Communicating with your health care team can often feel intimidating. As such, one may tend to shut down and live with troubling questions unanswered. This behavior often leads to further uncertainty, confusion, and exacerbated anxiety. Open communication can lead you to a better understanding of your condition, thus empowering you by giving you a greater sense of control over your circumstances.

Improving communication with your health care team:

Become a well-educated consumer. As a patient, it is important to remember that you are a consumer of health care. The best way to begin making difficult decisions about health care is to educate yourself.

Have someone accompany you to your appointment. It is helpful to have someone there with you for support as well as a second set of ears.

Use your "Questions to Ask Your Doctor" reference sheet. This way, you won't forget to ask about something that was important to you. Remember that your doctor has limited time, so try to be specific and brief. Also remember to ask your most important questions first.

Record your doctor's answers onto the question page. You cannot expect to retain everything your doctor says. Taking notes will help you remember your doctor's responses and instructions. It also allows you to go over the information later when you have more time to concentrate or do research.

If possible, tape-record your visits. Ask your doctor if you can record your conversation. Taping your visit gives you a chance to hear specific information again or share it with family members or friends.

How to Talk With Your Doctor:

Use "I" statements. Say "I don't understand" instead of "You are being unclear." This allows your doctor to hear you in a more communicative voice.

Be assertive. If your doctor says something you do not understand, tell him…but remember to keep it as specific and brief as possible. If your doctor's time is limited, ask if there is another more appropriate time for the two of you to talk in more detail.

If something is unclear, try repeating it back to your doctor, or ask again some other way. It may help to ask for pictures, charts, or other reading materials.

Remember That:

• Your health care team's goal is to help you
• Treatment is a partnership between patient and doctor
• You have a right to expect our doctor to listen to your concerns and to explain treatment decisions
• Good communication encourages an open and trusting environment

In this section, we have included two sets of questions:

• What to Ask When Calling for Doctor Appointments(pdf)
• Questions to Ask Your Doctor (Oncologist)(pdf)
• Questions to Ask Your Doctor (Beast Surgeon)(pdf)
• Questions to Ask Your Doctor (Surgeon)(pdf)​

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> Please review these questions PRIOR to contacting your doctor.

• This will allow you pressure-free time to edit the proposed list of questions to fit your specific needs.

> It is a good idea to write your own personal notes on these sheets.

• Add your own questions that address your individual situation.
• Being prepared with what to ask will lead you to gain vital information for optimal outcome.
• So be prepared when you ultimately contact your doctor's office and go on your doctor's visit.

> Enough space has been provided for you to note your doctor's responses.
> Also included is extra note paper for your convenience.
> Use these sheets to record all additional doctor visits and relevant notes.

Medical History

• Recalling your personal medical history at every doctor's visit can become frustrating and even difficult. Having this information readily on hand can be quite useful.
  Fill out the enclosed medical history form at a time that is convenient for you
• Then, simply transfer the readily available information over to the medical history form that your doctor asks you to fill out

Tips:

• Writing a little "story" of your current health issues before arriving at your doctor's office will help you to remember all the important things that should be reported to your doctor!
• Be sure to include all relevant information, such as dates, symptoms, duration, and medication history in your "story!"

MEDICAL HEALTH HISTORY FORM(PDF)
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This section is provided so that you may keep all of your medical records, including Test Results and Medical Reports, together in one place. Doctors often request such information; therefore it will be quite useful to have these on hand when you are meeting with your doctors.
Why keeping copies of important records are important:

• Records provide you with important information to share with other doctors
• Accurate records help if you need a second opinion
• Sometimes records are lost or put in storage at hospitals, making it difficult or impossible to find later on

The easiest way to get your records:

• Request a copy from your doctor when discussing results of tests
• Ask for copies of your diagnostic test results (i.e. MRI,CT, PET) at the time they are taken
  • These results are often available on CD's

Retrieving past treatment records:

• Call the medical records department of the treating institution and request that they fax or mail to you a "Release of Medical Records" form
• Keep track of the dates, times, and people with whom you speak
  • Corresponding with the same person will make things easier
• It often takes several calls to get records, but persist until you succeed
• If you encounter problems, ask to speak to the medical records librarian as this person can be helpful in searching for your records more quickly
• You can also ask a friend or family member to help you by signing a release form allowing them to act on your behalf

To learn about local laws regarding your rights to your own medical records, you may call the Health Privacy Project at (202) 687-0880 or visit their website at www.healthprivacy.org and click on "State Law."

• Remember to request 3 copies of all records!
  • This will enable you to provide one for your doctor, another in case you seek a second opinion, and one to keep for your own records

Tips:

• Keep your hospital discharge papers in this section!
• Keep copies of all your prescriptions in this section!
• Add a pocket folder to this section if you find that you have an overflow of documents!
• If you fax your records over to a doctor's office, remember to call to confirm receipt!

