At Home DIY Everyday Gear Medical Practice

Make A Medical Record Book, Part 3 – Tips and Tricks

In Make a Medical Record Book, Part 1, I described the parts of a medical record book, and in Make a Medical Record Book, Part 2, how to use it at a medical office. Here are some additional tips and tricks for making your medical notebook as useful as possible.

Keep old Medical Appointment Record sheets in Section 2, and keep past Current Medications records in Section 3 for future reference. They’ll come in handy, and it’ll be much easier for you to find the information in your binder than to get your doctor to find it in the office file.

Useful tip: Never again answer when a medical assistant asks you what medications you currently take. Instead, make a copy of Current Medications every time you go to the doctor, and simply hand over the updated copy to be kept in your permanent file. Your doctor will be thrilled, once he or she gets over the shock, and you’ll be happy because your doctor will never again wonder what the assistant’s scribble really meant. Win-win for everybody! (Yes, I learned this the hard way.)

I typed up a personal Medical History for each of us, and keep a copy in Section 5. It gets updated it with each event. For everyone, this should include an inoculation history, especially tetanus shot dates.

Useful tip: Give a copy of this page to every new doctor you see. Nothing’s more helpful that a clear, concise medical history. Ever watch ‘House’? If Hugh Laurie’s patients only had your notebook, half the time there’d be no show because that elusive bit of missing medical history would be right before the infamous misanthrope’s eyes!

Each of us also has a Family Health History — this isn’t your history, it’s the history of your siblings, parents, grandparents — as much as you know. This goes in Section 6.

Useful tip: Make sure every new doctor has a copy of this, as well. It’s a lot easier to read a printed, chronologically organized history than it is to try to interpret the scribbles in the too-small boxes on the form the office gave you to fill out. “Easier to read” can also be translated as “information more accurately interpreted”.

X-rays are increasingly being copied to CD in our neck of the woods, which makes storing them in a binder really simple — you can even buy pages meant specifically for CDs. I keep these in Section 8.

Useful tip: Get a copy of every x-ray taken. If you request it at the moment of the test, you may be able to leave with it, instead of having to follow up later. I learned to do this after a famous university medical center destroyed my neurological x-rays after only seven years. What were they thinking? Seven years in neurology can be nothing in the case of slowly-changing pathology!

We keep oversized x-rays in a large artist’s portfolio — a stiff plastic-like envelope with a handle. It’s too big to fit in a file drawer (some of our x-rays are old and huge), so it’s kept in the back of a closet where it’s easy to get to as needed.

I always make sure I have a business card from every doctor we see, as well as for any hospital department or individual we might have any reason to contact again (radiology, medical records, etc., and yes, the business office, if you’re talking to them). They’re kept in Section One. Being able to get directly to a specific person or department saves time and frustration; having the right FAX number on hand is really useful when doctors are a part of your life. Seeing the number on a card avoids mis-hearing it over the phone when you’re about to FAX something. Keeping the cards means you have contact information for doctors you’ve seen in the past, but may see no longer — quite useful when it matters.

Useful tip: Insist on having copies of blood and other tests and keep them in Section Eight. Your doctor, or a specialist, may want to order ‘official’ copies, but you’ll at least have the information with you when it’s being discussed — a huge advantage for you. Pull out only the relevant test results from this section as needed for a specific appointment so that you have the right ones handy on that particular day.

Putting a record book together requires a little effort at first, but you’ll probably be amazed at the difference it makes at every appointment, and pleased at how easy it makes tracking your health. Of course, these are just guidelines — over time, you’ll adapt your own notebook(s) as you want and need to. Once it’s put together, each update takes only a few minutes — well worth it compared to the frustration of not having the information handy the next time you need it.

Useful tip: Have kids? Keeping a medical notebook from birth can streamline baby care, makes filling out school records a snap, and is an invaluable gift to send off with your young adult when he or she leaves home — as well as modeling medical empowerment for your adult ‘child’.

When it comes to medicine, ’empowerment’ is the watchword — no one who is responsible for your medical care (or for medical care for someone you love) will ever care as much about it as you do. And no one will ever pay as much attention to your medical care, and needs, as you can and must. A well-maintained medical notebook is your first and most important weapon in the fight to maintain as high a standard of health as possible. Knowledge is power!


Make a Medical Record Book, Part1 — Putting It Together

Make a Medical Record Book, Part2 — How to Use It