by Jim Lewis, MSN, FNP
Did you know that your health care provider actually is not trained to just look at you and correctly guess what your problem is? A good provider is very much a detective, and detectives need clues to solve cases. Want to make your visit more productive? Here’s how you can help—write down as many answers as you can to this mnemonic: POLDCARTS.
P is for prior or previous. Has this ever, ever happened before? If so, how many times, and when was the last time before this visit?
O is for onset. When did it start? Providers hate hearing “a little while ago” or “I dunno.” I’ll bet you actually DO know, if you would think about it. Being able to say “This started about two months ago” or “It hit me out of the blue one week ago” is way more helpful as a clue than “it’s been a while.”
L is for location. Seems simple enough, but “my stomach hurts here on the left side” is very helpful. “I feel lousy all over” is not. “My head is throbbing, my left hip aches, and I have a burning, stabbing pain in my right heel” is superb. You get 2 gold stars.
D is for duration. How long does it last? Is it constant all day long? Does it last an hour and go away on its own? Does it happen during an entire season of the year? “It seems like forever” is very different than “this seems to happen every morning before breakfast, and by 10 o’clock, it’s gone.
C is for characteristics. What does it feel like? It’s okay to use your own terms. For something like pain, is it sharp, dull, aching, burning, stabbing, throbbing? Or for a cough, is it dry, hoarse, croupy, barking, productive (produces lots of phlegm or mucus), constant?
A is for aggravating and alleviating factors. What makes the symptom(s) worse or better? Example: An empty stomach makes the pain worse, eating bread makes it better.
R is for radiating. Does the symptom occur in just one place, or does it start there and then spread? “I get a sharp pain above my belly button that moves up my chest to my right shoulder.” Or “Every time I jog, I get a dull ache in my right knee, but only in the knee.”
T is for temporal or time of day. Is the problem worse at any specific, or several specific times of day? “I get horrible stomach cramps within 10 minutes of eating breakfast, but not with any other meal.”
S is for severity. You know the old “how bad is it on a scale of 1 to 10” routine. That might or might not be useful, and means something a little different to everyone. Saying mild, moderate, or severe is also acceptable. “When I finish jogging and sit down, I get a severe pain in my left calf, and can’t even walk for a few minutes.” Or “When I am lifting heavy boxes at work, I get a mild pain in my left jaw and shoulder.” What is really being asked is your perception of how bad the symptom is.
Even if you haven’t prepared the answers to these questions, a good healthcare provider/detective will know how to guide you through them. They will make it easier for you to give them the necessary clues so they can arrive at a working diagnosis. This part of your visit is actually the most important, and may provide enough clues that what is wrong is pretty obvious. Sometimes, your provider may even ask you what you think the problem is. This isn’t because they don’t have a clue. It is because you’re likely to be more tuned in to your symptoms than they are, and you may actually provide some clues that none of the previous questions uncovered. It is also frequently gives an opportunity for educating you so you can be more involved in your health care. And never be afraid to ask questions if you don’t understand something.
But a good detective doesn’t stop when the questions are all answered. He will want to confirm his theory by doing some checking. That pretty much always means some hands-on examination of you, the patient. You can be very helpful by following instructions carefully as you are asked to breathe deeply, stand, bend, sit, cough, and so on. Some parts of an examination may be uncomfortable, or even painful. They may also be embarrassing to you. You can make the experience better for yourself if you share that with your provider. He may be so used to doing a particular exam that it is easy to forget that the person being prodded and probed might not feel as casual about it. A good provider will do his best to ease your discomfort, or help you guard your modesty, so that the exam can provide the information he needs in order to treat you.
These recommendations are aimed primarily at adults who are able to think about and give reasonable answers to the POLDCARTS questions. But what about children? Oh, my! If they are really young, or shy, or afraid, they aren’t going to be much help at all, so as a parent you are going to have to be able to describe what you have observed that made you think a visit to “the doctor” was needed. It isn’t that hard, if you use the mnemonic.
For children who are old enough to understand, it is really helpful if you explain to them beforehand how important it is for them to help out. Will there be a blood draw for lab work? Children, like adults, naturally don’t like pain, but if you tell them what will happen, and why it is important, many children are able to endure the pain of a blood draw because they know they are helping provide clues to help them get better. And please, PLEASE avoid using the terms “being good” or “being bad” when you are talking about getting them to cooperate. They need to be praised for being helpful, if indeed they are able to, but they never need to be scolded or criticized or made to feel that they are bad because they couldn’t bring themselves to be stuck with a needle voluntarily.
So there are some suggestions for making a visit to your health care provider more productive for everyone involved. Hopefully, you won’t need to use them often, but when you do, you will get more answers and better care because you are able to provide accurate information about your symptoms.
Editor’s note: this is part of a series of posts aiming to draw on our collective knowledge and enrich our understanding of how things work. Jim is my amazing dad, and in addition to providing excellent healthcare he goes on hiking, kayaking, and photographing adventures with my mom.