Originally published in The Ottawa Citizen July 8, 2003
Original Title: What your doctor wants to know
Preparing medical and family history and other details in advance helps a family doctor tune into your needs.
Your first full checkup with your new family doctor (should you be fortunate enough to find one accepting new patients) addresses more than a full physical exam. This appointment should include your family, past medical and sexual histories, medication lists, allergies, lifestyle choices and, for women, a gynecological history.
Forty-five minutes may not be enough time to complete this survey and physical exam. Preparing this information before your appointment will provide more time to focus on your pertinent concerns and the physical exam.
Sometimes it may be necessary to split this comprehensive exam into two visits because of time constraints.
The past medical history includes your vaccination record and a chronological record of any serious illnesses, previous surgeries, traumas, fractures and infections such as chicken pox, HIV, hepatitis and pneumonias.
Provide a list of any medication allergies and the reaction you had (hives, blotchy red rashes, difficulty breathing or throat tightness).
Bring all your pill bottles with you. It is easy to forget medication names and the dose.
A complete list of medication, including herbal or “natural” remedies, helps determine the potential for adverse drug interactions.
Your family history should include siblings, your parents and grandparents. Find out if they suffer or suffered from:
– Coronary artery disease, heart attack, high blood pressure, stroke, elevated cholesterol levels.
– Thyroid disease.
– Ulcerative colitis, Crohn’s disease, or other intestinal disorders.
– Rheumatoid arthritis and other auto-immune disorders.
– Depression, anxiety, bipolar disorders and other psychiatric illnesses.
– Cancer of the breast, ovary, colon, stomach and prostate gland.
Many of these illnesses are inheritable. The family member’s age when first diagnosed with the illness is important.
Your sexual history should include your sexual orientation, your age when you first had intercourse, the number of previous partners over your lifetime and the number of partners over the past year.
If possible, it is helpful to know whether previous sexual partners were screened for sexually transmitted disease. This information provides an assessment of potential risk of disease exposure.
Part of the gynecological history includes your age when you had your first period (menarche) and the number of days between periods.
Do you have heavy or light bleeding? How long does it last?
Do you have pain with your period (dysmenorrhea)? If applicable, when did you begin menopause?
The lifestyle section of the history correlates well with the family history.
For example, if your father smoked a pack of cigarettes per day and had a heart attack at age 50, and you smoke as well, your risk just increased.
If you smoke, when did you start and how many cigarettes do you smoke per day?
Do you use other drugs such as marijuana, cocaine, LSD, amphetamines or narcotics?
On average how many glasses of wine, pints of beer or shots of liquor do you drink per week?
Do you always use your seat-belt and is it positioned properly over your lap and chest?
If you bicycle, in-line skate or skateboard, do you wear a helmet?
What is your occupation and any workplace environmental hazards (volatile chemicals, poor ventilation, hazardous materials, etc.).
Do you regularly participate in aerobic exercise? What do you do, how frequently and for how long do you exercise on each occasion?
The dietary history begins with a cursory review of eating habits. Do you eat breakfast, lunch and supper? Do you often snack between meals? How many fruits and servings of vegetables do you eat per day? Add up the slices of bread, breakfast cereals, pasta, potatoes and rice consumed per week. What other foods are eaten with them?
How about the weekly consumption of red meat (beef and pork), chicken (with or without the skin?) and fish? Vegetarians should include a list of all the legumes, beans, soya and other protein-containing foods in their diet. The dairy section includes daily milk, cheese and yogurt consumption; whether you use butter or margarine; and the number of eggs eaten per week.
Few pass the snacks, treats and extra fat section. This survey includes how frequently you visit your local fast-food haven, nibble on those cookies or indulge in your favourite chocolate bar, ice cream, salted and roasted nuts or bag of chips. These extra calories are the usual source of slow weight gain.
Your doctor may recommend tests tailored to address specific risk factors, if any, gleaned from this information. Feel free to ask questions relating to your specific concerns. Sometimes, trying to fit all this information into one visit can be frustrating and dissatisfying for both parties. Should time run out, make another appointment to have the rest of your questions answered and to review the test results.