“What brings you here today?”

“How have you been doing since I last saw you here in the office?”

When your doctor or healthcare provider asks you these questions, do you know what to say? Or, more importantly, do you know how to answer so he or she has the information needed to give you the right diagnosis and treatment?

Here are two fictional patients, Agnes and Bill, as they face their docs and answer these questions.

Agnes: Well, I don’t know…I think my breathing is worse, but I’m not sure… I have good days and bad days…I cough sometimes – it’s terrible - and I can’t stop, but then I seem to get over it. A lot of the time I’m clogged up and my breathing feels tight. I even have to sleep in the chair sometimes. I can’t do what I used to do.

Bill: Well, my oxygen sats are about two points lower now when I walk on the treadmill than they were a year ago. My cough is about the same - I cough mostly first thing in the morning and bring up clear mucous about the size of a quarter, and once I’m done with that, I breathe better. About a month ago I had to sleep in the chair for a couple nights, but I increased my rescue inhaler to four times a day for a few days - like you said I could - and now I can sleep in bed again with no problem.

Between Agnes and Bill, who do you think is going to have a more productive office visit? Which one of these patients is providing, in an efficient way, more solid information to the doctor, allowing more time for a meaningful discussion and the development of an effective treatment plan? If you guessed it is Bill, you’re right. How does he do it? Bill has a medical notebook.

What is a medical notebook?
A medical notebook is a means of organizing your medical information in one place, and keeping track, daily, of changes and the stability of your health. It can help you manage your disease, provide vital, up-to-date information to your healthcare provider, and get the most out of your medical appointments. There are many ways to make a medical notebook work for you. All you need to start is an inexpensive loose-leaf folder with pockets and a spiral tablet, at least 5x7 inches in size.

Spiral Tablet
Here are some suggestions of what to keep track of each day. You don’t have to do all of them – just those that are issues for you, or that interest you. Check with your healthcare provider for recommendations.

• Day and date
• How you are feeling today (tired, energetic, happy, sad, easy breathing, difficult breathing, etc.)?
• Do you have:
• Cough?
• Mucous – color, viscosity (thick, thin, sticky), and amount (think in terms of the size of coins or measuring spoons)?
• Triggers? (things that send you into difficulty breathing, such as strong odors, dust, allergens etc.)
• Medications you’ve taken – Routine meds, but especially rescue meds, via inhaler or nebulizer
• Oxygen Saturation
• Heart rate
• Blood pressure
• Your number on the Borg Scale for Dyspnea (see below)
• Peak flow, if appropriate

* Make sure to log these vital signs at the same time each day, at the same level of exertion. See Is That Good? Understanding Vital Signs for information on observing vital signs.