Take it step-by-step

The first steps in developing and monitoring a plan with your health care team are to define the team and understand what this new partnership means.

What is a patient-physician partnership?

 It’s a new approach to health care in which you, the patient, are an active participant in your health and decision making. It recognizes that good health care is a two-way street. Physicians bring their education and training to help you, but no one knows your body better than you do. 
You can learn why you should and how to partner with your physicians in your health care in “Getting the Health Care that’s Right For You,” a 20-minute video available from the Center for Informed Decision Making.
In “Transforming the Patient Experience,”  a series of videos produced by InformedDecisions.org, four patients share stories about how they became active participants in their medical decisions. Their health experiences include coronary heart disease, type 2 diabetes, back pain, and early stage breast cancer.

Who is on the health care team?

It’s important to have the right team in place to support you as a patient and to help you achieve your health care goals. Here’s a list of people who may be involved in your overall health care. Circle those that you have on your team and think about others you might want to add.
Health Care Providers
  • Primary care physician
  • Nurse practitioner
  • Physician assistant
  • Nurse
  • Medical specialists
  • Health educators (eg, diabetes)
  • Nutritionist
  • Physical therapist
  • Occupational therapist
  • Nutritionist
  • Therapist/counselor
  • Dentist
  • Pharmacist
  • Care/case manager
  • Spouse/partner
  • Son/daughter
  • Niece/nephew
  • Health advocate
  • Other
Health Support
  • Home health aides
  • Billing/reimbursement
  • Home companion
  • Life coach
  • Community health worker
  • Fitness center/coach
  • Spiritual advisor

Planning Your Office Visit

1. Prepare for a visit to your physician or pharmacist by reviewing suggested questions from the AHRQ. Questions are grouped according to common patient scenarios, such as:
  • Did your clinician give you a prescription?
  • Are you scheduled to have medical tests?
  • Did you recently receive a diagnosis?
  • Are you considering treatment for an illness or condition?
  • Did your clinician recently recommend surgery?
  • Are you choosing a health plan?
  • Are you choosing a clinician?
  • Are you choosing a hospital
  • Are you choosing long-term care?
2.  You play a critical role in improving your own health care and making wise medical decisions by asking questions. Learn the right questions to ask – visit the AHRQ website and watch this video.  And print out this list of questions about different aspects of care, from Whole Hearted Health.
3. Prepare a list of all your medications, including vitamins, aspirin, and other over-the-counter drugs, to take with you to the doctor. Use the Medicine Record Form availableat The Medical Library Association website. Another easy-to-use form is available from the United Hospital Fund’s Next Step in Care program.

Now it’s time to develop a Collaborative Care Plan

 Ask your physician or a member of your health care team to write out a collaborative care plan during your office visit. It should include all important information about you, your health status, goals, and steps you have agreed to take to attain them. Use the material you already prepared in your health assessment and in setting your goals and priorities. Make sure the plan is written in “plain language” – meaning you understand the words and recommendations and that a member of the health care team reviews it with you before you leave. The plan should include the following elements:
  • What you need to know about me (eg, I like to be called Ed, not Edward. I am deaf in my left ear)
  • My life goals (eg, To climb Mount Rainier with my grandson)
  • My problem list – current, active problems
  • My past history – relevant to current problems
  • My action plan, or self-management goals (eg, I will walk 30 minutes every day at lunch)
  • The medications I ACTUALLY take – doses and times for all medications, including over-the-counter drugs and health supplements
  • My health log – a place to track blood pressure, weight, blood glucose, exercise
  • My target outcomes – for blood pressure, cholesterol, blood glucose, lifestyle changes, and other goals agreed upon by the team
  • My follow-up plan to achieve my goals, plus all upcoming appointments

How can I keep on track? 

The Personal Health Record from the United Hospital Fund’s Next Step in Care program is designed to help caregivers keep track of a family member’s medical information – but it can be easily adapted for your own personal use. It includes space for information about medical conditions, treatments, insurance coverage, and advance directives.

What should my follow-up plan be?

Be sure to take home a copy of the collaborative care plan, indicating target outcomes and your own expectations with respect to diet, exercise, medications, etc. Keep track of your progress in each area; when you return for your next appointment, you can discuss where you stand and look at changes that might help improve your progress. Or, if your progress has been excellent, you may wish to discuss new goals with the team.
Copyright © 2010-2013  Perelman School of Medicine at the University of Pennsylvania Office of Continuing Medical Education. All rights reserved.