Because office visits are short (about 15 minutes), preparing can help you make the most of your time with your doctor. Researchers at Ohio State University developed the PACE Guide Sheet1 to give you an easy way to organize your feelings, questions and concerns before your visit. PACE stands for:
- P = Provide information about how you feel.
- A = Ask questions if you don't have enough information.
- C = Clarify what you hear.
- E = Express any concerns you may have.
Here's how to use the PACE sheet:
- A day or two before your doctor visit, answer the questions on the sheet. If you're not having problems or concerns, leave blank spaces on the form.
- Show the sheet to your doctor at the start of the visit. During the visit, use the sheet to remember what you wanted to discuss with your doctor.
1Used with permission from Donald J. Cegala, Professor of Communication and Family Medicine, Ohio State University
P.A.C.E. Learn more:
P = Provide information about how you feel.
Write down your symptoms, concerns or problems. If you've noticed changes in how you're feeling, make a note of when the change started.
Use these questions to help you describe your symptoms and concerns:
How you feel
- Do you have pain (such as chest pain)? If so, where?
- Is the pain constant, or does it come and go?
- Is it a sharp pain, a dull ache, tightness, pressure or a burning feeling?
- When and how often did you notice it? For example, does it happen before or after eating, when you get up in the morning, when you are resting or after physical activity?
- How long does it last — a few seconds or a few minutes?
- Does the symptom get worse when you're active? If so, what activities make it worse?
What you do for your symptoms
- Do you take medicine to make you feel better? What medicine (for example, nitroglycerin for chest pain)? When and how do you take the medicine?
- Does the medicine help?
- Do you use other treatments to help you, such as vitamins, herbs, dietary supplements, over-the-counter medicines, physical therapy, acupuncture or other treatments?
- Does avoiding certain things, such as specific activities, foods or medicines, help this condition? If so, what are the things that help?
- Have you seen another doctor about this condition? If so, how was your condition treated?
- Do you think your symptoms might be affected by problems, worries or stress? (If so, explain this to your doctor.)
- Are you concerned that these symptoms could be a sign that your heart condition is getting worse?
How can the doctor help you?
Think about what you hope the doctor can do for you. If you have an idea, you can write it on the PACE sheet. You won't always know exactly what you want your doctor to do for you, so you may leave this section blank.
A = Ask questions if you don't have enough information.
Always think about your questions before you see the doctor. Write your questions on your PACE sheet or a note card so you don't forget them. If you have more than three questions, mark the most important ones with a star, so you'll be sure to ask them first.
Use these sample questions to think about more information you'd like to know about your condition, medicines, tests and other treatments.
Sample questions about your condition
- What is coronary artery disease (CAD) and why do I have it?
- How bad is my CAD? Will I recover? Remain the same? Get worse?
- Will the disease affect my normal activities? If so, how?
- How long will I need to follow the treatments for this condition?
- How will I know if my CAD is getting worse?
- Are there programs or support groups to help me take care of and cope with my condition?
Sample questions about tests or procedures (such as ECG or angiogram)
- What is the purpose of this test or procedure? What will it tell us about my condition?
- Are there any risks in doing this test or procedure?
- What does the test involve? For example:
- Is the test painful?
- How long does it take?
- Will I be awake or asleep?
- Do I need to bring someone with me?
- Is the test covered by insurance?
Sample questions about medicines
- Why do I need to take the medicine? What does it do?
- What side effects should I watch for and report to my doctor?
- Do you have any samples I can try?
- Is there a generic form of the medicine?
- Will I feel better when I take this medicine? How long until I feel better?
- How should I take the medicine, and what should I do if I miss a dose?
- How long will I need to take the medicine?
Sample questions about other treatments (such as dietary changes and physical activity)
- What do I need to do?
- How often?
- How long will I need the treatment?
- When will I see results?
- Does the treatment have any risks?
C = Clarify what you hear.
When you talk to your health care team, you may hear things that are hard to understand. Or you may get mixed up because you hear so many things. Even if you think you know what the doctor, nurse, pharmacist or other professional is telling you, it's a good idea to clarify what you hear.
When you clarify what you hear, you:
- Ask the professional to explain.
- Repeat the professional's instructions.
- Review what you heard.
Ask the Professional to Explain
If you don't understand something, ask the professional to repeat what he or she said. If you don't understand a word, ask them to use a simpler word that you will understand. Make sure you know what the professional wants you to do and why you should do it.
Try these phrases:
- "I don't understand. Can you say that again, using different or simpler words?"
- "Can you clarify?"
- "Could you please repeat that last part?"
- "What does that word mean?"
- "Please spell that word for me."
Repeat the Professional's Instructions
Health care professionals give a lot of instructions, such as when to take your medicines, what to watch out for and how to take care of yourself. These instructions are important. To be sure you understand them, repeat the instructions back, using your own words, and ask the professional if your understanding is correct.
Try these phrases:
- "I think you're telling me that…"
- "Am I correct that you want me to…"
- "Before my next visit, I will…"
- "You want me to call you if…"
Review What You Heard
At the end of a phone call or office visit, review what you've heard. Repeat the things on which you and your professional agreed. If you think you might forget something, write it down (or ask the professional to write it down for you).
Here is an example of reviewing what you heard:
Patient: "I understand that my cholesterol is still high and that you want me to take this new medicine. You think my exercise is helping and that I can increase my walking to 35 minutes a day. Finally, you think my headaches are not related to my heart condition. Is that correct?" Doctor: "Yes, and we also agreed you would eat at least five servings of fruit and vegetables every day." Patient: "That's right. Could you please write that down for me? Have I missed anything else?"
Try these phrases:
- "I heard you tell me these three things…"
- "We decided that…"
- "You want me to try a new medicine because…"
- "You think I'm doing fine except for…"
- "Could you please write down the things you want me to remember?"
Bring a tape recorder and ask your doctor if it's OK to tape your visit. If he or she would prefer not to tape the whole visit, ask him or her to record any instructions for you.
Bring someone with you to help ask questions and write down important instructions and information for you.
Ask your doctor to spell medical words or draw pictures to help you understand a procedure or instruction.
E = Express any concerns you may have.
You may have concerns about your condition and treatments, including procedures, tests, medicines, dietary changes and physical activity recommendations. It's very important to speak up and talk to your health care professionals about your concerns. Make sure you understand why the doctor is prescribing a certain treatment and how it will help your condition. You'll find it easier to follow a treatment plan when you know how important it is to your health.
You can make your condition worse if you don't follow your health care team's instructions. If you can't follow your treatment plan, be honest and talk with your doctor about it. He or she may be able to recommend another treatment that will meet your needs better. For example, if one of your medicines has unpleasant side effects, don't just stop taking it. Tell your doctor about the problem and ask if there's another medicine that will help your condition without the side effect.
Use the PACE Sheet to write your questions or concerns to review with your health care professionals. Write down what you would like to change and why.
Remember, you're the most important part of your health care team. It's up to you to carry out the professionals' advice to make yourself healthier. You need to have your concerns and questions answered, so you can understand and follow your treatment plan.