Health Appointments and Follow-Up in ADHD

There is a pain. You know you need to see a doctor. You put off calling to book an appointment. Finally you call, the appointment comes out two weeks later, and by that day you have forgotten. You go, tests are requested, you do not have the tests done.

A link that breaks anywhere in this chain stops the whole process. In this area I am the person who most often says "I started but did not finish," and understanding the reason for that really changed how I handle my health.

Why such a fragile chain

Health follow-up is talked about as a single task but it consists of at least five steps:

1. Deciding that you need to go
2. Booking an appointment
3. Remembering the appointment
4. Going
5. Following up on the result and planning the next one

Each step carries its own difficulty. At the first step body signal blindness comes into play: a symptom is noticed only when it has grown very large; details in the article body signal blindness. At the second step, avoiding the phone. At the third, prospective memory, that is, the ability to remember to do something in the future.

The fifth step is where it breaks most. When the examination ends it feels as if the loop has closed; yet the real work begins there. In the glossary this is called closure blindness, and it was the item that cost me most: months passing with test requests I never had done.

A health matter does not end with the appointment. It begins with the appointment and needs someone to remember what comes next.

There is a serious side to this

This is not just a matter of the discomfort of disorganization. There are reviews reporting an association between adult ADHD and some physical health problems (Instanes et al., 2018). Nigg's (2013) review points out that part of the adverse health outcomes may be explained by behavioral mediators, that is, failing to follow up and risky behaviors.

So setting up a follow-up system stops being a negligible organizational chore. As I write this I am writing it to myself too.

A system that does not break the chain

Set up the next step at the end of each step. This is the most important rule here. Book the follow-up appointment before you leave the examination room. When tests are requested, arrange the test appointment right then. The chain is tied before it can break. In the glossary: appointment chain.

Use a single calendar. A person who uses two calendars trusts neither. All appointments go in the same place.

Set two reminders. One a day before, one two hours before. The one a day before is for preparation, the one two hours before is for setting off. I covered the lateness side in the article chronic lateness.

Write the questions in advance. Forgetting what you wanted to say at the examination is very common. A three-item note markedly improves the yield of the examination. For me this is the single habit that makes the most difference: I used to leave every examination I entered without three written items thinking "I was going to ask that too."

Take a note on the way out. What the doctor said, what you need to do, when. Write this on your phone as soon as you leave the room. Five minutes later some of the details are gone.

Keep a single health file. Test results, prescriptions, reports. A physical folder or a single album on the phone. In the glossary the entry is health tracking. I described the whole paper side in the article paperwork and bureaucracy.

A self-referral rule. Write in advance when you will take a symptom seriously. A rule like "if it lasts longer than two weeks, I book an appointment" does not require you to decide in the moment. The decision has been made in advance and in that moment it is only applied.

What to tell at the examination

This is a part that is rarely discussed but decisive. The information the doctor has is only as much as you can convey.

In ADHD two separate problems arise here. The first is remembering symptoms: when the pain began, how often it occurs, what makes it pass. When these are reported from memory they are usually incomplete and wrong.

The second is the conversation scattering. Moving to another subject while answering the question asked uses up the limited time of the examination.

The same thing is the remedy for both: going with it written down. Three lines on a sheet of paper are enough. When the symptom began, how often it happens, what question you are most curious about. Reading from the paper is both faster and more accurate than trying to remember.

Why booking an appointment is so hard

The second step is where the chain breaks most often, and the reason is generally a single thing: you have to make a phone call.

Calling an institution, waiting in a queue, not knowing what to say and an unexpected question coming from the other end. Each of these is a small obstacle; added together they become an obstacle that eats a month.

A few things help.

Prefer online booking. If there is a channel that does not require a phone call, half of the job is solved.

Write your first sentence before calling. "Hello, I would like to book an appointment for this department." A single line markedly lowers the threshold for starting the conversation.

Put the call at a fixed time. Instead of calling when it occurs to you, setting aside a half hour once a week in which you do this kind of job in a batch holds better.

Have the information at hand. ID details, file number, which department. When you have to look for something during the conversation it is very easy to get scattered.

If you are taking medication

If you are being treated for ADHD the follow-up list gets a little longer:

• Add the prescription renewal date to the calendar, a week before it runs out.
• Use a visible box or an alarm against forgetting to take medication.
• Note side effects and observations somewhere; when going to a check-up, looking at the record gives much more reliable results than trusting your memory.

The details of this are in the article ADHD medication treatment. It also needs to be said separately that the dose and the medication decision belong to the doctor.

Three common mistakes

Putting off the appointment with "I'll book it later." The real meaning of this sentence is often months. The moment you think of booking the appointment is the best moment you have for doing that job.

Hiding what was postponed. Not telling the doctor about a test you did not have done makes the next examination wasted too. Saying "I couldn't get it done" is information needed to correct the plan, not to be judged.

Going only when it gets worse. Check-up examinations are the easiest jobs to postpone because there is no symptom. Yet an annual check-up written into the calendar is the cheapest system for catching a forgotten problem early.

A reminder

As the review by Barkley and colleagues (2008) lays out, the effect of ADHD on everyday functioning spreads across a wide area and health follow-up is within that area. So neglecting health matters is not a sign of carelessness.

The sentence that worked for me: I do not try to remember health matters, I set them up so that they do not require remembering. When each step ends by setting up the next one, the chain does not break.