Your Medical History: Create a Timeline That Saves Precious Minutes
One of the most effective ways to maximize your appointment is to arrive with your medical history well-organized. This isn’t just helpful—it’s essential.
“Getting all that background stuff done and dusted quickly,” Dr. Johnston explains, is crucial to making the most of your limited time. “That means coming in with a list of especially your active medications, which ones they are by name, what the dose is, how you take them.”
Your comprehensive history should include:
- All prescription medications with dosages
- Over-the-counter medications (including daily aspirin)
- Vitamins and supplements
- Medical diagnoses with dates
- Previous procedures or operations with dates and locations
- Any complications from past treatments
Dr. Johnston acknowledges a common patient frustration: “I understand this is such a point of frustration for patients because they say, ‘Well, doc, it’s in my chart.’” But as she points out, “You have thousands of records in that chart. And if it wasn’t done in the last year, it’s going to take five, ten minutes to go find it.”
Those are minutes you can’t afford to lose from your consultation time.
Lead With Your Concerns: Front-Load Your Most Important Questions
Perhaps the most transformative advice Dr. Johnston offers is to lead with your most pressing concerns right at the start of your appointment.
“If you have fears, questions, concerns, things you are absolutely sure you want addressed in that appointment, lead with that,” she emphasizes. “Bring that up early because if we go through 13 minutes of your 15-minute appointment with me and you leave that to the end, by the way, ‘Doc, I’m really afraid that the bacteria I had at my last operation might be a problem,’ well, now I have to refocus.”
This approach ensures your doctor knows exactly what worries you most, allowing them to frame the entire conversation around addressing those specific concerns. When you clearly state your purpose for the visit, you create a roadmap for the appointment that keeps everyone focused.
The Power of a Second Set of Ears: Why You Shouldn’t Go Alone
Many patients find themselves caught in a frustrating cycle during appointments: they’re so focused on remembering what they wanted to ask that they can’t fully absorb what the doctor is saying.
“We have so many patients that say that when they get to the doctor, they think they’re prepared and then they get there and they can’t remember anything that they wanted to,” I shared during our conversation. “And even more importantly, because they can’t remember what the doctor said when they left because they were thinking too much during that appointment about what they wanted to ask.”
Dr. Johnston wholeheartedly agrees that bringing someone with you to be a “second set of ears” can be invaluable. At the Global PAD Association, we take this a step further through our Leg Saver Hotline (833-PAD-LEGS), where we not only help patients prepare for appointments but can join during consultations to take detailed notes.
“We help them to not only prepare for the appointments, but we’ll show up during the appointments and we take copious notes on the appointment and we run them by the doctor and make sure we’re on point. And then we send them to the patient,” I explained.
Dr. Johnston notes that even calling someone in on speakerphone can be helpful if they can’t physically attend the appointment.
Honesty is Your Best Medicine: The Critical Importance of Transparency
For patients with PAD, being forthright about lifestyle factors—especially smoking—is absolutely critical. The success of procedures and long-term outcomes hinges on this transparency.
“If you’re still smoking, it’s gonna be a very different conversation,” Dr. Johnston explains. “I really don’t offer interventions to patients who are actively smoking for claudication because the failure rate is so high and the risk of limb loss goes up.”
I shared a stark example: “We just had a patient that had called into our Legsaver hotline and they had had a bypass that failed. And it was literally within two weeks. And the first question I asked, well, do you smoke? Yes. You’re still smoking? Yes. Well, there you go.”
Dr. Johnston emphasizes that she’s not there to judge patients but to help them understand realistic expectations based on their current health behaviors. “You are a grownup. You get to make those decisions. But I do have to tell you what we can expect based on where you are today.”
Know Your PAD Symptoms: Speaking Your Doctor’s Language
For patients with peripheral artery disease, accurately describing symptoms can make all the difference in receiving proper diagnosis and treatment. Dr. Johnston provided a masterclass in how to communicate PAD symptoms effectively:
For intermittent claudication (pain with walking): “Pain with walking that is reproducible. It happens every time. And it happens at a specific distance. Every time I get to the fourth neighbor’s mailbox. Every time I crest this hill on my daily walk, this is when my calves and thighs start to burn. And when I stop and rest, it gets better. When I walk again, the pain comes back.”
For ischemic rest pain: “My feet hurt when I put them up. The minute I put them back down and gravity brings those extra couple of blood cells down to my toes, the pain gets better.”
For critical limb ischemia: “Tissue loss, which is wounds, ulcers, or gangrene.”
Understanding these distinctions is crucial, as Dr. Johnston explains: “Classic ischemic rest pain, tissue loss, wounds, ulcers, gangrene, those are don’t pass go. This is urgent. Your leg is at risk.”
