MEDICAL PRACTICE IN THE U.S.

Many individuals from other countries are unaccustomed to the particular practices of, and requests made by, American clinicians. For example, because privacy is very important, clinicians assume that you will want to be seen alone. If you want someone to be with you during an appointment, be sure to tell both the receptionist and your clinician.

At HUHS and most other clinicians' offices each clinician has a private room in which he or she sees patients. A health assistant will usually bring you to the clinician's exam room, ask you some preliminary questions and may check your temperature or blood pressure. It is not unusual for patients to be asked to undress and put on a gown provided for them before they are examined. Be sure to ask the health assistant and your clinician to explain or repeat instructions that are unclear.

CHOOSING A PHYSICIAN
It is advisable to choose a physician before you or a family member become ill. Some factors to consider in choosing a personal physician are the cost, the office hours, whether you would prefer a male or female physician, how questions are handled outside of office hours or when the physician is away, the possibility of consulting with the physician by phone, and the physician's response time in an emergency. When choosing a pediatrician you should be sure that the physician will visit your newborn in the hospital, that you will be able to call him or her frequently when the baby first comes home, that you share the same opinions on issues such as breast versus bottle feeding, and medications for babies and children (will the doctor prescribe medication at the first sign of illness or will he or she wait to see what develops).

If you have not enrolled in a health plan and do not have a personal physician in the area, you should telephone or visit the Outpatient Department of the nearest hospital for information about the health care services it provides. You should not use the hospital's emergency room for non-emergency care, since emergency rooms handle only serious problems. In addition, being treated in the emergency room is more costly than being treated in an office visit.

COMMUNICATION WITH YOUR PHYSICIAN
Because it is important that your personal clinician know about your individual health history, you should feel comfortable discussing any of your needs and/or concerns with him or her. Be prepared to tell the doctor or nurse practitioner about your medical history, all medications and any other kinds of treatment or remedies you are using. Also be sure to tell your clinician about any medication allergies you have.

If you are concerned about using English to discuss such important medical information, prepare a list of your questions and concerns before you go to your appointment. Bring along someone who can translate for you, or ask if there is a clinician or translator who speaks a language you are more comfortable using. If you ever have difficulty understanding your clinician, you should feel free to ask him or her to repeat, talk more slowly, or explain more carefully.

Clinicians expect you to have questions regarding your health, diagnosis, treatment, or medications. This kind of dialogue between the patient and the clinician is a common feature of U.S. health care that may be different from what you may be accustomed to at home. Ask your clinician to write down any instructions that you should follow, and tell him or her if you still have questions or need more information. State what information you need, and ask if you should schedule another appointment. Your clinician may suggest other resources for answering these questions or meeting other needs. If you have more questions or problems after you leave the clinic, telephone your clinician for advice or another appointment.

APPOINTMENTS
Physicians and nurses rarely make home visits in the U.S. Usually you must call for an appointment and visit the physician's office. If you are covered by a health plan, it is usually necessary for you to visit one of the health plan's physicians in order to avoid paying extra fees. For example, Harvard students and affiliates enrolled in the University Health Service plan must use UHS facilities in order to avoid having to pay an office fee.

MEDICATIONS
The U.S. Government regulates the sale and distribution of medications in the United States. Many medications (such as antibiotics, strong pain relievers, birth control pills, and drugs for respiratory and heart conditions) are available only with a written prescription. Prescriptions, written and signed by a certified clinician, are given to patients during an appointment or after a phone consult. The medications ordered in a prescription may only be obtained at a pharmacy or drug store. A pharmacist will package your medication and provide written and verbal instructions on how and when it should be used. Your health plan may or may not cover the cost of medications.

UHS operates its own pharmacy located in the Holyoke Center Arcade near the main entrance to UHS. This pharmacy is open to anyone with a Harvard identification, but fills prescriptions written by UHS clinicians only. If you need to fill a prescription when the UHS pharmacy is closed, take your prescriptions to a local drug store (like CVS or Walgreens) to be filled.

If your physician prescribes medications, be sure to get complete information regarding the medication, where to get it, how to take it, potential side effects, and special instructions (such as whether it should be taken with food, whether you should avoid alcohol while you are taking it, etc.). Ask your physician if you should finish the prescription completely, or use it only until your symptoms disappear. Inquire also if it is available generically, that is, by the name of the chemical formula rather than the brand name, since generic prescriptions are usually less expensive