Healthcare Provider Visit Worksheet

Visits to your healthcare provider can be stressful.  Using a personal diary or a worksheet can help your time spent together more effective. When you visit your healthcare provider you will want to know what is wrong, what the physician can do to treat it, and what you can do to better manage it. Your physician will begin by taking a history asking for a description of the symptoms as well as possible factors that can bring them on or make them better. This will be followed by a physical examination, possibly diagnostic tests, a diagnosis, and a discussion of treatment options.

Symptoms of irritable bowel syndrome (IBS), though chronic or recurrent, can vary in duration, intensity, and description. Management of symptoms often is not easy and requires individual participation while working with a physician or healthcare provider. Don’t be afraid to ask questions; write them down before your appointment. As a patient with IBS, you should never feel devalued, ignored, or uncomfortable with your healthcare provider. If you do, or if your concerns are not being met, it is time to change to another physician. Your goal is to obtain a diagnosis, understand IBS and your symptoms, and develop a management or treatment plan designed to meet your individual needs.

The course of IBS is highly individualized and can be challenging to even the most knowledgeable and caring physician. Be organized when you visit your healthcare provider. Here are some things you can do to help make your physician visit most effective.

Talking to your healthcare provider worksheet

List your symptoms and how frequently they occur. Try to be as specific as you can. For example, describe where pain is located, how often it occurs, and what makes it worse or better. Keeping a daily symptoms diary for a couple of weeks that lists symptoms and associated activities can help sort this out.

Symptom Description Frequency
____________________ ____________________ ____________________
____________________ ____________________ ____________________
____________________ ____________________ ____________________

Provide your healthcare provider with a list of all other chronic illnesses currently affecting your health, or of prior infectious gastrointestinal illness.

____________________________________________________________
____________________________________________________________
____________________________________________________________

List all prescription and nonprescription (over-the-counter) medications as well as herbal supplements you currently take. Include dosage and frequency.

Medication Dosage Frequency
____________________ ____________________ ____________________
____________________ ____________________ ____________________
____________________ ____________________ ____________________

Inform your healthcare provider of any previous gastrointestinal procedures or tests. Samples would include colonoscopy, sigmoidoscopy, endoscopy, and ERCP (endoscopic retrograde cholangiopancreatography).

Year Procedure/Test Results
__________ ____________________ ____________________
__________ ____________________ ____________________
__________ ____________________ ____________________

Inform your healthcare provider of any previous surgeries, especially abdominal or gastrointestinal surgeries.

Year Surgery
__________ ________________________________________
__________ ________________________________________
__________ ________________________________________

Use the space below to write down any other questions you may have for your healthcare provider or to take notes during the appointment. It is imperative that you walk away from your healthcare provider’s appointment with a clear understanding of what he or she tells you. Therefore, do not be hesitant to ask questions.

____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________

Adapted from IFFGD Publication #185 “Talking with Your Doctor About IBS” By Sarah Quinton PsyD, Director, Behavioral Medicine for Digestive Health, Co-Director, Interdisciplinary Bowel Dysfunction Clinic, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL. Edited by: Lin Chang MD, Professor of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA

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IFFGD is a nonprofit education and research organization. Our mission is to inform, assist, and support people affected by gastrointestinal disorders.

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