Insurance plans have become more and more complicated and certainly more difficult to fully comprehend. With PPO's, EPO's, and HMO's, understanding exactly what you are covered for can get quite confusing.
It is important to familiarize yourself with your individual coverage by contacting your insurance company and by asking questions

• Use the forms we have provided to fill in the details of your specific plan so that you may have this essential information readily on hand when you need it

Tips:
Make sure to have the enclosed forms in front of you when you are on the phone with your insurance company! Ø Keep a photocopy of your insurance card (front and back) in this section!

• Use the pockets to hold copies of prescriptions, bills, etc.
• Remember…….the more you know, the better prepared you are!

INSURANCE FILL IN FORM
MEDICAL INSURANCE INFORMATION

​Medication Regimen

• The following medication chart is included in order to help you organize your personal medication regimen.
• he different columns allow you to plug in important information, such as the start date, name, and purpose of every prescribed medication.
• Space is also provided for you to fill in the name of the prescribing doctor, as a patient may be under the care of more than one doctor (i.e. surgeon & oncologist) at the same time.
• Filling in the required dose and times of the day to take the medication is helpful as with one glance your doctors' instructions will be clear to you.....no thinking, no checking each individual pill bottle.

Tips:

• Reviewing the medication-related questions included in this section will help you prepare to inquire about your particular medication regimen!

MEDICATIONS CHART(PDF)
MEDICATION QUESTIONS TO ASK YOUR DOCTOR(PDF)
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​What can you do to empower yourself during your hospital stay?

• How can you hold on to some degree of self-control and self-respect while in the hospital?
• What do you do if you feel confused when the "professionals" are discussing your health?

We have included this section to help answer some of these questions and address some potential fears…..

1. First and foremost, it is imperative to remember that you are your own best advocate and you are the expert on you. Putting your trust and faith in your doctors does not mean that you can not or should not take an active role in your medical care. In fact, staying informed and playing an active role in your care not only gives you some degree of control, but it could also help in limiting potential medical mistakes and negligence in the care that you receive.
2. You have the right to information, so stay alert, be vigilant, and ask questions! A hospital should provide you with basic information even prior to admission:

-Patient Rights
-How to complain, internally and externally
-Telephone/TV info
-Advanced DirectivesVisitor Accommodations
-Specific accommodations for religious reasons

1. Take your workbook with you so that you may take notes:

Ask what medications and doses you are being given and why
When they come to wheel you out of your room for some test, ask them where they are taking you and why, and write down that information so that you may later follow up if necessary
Ask for the titles of those who approach you and keep track of who's who (see list of hospital personnel below)
Write down people's names (doctors, nurses, social workers, etc)
-Collect business cards of those who visit, and keep these in your personal card holder
Things to Pack for Your Hospital Stay:
- Insurance Card
-Personal Identification
-List of current medications (and dosage)
-Comfortable pajamas (loose-fitting is best)
-Socks and slippers
-Underwear
-Comfortable clothing and shoes to wear home (something loose-fitting)
- Eyeglasses (you might want to leave contacts at home)
Toiletries
-Hairbrush
-Shampoo
-Soap
-Tooth brush and tooth paste
- Deodorant
-Feminine hygiene products Your own pillow (if you choose) Entertainment Material-
Books, Magazines
-Music, IPOD
-Portable DVD player Cell phone and charger
Do not depend on supplies provided by hospital staff
Be sure to leave jewelry, credit cards, and any other valuables at home

Hospital Personnel:

• Attending physician - most probably the doctor who admitted you and/or is responsible for your continuing care
• House Staff –
  • Intern: a medical school graduate who has completed one year post graduate medical training in a hospital
  • Resident: a medical school graduate who has completed more than one year post graduate medical training in a hospital
• Medical student/intern –Third and fourth year medical school students generally rotate through a teaching hospital
• Registered nurse R.N. – A person who holds a Baccalaureate in nursing and sometimes even a Masters degree
• Licensed practical nurse L.P.N. – A person who could have just one year of nursing school
• Nurse's aides and orderlies – A person who assists individuals with healthcare needs, with activities of daily living, and provides bedside care – including basic nursing procedures, like checking blood pressure and body temperature– all under the supervision of an R.N. or L.P.N.
• Nurse practitioner – A registered nurse who has completed specific advanced nursing education (generally a master's degree or doctoral degree) and training in the diagnosis and management of common as well as a few complex medical conditions. Nurse practitioners are generally licensed through nursing boards rather than medical boards.
• P.A. Physician Assistant - A specially trained person who is certified to provide basic medical services (as the diagnosis and treatment of common ailments) usually under the supervision of a licensed physician.
• Patient Representative
  • A hospital-employed person who serves as a liaison/go between patient and hospital
  • A Patient representative's job is to make the alienating environment of a hospital seem more humane and responsive to the patient
  • He/she looks out and speaks up for the patient and is there to listen to complaints and suggestions, assess the situation, and pass along your thoughts (along with their own analysis) to the proper authorities for action
  • Often a nurse, but not always
  • Patients and /or their families should be encouraged to contact the Patient Relations/Customer Service department to express any concerns they may have
• HIPAA Laws:
  • Health Insurance Portability and Accountability Act
  • Provide federal protections for personal health information held by covered entities (i.e. doctors, hospitals, health insurance companies)
  • Give patients an array of rights with respect to their personal health information
  • Balanced so that it permits the disclosure of personal health information needed for patient care and other important purposes
  • Intended to lead to reduced fraudulent activity and improved data systems When fully adhered to by all that are required to comply, HIPAA regulation is estimated to save providers nine billion dollars annually You can learn more about HIPAA by going to http://www.hhs.gov/ocr/privacy/
• The key things to keep in mind about HIPAA are the following:
  • You have the right to receive complete and understandable information about your diagnosis, treatment, and expected outcome
  • You have the right to review and understand your medical record
    (Ask your physician about anything you do not understand)
  • You have the right to refuse any treatment or test

