The Doctor Visit Report

We need the best working relationships with our doctors that we can have.  Cultivate that relationship and change doctors if you can’t seem to talk to yours or you only find out important information after the fact.  I’ve been diagnosed for just over two and a half years and have had two different nephrologists.  If, at some point in the future, I find I cannot work with my present nephrologist (although I really can’t see that happening), I have no compunction about seeking another highly qualified nephrologist.  The same goes for your family physician.

Being the thorough doctor that she was, my primary care physician sent me for an ultrasound to take a look at what was going on inside. This uncovered a mild fatty infiltration of the liver. Was I in trouble here, too, I asked? It seemed this is fairly common, occurring in almost 20% of the population and could be helped by losing weight: obesity is one of the most usual causes of this condition. The obesity handwriting was on the wall for me.

That one pound loss also seemed to have had a slight benefit on my BMI. It was enough to convince me I should really work on the weight.  Remember, I was still grasping at straws here. (I kept an eye on this in my doctor visit reports and saw right there – in black and white – that as my weight went down, so did the BMI and the blood pressure.)

I began requesting copies of my doctor visit reports, as well as those of my blood and urine tests so I could have my own – more thorough than previously – file at home and stay on top of whatever I needed to. I was feeling burned by my previous P.A.’s failure to pick up on the low readings for the estimated GFR and felt I had to be my own case manager.  I still do and find both the nephrologist and my primary care physician agree with me. Not a single doctor that I’ve seen for a test or a consultation has ever refused or been difficult about making certain I receive these copies.

Since they are so highly personal, I decided not to include a sample of the Patient Exam from my own files in this blog, but to describe one instead. My doctor visit reports, or Patient Exam reports, are usually several pages long and on my doctor’s letterhead. They start with the date and then my history: name; date of birth (DOB); age; medications and dosages (including supplements and over the counter); allergies; vitals – height, weight (ugh!), BMI, temperature, pulse, blood pressure; smoker or not; chief complaint (why I was seeing the doctor for this appointment); whether or not I had an Advanced Directive , a durable power of attorney for healthcare decisions or a health care proxy – in other words, you give someone else the power to make health care decisions for you if you can’t,  and, if so, what kind.  The History section was broken down into Pertinent Past Medical History; Surgical History; Family History; Social History including: alcohol, caffeine, tobacco and drug use; Number of Children, Martial Status, Sexual History; Education and Employment; and the number of times a week I Exercise.

Check you Patient Exam reports, which are sometimes called notes, as well as doctor’s visits reports .  It’s amazing what mistakes can creep in during the transcription stage. For example, I’ve never taught high school in my new home state, but these reports had me doing so for five years.  While it was just a simple transcription error, it completely obliterated my contact with asbestos that doctors know NYC school teachers were exposed to.  My doctors, especially the nephrologist, should know about my exposure to this friable substance since it just might have some bearing on the disease.

Time to make a request of you.  I believe I mentioned that this blog is in anticipation of a book I’m writing about the early stages of Chronic Kidney Disease.  I’m interested in YOUR initial reaction to your diagnosis.  It’s certainly just as important as mine. I’d like to include it in the book, even if we do anonymously.

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Published in: on October 4, 2010 at 8:42 pm  Comments (10)  

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  1. I was referred to nephrologist about 8 months ago because of elevated creatin. About a month ago it elevated to 2 and she informed me I was in stage 3 of a 5 stage progression to renal failure. At first it was a death sentence and I was in shock. I read all I could on the internet. I have friends who are physicians and they said I should be concerned but not frightened. I had tests to determine if the blood was flowing to my kidneys; it was. My blood pressure was the culprit. The top number now that I was older. It had been in the 160’s; I began a diary and tried a new regiment of medication that caused migraine headaches. I cut back on the medication but monitored my blood pressure and adjusted the medication as per the pressure. It leveled and last blood test my creatin level was 1.1.To say I was pleased is an understatement. I continue to monitor and work with my nephrologist and primary care physician to maintain the normal level.

    • Hi Larry,

      You know the feeling, don’t you? It still gives me the creeps to think about it, although I’ve come to terms with what I need to do to impede the kidney deterioration – or so I like to think.

      I’m so glad you were able to work on the problem successfully. Please keep me posted.

      • I did not read or get a response until I received your blog report today. I am probably not doing something or have failed to sign up for something or that was the way it was supposed to be. Regardless, I wish you the best of luck in your endeavor because it is much needed

  2. Good day!This was a really marvelous Topics!
    I come from roma, I was fortunate to look for your topic in google
    Also I get a lot in your topic really thank your very much i will come daily

    • Bonjouro! (I think that’s the extent of my Italian.)

      We’re in the process of having the book of the blog (or is it the blog of the book?) edited now, so keep an eye out for it.

      I’m glad to be of any health. No one, and I mean no one, needs to go through that lonely, scarey time alone.

  3. I keep forgetting how to send a response back to you.

    I am wondering whether anyone has given a response to your request.

    Has anyone shared their own experiences with this Disease?

    • Yes, thank you, I am getting responses but would like to receive even more.

      By the way, you did successfully send a response to me.

  4. To Larry,

    You did successfully leave a comment. I apologize for my delay in responding (I’m just learning which button to press, too.) My reply to your comment IS the response you were meant to get, so you’re doing something right too.

  5. My experience is very much like Larry’s experience above. About nine months ago, I was being monitored with blood panels while I was put on a cholesterol medication (fenofibrate) by my GP. My creatinine jumped to 1.4 within two months on the drug and then my GP raised the dosage! Anyway, needless to say, my creatinine went to 1.6 after another two months and my GP became alarmed and sent me to a nephrologist. At the beginning of this appointment with my GP, my nurse and doctor informed my of my creatinine level and they looked at me like I just had been given a death sentence! The nurse told me I should have been more vigilant about the blood pressure (excuse me, you guys are the ones monitoring my blood pressure, I thought).

    The nephrologist took me off the cholesterol med and cut my blood pressure med in half and in three months, my creatinine went back to 1.1. Although I still may have kidney damage, my diet assigned to me and the medication adjustments by my neph to increase the kidney filtration seems to be working. I have lost 20 pounds, have lower blood pressure on decreased meds, and my kidneys seem to be in better shape. I have gone from Stage 3 CKD to Stage 2 CKD and I will continue this renal diet (low sodium, low protein). I will also continue my new exercise program to keep the weight off.

    • Good for you, Mark. It’s that weight loss that has helped you move back to Stage 2 since your weight is part of the formula for assessing stages. This is not to malign your having your meds lowered and your wonderful work with the diet and exercise.

      Thank you for allowing me to use your story in my book.


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