving to a paperless office makes sense.  When one considers the costs of time, maintenance, disposal, and environmental impact of printing thousands of reams of paper each year, it makes sense to minimize the use of paper when possible.

One last thing…

I would recommend that all litigation attorneys who have paperless offices take small laser printers to evidentiary hearings and trials.  In our practice, we always prepare our anticipated evidence for hearings and trials, but occasionally we need to submit a document that we don’t already have in paper.  Sometimes paper is necessary, and a small printer helps tremendously in such a situation.

The Daily Show on Human Gene Patents

From the Daily Show, host John Oliver and deranged millionaire John Hodgman discuss human gene patents:

The Daily Show with Jon Stewart
Get More: Daily Show Full Episodes,Indecision Political Humor,The Daily Show on Facebook

All kidding aside, this clip discusses a serious issue of patent law. The very first patent law, 35 U.S.C. § 101, says: "Whoever invents or discovers any new and useful process, machine, manufacture, or composition of matter, or any new and useful improvement thereof, may obtain a patent therefor[.]" This doesn't include laws of nature (like E=mc²) or discoveries of natural things (like genes or a type of diamond). Patenting a gene would be like patenting a leaf off a rare, exotic tree — perhaps it took work to locate it, but the tree species itself had already been there for thousands of years. 

Many large companies, particularly in the pharmaceutical industry, apply for thousands of patents every year. This is one reason why prescription drugs and medical testing devices are so expensive. Unfortunately for consumers, many of these patents are of questionably quality because they cover slightly modified uses for old drugs or don't cover patentable subject matter.  If low-quality patents like human gene patents can be weeded out, perhaps we can ease the crisis of the ballooning costs of health care in this country. 

What do you think about patents on laws of nature and discoveries of natural things like genes? 

Banish the Paper Blizzard, Part 4: Who Needs to be Involved at My Office?

You already need an expert network administrator.

In most law practices, computers are already used to a great extent for word processing, calendaring, correspondence, and other tasks. Have you insulated your practice from delays due to a server crashing in your office?  How would you operate your practice if your computer systems were to suddenly crash?  Who would you call?  Having an answer in place to these questions is already imperative because so much of the modern practice of law relies upon computers.

The vast majority of attorneys should hire network administrators (third party or in-house, depending on the firm’s size) to handle configuration and troubleshooting of security and computer issues.  Your network administrator will be the first (and perhaps last) person you need to contact to establish a paperless office.  The participation of a network administrator is vital, as moving to a paperless office will require changes to your current setup.

Your network administrator will need a clear set of goals (like searchability of documents) and a budget for doing so.  Take a list of reasons why you want to implement a paperless office and a list of consequences you wish to avoid to your network administrator.  Your network administrator will make recommendations on hardware, software, and workflows needed to ensure a smoothly-running paperless office.

Your staff must undergo a learning curve.

Implementing a paperless office will require your staffers to change their day-to-day routines.  For instance, your assistant responsible for filing will need to learn a new workflow in order to properly categorize documents within your electronic filing system.  One of your assistants will need to be responsible for ensuring that all documents received by the firm electronically (such as documents filed electronically in federal court) are stored in the appropriate location.

As part of keeping the learning curve short for your employees, your network administrator will need to ensure that the process is easy enough for your employees to learn quickly and operate efficiently.

The attorneys must be committed to overseeing the process.

The attorneys in your firm need to be patient and committed to making the paperless office work.  There will be growing pains, such as mis-categorized and mis-filed documents.  Attorneys need to be capable of recognizing and correcting these errors and instructing the staff on corrective measures.  Attorneys should recognize that the purpose of a paperless office is to reduce overall costs, improve efficiency, and increase productivity, which in turn makes the attorney’s job easier.

Banish the Paper Blizzard, Part 3: Pros and Cons

Pros

Electronic files don’t gather dust.

Literally. Dust is gross. 

Moving to electronic files means that your risk of total loss of all files is shifted to a different kind of risk of loss.

Each lawyer fears a fire most because of the catastrophe that her practice would be if her files burned.  A busted pipe near the filing room isn’t too far behind.  I don’t know anyone who maintains one set of physical documents at her office and another duplicate set offsite.  How would you recreate your files if your office burned down while you were at a CLE?

The benefit of using virtual storage space is that your files can be easily duplicated several times at multiple locations.  Should one location be compromised, your data can be retrieved from another location quickly and easily.  One can hardly listen to talk radio anymore without hearing several advertisements an hour for automated online data backup systems.  Many cloud-based options are available.  Regardless of who you are and whether you have a paperless office, you should already be backing up your important data (such as email) on a daily basis.  Backups are not something you usually think about until you need it, and by then it is too late.

Document retention policies are at best irrelevant and at worst easier to implement.

With virtual storage space as inexpensive as it is, many firms will choose to archive old client records rather than deleting them.  In my trademark prosecution practice, clients can renew their trademark registrations indefinitely by filing appropriate affidavits every ten (10) years.  If litigation ever arises over the trademark, even fifty (50) years later, the trademark application file could very well be relevant. 

Most lawyers I know look back to similar cases as a starting point for research and drafting pleadings or other documents.  If those documents are in a folder among hundreds in a box among thousands at a warehouse across town, the mere existence of those documents provides little benefit to the lawyer needing them.  If, however, those records have been archived electronically, they can be retrieved rather quickly.

Even if you do decide to implement a retention policy and discard documents older than a certain age, a paperless office makes it easier to determine which files have had no activity within the specified time period.  Sorting files by date is much easier than peering into a stack of boxes for expiration dates written on the boxes.