(Be sure you understand the benefits and risks before you sign over your consent)

Familiarizing yourself with what to expect upon entering a hospital may help to reduce the stress of an upcoming surgical procedure. The following points were highlighted in an effort to educate and therefore lessen the uneasiness sometimes caused by an anticipated surgery date.
Preoperative Testing:

• Most surgical procedures require preoperative testing, which includes a complete medical history and a physical examination. This can often be carried out by your primary care physician in his office.
• If general anesthesia is necessary for your surgery, most hospitals will also require you to have an EKG (heart), X-ray (lungs), and Urinalysis (kidneys) prior to your surgery date. A blood test is also required to check for relevant issues, such as infection and blood clotting abnormalities.

Admissions:

• Upon checking into a hospital, you will go directly to the admissions department where your insurance will be verified and a name tag will be applied to your wrist.
• If you are there to be admitted for a hospital stay, a room will most likely be assigned to you at this time.

Surgery:

• Patients are first taken to the preoperative holding area.
• While there, an anesthesiologist should come to speak to you and to start an intravenous drip of fluids.
• You are then transported to the OR where you will be placed on a narrow operating table.
• Present in the OR is a scrub nurse (hands surgeon surgical instruments and sutures), circulating nurse (there to help you and to obtain any required items that may not be present in the room), the surgeon and his surgical assistants.

Anesthesia:
General Anesthesia:

• Involves depression of the pain centers of the brain.
• An oxygen mask is placed over your nose and mouth and you will be asked to breathe deeply.
• An intravenous sedative will be inserted into the drip, you will probably be asked to count backwards from "10" and you will fall asleep.
• Once asleep, an endotracheal tube is placed in your windpipe through your mouth to more effectively control the administration of the anesthetic gases.
• Once your operation is complete, a dressing will be applied to the area and the level of anesthetic gas will be gradually reduced.
• When you are breathing on your own, without assistance, you will be transported to the recovery area where you will be closely monitored until the effects of the anesthesia have worn off. Nausea and occasional vomiting is a possible side effect of anesthesia.
• One of the main reasons why you are instructed not to eat for some hours before surgery is so that in case you vomit, no gastric contents might enter the windpipe while you are asleep (called aspiration), which can be very dangerous.

Regional Anesthesia:

• Involves remaining conscious. Effects are confined to a specific region of the body without affecting other areas, such as the heart, the lungs, or the brain. Anesthetic agent is injected directly to the nerves that serve the area of the body where the operation will be performed.

Local Anesthesia:

• Administered by needle injection into the immediate vicinity of the procedure.

Recovery:

• Coughing and walking are two of the most important things you could do for a speedy recovery
• Coughing helps prevent postoperative pneumonia o Walking helps prevent clots from forming in your veins You may be hooked up to continuous monitoring instruments, such as an electrocardiograph or gauges to measure central venous pressure, arterial pressure, pulmonary capillary pressure, and oxygen saturation. Each is designed to provide moment-to-moment information of your body's response to the stress of surgery. As you improve, the monitors are discontinued.
• General Anesthesia slows all body processes, including intestinal function. This is why food intake is limited for several days after major surgery; it takes more time for the intestine to "awaken" than it does for the brain.
• You will first begin to feel pain while in the recovery room. As the anesthesia wears off, you will begin to need analgesia (reduced sensibility to pain without loss of consciousness and without the sense of touch necessarily being affected).

Blood Transfusion:

• Transfusion therapy is now one of the safest of all major medical treatments.
• Donated blood is subjected to several levels of screening for contamination.
• Some patients request donations from close friends or relatives rather than turn to the public blood supply.
• Many patients opt to donate blood to themselves:
  • You donate as often as once a week beginning a month or so before scheduled surgery
  • Your physician will monitor your blood count and give you iron supplements as needed to ensure your safety

PERSONAL NOTES(PDF)
SPECIAL INSTRUCTIONS(PDF)
NOTES SHEETS(PDF