Clarify Your Treatment Goals: What Success Looks Like to You
What constitutes a successful treatment varies dramatically from patient to patient—every patient has their own circumstances, priorities, and goals. Dr. Johnston shared a powerful story about a patient seeking her opinion on a heart valve procedure.
“I had a patient in my clinic who asked me about a procedure for his heart, which is actually not my area of expertise, but we had established trust and rapport and he wanted my opinion,” she explained. “I asked him, ‘What’s most important to you? Is it being able to get back to this hobby? Or is it just being able to stay at home with your wife and avoiding the chance of any complications that might land you in a nursing facility?’”
Dr. Johnston didn’t even need to hear the answer. “I could see the light bulb go off in his brain. And it was clear that now he knew how to answer those questions and how to think about the procedure that was on the table for him.”
She also shared another illustrative case of a PAD patient with rest pain and foot wounds who couldn’t afford a lengthy hospital stay: “Doc, I can’t do it. You cannot do a bypass, even if it’s the right thing for me. I cannot be in the hospital for two weeks…My goal is to get out of the hospital as soon as possible.”
Understanding this priority allowed Dr. Johnston to adjust her approach to a minimally invasive endovascular procedure instead of bypass surgery, ultimately delivering care that met the patient’s needs while respecting his personal circumstances.
“Is it what is recommended by the clinical trials and our guidelines? No, it wasn’t, but it was his goal,” she noted. “My job is not to follow some checklist. My job is to work with my patients and get them where they need to be in their mind and in their heart.”
The Contingency Plan: Always Ask About What Comes Next
For PAD patients in particular, understanding the durability of interventions and having a contingency plan is essential.
“We always tell patients delay as much as you can—walk, walk, walk and mitigate any sort of risk factors such as smoking cessation and diabetes,” I emphasized during our conversation. “But what is the contingency plan when it fails? You’re always wanting to kick the can forward.”
This is a question I find myself asking repeatedly when patients call our Leg Saver hotline. Too often, I see doctors jumping straight to bypass surgery as the frontline treatment without trying minimally invasive approaches first. While I understand the desire to provide a more durable solution, I always wonder: what’s the contingency plan when that bypass fails?
In many cases, a minimally invasive endovascular procedure can provide sufficient blood flow for a patient to go home, work on lifestyle modifications, and allow the body to grow its own collateral vessels. This approach can be particularly valuable because it preserves options for the future. When vessels do re-block after a minimally invasive procedure, patients may not need another intervention at all thanks to their improved collateral circulation through walking as medicine (the best medicine!)—or they may still have bypass as a viable contingency plan if the surgeon has been careful to preserve “landing zones” for future procedures.
Dr. Johnston acknowledges this reality: “None of these are ever quite as good as the blood vessels that you were born with. So in my brain, when I’m thinking about interventions, I start a timer, a clock. And some of these procedures have more durability than others.”
By asking about contingency plans upfront, patients can develop a more complete understanding of their treatment journey and prepare mentally for potential future interventions.
Putting It All Together: Your Appointment Success Blueprint
As Dr. Johnston summarized, the key points to “training your doctor” are to:
- Lead with your most important questions and concerns first
- State your purpose of the visit as soon as you walk in the door
- Come prepared with your detailed medical and surgical history
- Bring a comprehensive medication list, including over-the-counter products
- Be completely honest about your lifestyle and health behaviors
- (Kym’s add!) Clearly communicate what will make you satisfied when you leave the appointment
Ultimately, the goal is a partnership where both doctor and patient work together toward the best possible outcome. By taking these steps to prepare for your appointment, you’re not just optimizing those 15 minutes—you’re potentially changing the trajectory of your health journey.
For PAD patients in particular, where early diagnosis and appropriate intervention can mean the difference between saving or losing a limb, these preparation strategies aren’t just helpful—they’re potentially life-changing.
If you want help preparing for your appointments to talk about PAD, call our Leg Saver Hotline at 1-833-PAD-LEGS. We can also provided comprehensive education, high-touch advocacy where we attend your appointments with you, and lifestyle modification support with our free walking program and diet seminars. We can also get you in touch with Dr. Lily Johnston if you live in California, to learn how to take advantage of her metabollic health services in person or via telemedicine.
Citations:
Yost ML. The Current U.S. Prevalence of Peripheral Arterial Disease. Vascular Disease Management. 2023;20(4):E67-E73.
- National Heart, Lung, and Blood Institute. Facts About Peripheral Artery Disease (P.A.D.). December 2021.
- Centers for Disease Control and Prevention. About Peripheral Arterial Disease (PAD). May 15, 2024.