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It is official...Marcus Welby is dead! His assassins, managed care and medical malpractice are still at large.

The days of house calls and familiarity between doctor and patient are going the way of vinyl records. What may be surprising to many is that the majority of doctors are just as angry and frustrated with the situation as the patients.

As a physician, I have had the opportunity to experience this dilemma from both sides; as a doctor and as a patient. The following 7 tips include gestures that I responded to favorably as a doctor and actions that aided me as a patient.

1. Have your insurance and personal information updated and ready prior to your visit. Nothing slows down the front office more than unprepared patients.If all patients are prepared with the above information the office staff is less stressed, delays are avoided, and the amount of time you spend waiting for the doctor is reduced.This tip avoids stress on both sides of the fence.

2. Have a list of your current medications with you at your visit. You would be surprised how many patients take medication without knowing the name or dose of what they are taking.Take responsibility for your health by knowing what you are putting into your body.In a busy primary care office medication changes sometimes may not be charted. This can cause the wrong medication to be prescribed on a refill request.Knowing your medication name and dose helps prevent medication errors.

3. Have a list of your symptoms with you at your visit. You can help your doctor arrive at a speedy, accurate diagnosis by having a list of symptoms which are specific to your complaint.This saves the doctor from having to perform a complete review of systems to look for clues.

4. Have a list of questions prepared. Prepare a few reasonable questions for your visit,keeping in mind that time is a factor.Common questions come up frequently,and in many cases the nurse can give you an adequate answer.If the nurse is unable to answer your question she will often alert the doctor to the question before you are seen.This often helps the doctor prepare in advance, so your question can be answered in a rapid, concise manner.

5. Ask your doctor about his family Doctors are human beings with human lives and problems.When a patient asked about my family my engine automatically slowed down and a smile came to my face.I was grateful for the break in the action.I found myself making sure that all of that patient's questions were answered.

6. Ask your doctor how the malpractice crisis is affecting him When patients asked me this question I always forgot how busy I was. I gave them a passionate answer. I made sure all their questions were answered and that they were satisfied before they left the office.

7. Ask your doctor how the healthcare crisis is affecting him. I loved it when patients asked me this question. It gave me a chance to explain the problems with managed care and how the increasing doctor shortage was influencing patient volume and waiting time. I always walked away from that patient encounter feeling a little lighter. the patient usually walked away with a bag of any drug samples he needed. At the end of the day, after seeing 50 patients and answering countless phone calls, that patient's name and face remained in my mind.

Use the first 4 tips to be a responsible patient and to take ownership of your health. Use the last 3 to be a human being, and to help your doctor remember why he became a doctor in the first place.

Nicholas Messina M.D.

Dr. Messina became a Board Certified Family Practitioner in 1985. He was in solo practice until 1994.He then helped form a group Family Practice in which he served as Vice President.

He left group practice in 1997 and became the Medical Director of a Wellness Center. He was responsible for coordinating the efforts of nutritionists, acupuncturists, massage therapists, exercise physiologists, and Chinese medicine practitioners into integrated medical care plans that were individualized to the patient.

He became the Medical Director of an independent clinical research facility in 2000. He has been the Principal Investigator in over 50 clinical trials involving osteoarthritis, diabetes, hypertension, hypercholesterolemia, chronic pain, depression, anxiety, dry eye, migraine, and diabetes prevention.

He has served as consultant to a nutritional company, and has formulated nutritional supplements.

By way of his website,his vision is to provide a road map for healthy living in today's hectic world.

As the site grows, information on diet, exercise, nutritional supplements, and stress reduction will be provided. Common illnesses will be explained, as well as their treatments.

He will continue to formulate and make available healthy, reliable, nutritional supplements.

Through the miracle of technology, he hopes to spend the same quality time with the many as he now does with the few.

He intends to accomplish this through the addition of free content on medical illnesses, a free newsletter, and eventually the addition of e-books and e-courses on specific topics.