Documents are accessible.

I alluded to this in the previous section, but when documents are in digital form they can be searched quickly.  The digitization solution best for lawyers stores an exact image of the document along with the text of the document that has been interpreted into English by a computer.  This process is called OCR, for optical character recognition.  Depending on your digitization solution and computer systems you use, the documents can be indexed in various ways to make keyword searching a reality.  Would you use a keyword search on your own documents similar to the way Lexis and Westlaw allow you to search cases and other records?  I certainly do.

In a paperless office, documents are also accessible in another sense because you can remotely access your files.  You truly can work from anywhere.  The cloud-based solution I use to backup my documents also lets me keep a copy on my laptop, and any changes I make to a document get synced across several different locations.  My physical location is now irrelevant to the work I do.

You can do things with electronic data that simply can’t be accurately or easily done with paper documents.

Electronic documents are simply more flexible than their paper counterparts, particularly where the documents were originally created in an electronic format (as opposed to being converted from paper to digital format).  When documents originate in electronic format, you don’t have to worry about the conversion software making errors translating the written words to electronic text.  As a general rule, I always ask for subpoenaed documents and other discovery in digital format because it is easier to handle.  Furthermore, electronic production is often less costly for all parties involved.

There are many reasons electronic documents are preferable to paper ones.  An example will demonstrate my point.  In a trademark infringement lawsuit a few years ago, I represented a trademark owner on two theories of trademark infringement.  One of the two theories was challenged on the basis that my client had not penetrated the market sufficiently in the southeast United States (Texas to Virginia) to receive damages for infringement of an unregistered trademark.  Because the infringer was also my client’s exclusive U.S. distributor, to prove market penetration, I needed to present evidence on the extent of the infringers’ advertising.

During discovery, I subpoenaed the primary phone line for the infringers, which was the telephone number used in all advertising placed on websites and in trade journals.  The phone company responded with a CD-ROM containing an electronic document.  I was able to request, receive, and extract the phone number, date, and time of over 31,000 phone calls in a few short hours.

I plotted the infringers’ phone calls on a map, as follows:

View fullsize

As the saying goes, “a picture is worth 1,000 words.”[1]  The map assisted us in prevailing on our argument against the infringers’ market penetration defense.  Had the phone records not been produced electronically, my client would not have been able to present such a succinct and powerful summary of his position.

Cons

Network security becomes even more important.

We are ethically obligated to keep documents and other materials in trust for our clients, and we must do so in a manner that protects the confidences of our clients.[2]  When your entire practice is accessible over the Internet, it becomes important to keep your network security filters up to date.

In reality, every law practice that has a computer connected to the Internet should already be using up-to-date network security.  Security breaches cost firms time, money, and headache.  How much time have you or your office personnel lost because a computer was infected with spam, spyware, or a virus?  Prevention really is the best cure.

Computers fail.  Back them up.

The manufacturing process for computers is not perfect.  Every single computer chip has hundreds of imperfections that affect the way it performs; manufacturers address this unavoidable problem by making the chip redundant so that each process the chip is designed to perform can be executed on different physical parts of the chip.  However, the inherent imperfection in computer chips means that they fail.  The only way to address the inevitable failure of a computer system, and the data associated with that system, is to back up information that you don’t want to lose.

How will you incorporate legacy documents into a new system?

If you decide to commit to a new system, you must decide what to do with the paper documents you have now.  Three options exist.  First, you can fully incorporate old files into the new system by treating each individual document in the old file as if it was a newly-incoming document. This approach is time-intensive and detracts from your employees’ day-to-day activities.

The second approach is to digitize the entire file in a single batch. Finding a document after using this approach is exactly the same as opening a box and browsing for the correct document.  This is a good middle ground because the file is still more accessible than it would be if it were in a box (because you can search the file), but you have to dig a little to find what you’re seeking.

The third approach is to maintain current document retention protocols for your old documents, which can be phased out over time.  This is an acceptable but archaic method that has been used for hundreds of years.

In deciding how to handle old files, you must perform a cost/benefit analysis for your particular situation.

Attorneys are resistant to change.

At a CLE I attended once, a sitting judge cracked a joke about having a hard time removing the green highlighter ink from his computer screen.  Attorneys, especially older ones, distrust electronic recordkeeping because they have been trained to believe that the more paper involved in a file, the more money the file is worth.  Most lawyers I know prefer to edit drafts of paper documents prior to making changes to word processing documents.  Also, lawyers as a group like to make notes in margins of books and opposing parties’ briefs for later reference.

I understand these arguments, and to an extent I still use some of these methods in my own practice.  As I said earlier, no lawyer’s office will be truly paperless, at least not in my lifetime.  The fact that paper is more convenient in some aspects of your practice is acceptable and understandable.  The purpose of implementing a paperless office is to eliminate unnecessary and duplicative paper costs, rather than entirely eliminating the use of paper.  I stated at the beginning of this series that the purpose of a paperless office was to think intelligently about workflows and the use of paper.  If using paper sometimes facilitates efficient work, then by all means use paper in that situation.

[1] This saying is codified in Ark. R. Evid. 1006 and Fed. R. Evid. 1006, which both state:  “The contents of voluminous writings, recordings, or photographs which cannot conveniently be examined in court may be presented in the form of a chart, summary, or calculation.”

[2] Ark. R. Prof. Conduct 1.6(a) (“A lawyer shall not reveal information relating to representation of a client unless the client gives informed consent[.]”).