April 21, 2017 Liza Colimon, MD Honoring Health Vow # 4 I Promise to Be an Active Participant in the Patient-Doctor Relationship Although the Doctor you choose is a very important player in your health care experience, the most important person in the Doctor-Patient relationship is you. Before deciding which imaging and blood tests to order; before deciding what type of exam you need and why; before making a diagnosis; a detailed medical history is extremely important in the process your physician will use to find answers to your concerns. It is key to be mindful about what your upcoming visit to the doctor’s office is all about and be prepared to discuss any perceived issues you are having. This is especially true if you have an appointment scheduled to discuss your menstrual cycle. I’m often amazed by the number of women who present to talk about their menstrual periods but have no dates to share. Most women I see do not keep a detailed menstrual log we can review and discuss at the time of their appointment. You can be guaranteed we will at least ask you for the date of the first day of your last menstrual period. The information is often buried in smart phone calendars or not recorded at all. Your cycle length is the first day of your period to the first day of your next period and all days in-between. If you are using an App make sure the dates are visible and easy to see and report to your doctor. I often spend a good portion of allotted visit time trying to help patients remember dates. I recall my visit with Eva three weeks ago. She was a young professional woman, in her late twenties, referred to me to discuss her irregular periods. But yet, she did not have a single date written down. She couldn’t recall the time frame of her last menstrual period or the dates for months prior. After re-framing my questions in several different ways, it was clear that without a good history of what was bothering her, I couldn’t provide an expert opinion or confirm whether or not her cycles were irregular. I could sense my questions were frustrating her and making her uncomfortable. Within five minutes of the visit she started crying and telling me how much she hated coming to see doctors and particularly gynecologists. I reassured her that the best way to start to solve a problem is to closely listen to the patient and her history. We came up with a plan for her to log her future menstrual periods and follow up so that I can make a more informed approach in her care without ordering unnecessary tests. Truth be told, I doubt she will come back. If you are concerned about your menstrual period here are seven tips to consider which will optimize your visit with your doctor and leave more time for discussion. 1. Know the dates of your menstrual period for a 4-6 month time frame. If you are having irregular periods or have skipped your period, this is information we need to know. For women who are menopausal (have not had a period in 12 months), we will also need to know when you had your last period and if you’ve had bleeding since. 2. Have dates written down, preferably on paper or a calendar. Be ready to communicate this information to your Doctor efficiently. Be prepared. Not all Apps are created equal and calculate your cycle length correctly. 3. If you are taking hormones, have taken Plan B, or have an intrauterine device or a Nexplanon implant be sure to communicate this information to your doctor. Be thoughtful about what medications you are taking and be ready to provide a list to your physician. Don't assume all of your information in your electronic medical record is correct. Not every doctor is thorough in keeping it up to date. 4. Be prepared to discuss the general history of your menstrual cycles. Do you have a life long pattern of skipping your period? Heavy bleeding? Painful periods? Or are you having new symptoms or changes that warrant further investigation. 5. If you’ve had surgery which may be effecting your menstrual cycles be able to discuss which procedures you have had, when the procedure was performed and why. 6. If you’ve had a recent evaluation at another hospital, office, or emergency room have the results of blood tests and ultrasound reports ready. You can request these records from any medical facility where you have received care. 7. Be prepared to leave a urine sample if there is any possibility you may be pregnant or if your period is irregular. This may seem obvious. However, we often have patients who are required to wait and provide a urine sample because they took a bathroom break upon arrival. Be sure to check in with the medical assistant prior to using the restroom.