After a new chronic diagnosis: what to do in the first week, the first three months, and after

This checklist is written for people just diagnosed with a chronic condition such as high blood pressure, diabetes, high cholesterol or gout. The related entries in the book are scattered over several sections, so here they are put in time order. Each item says only the action to take, followed by a pointer. The reasons, numbers and sources are in the entry it points to. Skip any item that doesn't match your condition.

The week of diagnosis

1. If the illness is serious, find someone to go with you on the day you get the report, and don't be alone at home. Put off things like quitting your job or selling your home. See §29.2 (the week you are told a serious diagnosis).
2. If the doctor tells you to take medicine, start today and take it as prescribed. Don't stop when you feel better. See §16.1 (take your medicine as prescribed to the end of the course).
3. Take medicine for high blood pressure and high cholesterol regularly, and don't stop on your own. See §2.12 (if you have high blood pressure or high cholesterol, take your medicine regularly as prescribed).
4. If you have high blood pressure, buy an electronic blood pressure monitor, measure at home, and keep going until it is down to target. See §1.7 (check your blood pressure, and if it's high, take medicine to bring it to target).
5. When a medicine is prescribed, ask the doctor whether there is a volume-based procurement (集采) version or one sold under its generic name. See §5.12 (generics that passed the consistency evaluation, and drugs chosen in volume-based procurement).
6. If you are diagnosed with type 2 diabetes, get a dilated eye exam right then. With type 1 diabetes, start screening 5 years after onset. See §16.7 (when diabetes is diagnosed, get an eye-ground exam once).
7. If gout has already produced tophi, imaging shows bone eaten away into a defect, or you have 2 or more attacks a year, take a urate-lowering drug long term. Bring blood uric acid below 360 µmol/L. If attacks are rare, talk with the doctor about whether to take one. See §16.9 (if gout is diagnosed, take a urate-lowering drug long term).
8. Before a person of Han Chinese descent takes allopurinol, ask the doctor whether to test first for the HLA-B*5801 genotype. See §16.9 (if gout is diagnosed, take a urate-lowering drug long term).
9. If a checkup finds only high uric acid and you have never had the pain, that is not gout, so don't take a urate-lowering drug yet. See §6.19 (a checkup finds high uric acid, but you've never had a gout attack).
10. If you smoke, set a quit day and stop all at once on that day. See §2.4 (set a quit day).
11. Don't rely on willpower alone to quit smoking; go to a smoking-cessation clinic or respiratory medicine department to get medication. See §2.3 (don't rely on willpower alone to quit; get medication first).

The first three months

1. Get a notebook. At each follow-up, write down the date, the numbers, the medicines you take and the doses. See §16.3 (record every measurement in the same notebook).
2. After every visit, keep your own copy of your medical records, test results and imaging. See §24.5 (keep your own copy of medical records, test reports and images).
3. Apply for outpatient chronic and special disease recognition (门诊慢特病) where your insurance is registered. If you often get care in another city, also file for out-of-area medical care. See §16.2 (get outpatient chronic and special disease recognition first, then file for out-of-area care).
4. If someone in your family has employee medical insurance, ask them to set up family mutual aid linking once. The money in their personal account can then pay for your doctor visits and medicine. See §5.13 (family mutual aid linking).
5. Before signing up with a family doctor at your community clinic, ask which services are covered by insurance and which you pay for yourself. See §16.6 (ask before you sign with a family doctor).
6. Switch the salt at home to low-sodium salt. If you have kidney impairment or take potassium-sparing drugs, ask your doctor first. See §2.9 (switch the table salt at home to low-sodium salt).
7. Start walking every day. The target is 7000-8000 steps, or a total of 150-300 minutes of brisk walking a week. See §2.11 (walk 7000-8000 steps a day).
8. Drink less, and don't drink if you can avoid it. See §2.19 (drink less alcohol, or none).
9. If you drink every day and your hands shake and your heart races when you stop, don't try to quit hard on your own; go to a hospital first. See §2.20 (if your hands shake and your heart races when you stop drinking, don't quit on your own).
10. If someone urges you to stop your medicine and try folk remedies, don't stop. If you want to take a supplement, tell your treating doctor first. See §16.4 (don't stop proper treatment to try folk remedies or health products).
11. Don't spend a lot of money on supplements, herbal tonic pastes (膏方) or tonics to "regulate your body." See §6.10 (don't spend a lot of money on supplements, tonic pastes and tonics).
12. When you have just started lowering uric acid for gout, attacks are more likely in the first 3 to 6 months. When it hurts, add an anti-inflammatory drug as prescribed, and don't stop the urate-lowering drug. See §16.9 (if gout is diagnosed, take a urate-lowering drug long term).
13. Before buying cold medicine or painkillers yourself, read the ingredient list; acetaminophen (paracetamol) may appear in only one of them. See §34.1 (read the ingredient list first; acetaminophen may appear in only one product).
14. If you take an anticoagulant or a steroid, ask your doctor before taking painkillers such as ibuprofen. See §34.3 (ask your doctor before taking painkillers like ibuprofen).
15. If you have had gout, don't eat large amounts of meat and seafood in one sitting at barbecues and group dinners, and drink less alcohol, even while taking a urate-lowering drug. See §16.10 (at barbecues and group dinners, don't eat large amounts of meat and seafood in one sitting).

Once your condition is stable

1. If your condition is stable and your medicines haven't changed, go to a community clinic and get a full 12 weeks of medicine in one prescription. See §16.5 (a community hospital can prescribe up to 12 weeks of medicine at a time).
2. Go to follow-up checks at the interval your doctor sets, and record each one in the same notebook. See §16.3 (follow up at the interval your doctor sets).
3. After switching to a volume-based procurement drug, keep an eye on the numbers in your notebook. If they really get worse, see your doctor, and don't stop the medicine on your own. See §5.12 (prefer generics that passed the consistency evaluation and drugs chosen in volume-based procurement).
4. If you have diabetes, have your feet checked every year, and your eyes at the interval your doctor sets. See §16.7 (when diabetes is diagnosed, get an eye-ground exam once, and check your feet every year).
5. If you take a urate-lowering drug long term, keep taking it after your uric acid reaches target, and don't stop it on your own. See §16.9 (if gout is diagnosed, take a urate-lowering drug long term).
6. If you have had a kidney stone, drink 2.5-3 liters of water a day and keep salt under 6 grams. See §16.8 (if you have had a kidney stone, drink 2.5-3 liters of water a day).
7. If you have cardiovascular disease, get a flu shot every autumn. See §1.20 (people with cardiovascular disease and older adults should get a flu shot every year).
8. See a community clinic first for common illnesses. If you need to be admitted, go up through the community by stepwise referral, and the hospital admission deductible keeps counting. See §24.1 (see the community clinic first for common illnesses, with stepwise referral from primary care).
9. Don't run to a higher-level hospital for things that can be handled at the primary level. Within the same insurance region, each level up lowers the reimbursement rate by about 10 percentage points. See §24.2 (the lower the level, the higher the reimbursement rate).
10. To see a specialist at a big hospital, go through community referral or the hospital's referral center, and don't use scalpers who resell appointments. See §24.3 (go through primary-care referral or the hospital's referral center).
11. If you plan to get care in another province, ask locally before you leave; the reimbursement may be somewhat lower than at home. See §24.4 (ask locally before seeking care across provinces).