Talking to Health Pros: Issues to Consider
Care for an older parents and good contact with the medical community go hand-in-hand. Your peace of mind is totally dependent on how you clearly communicate with doctors, dentists, nurses, pharmacists, social workers, and other health professionals. While barriers get in the way for both older persons and their family members, good communication with health professionals boils down to three facts:
- Youíve got to ask the right questions to get the information your parents and you need to make decisions
- Youíve got to give health professionals the information they need about your parents to make informed judgments
- You must demand the quality care your parent deserves.
Whether you are communicating on behalf of your parents or helping them communicate better on their own, this tip sheet offers some suggestions.
Issues and Barriers Your mother wants to save money. Without telling her doctor, she starts taking only half of her heart medicine and as a result needs emergency care. The doctor canít find any cause for your motherís pain and suggests it may be a natural part of aging. Your father returns from a clinic visit with a referral for tests, but he doesnít know what theyíre for. You ask how your fatherís checkup went, and he replies, ďThe doctor didnít say much, so it must have been fine.Ē
These kinds of situations occur every day because of communication barriers between health care professionals and older patients. Here are some basic issues:
- Patient Attitudes. Older patients are less likely than younger ones to ask questions of their doctors and nurses and are more likely to follow doctorís orders rather than take an active part in medical decision-making. Older parents are less likely to actively seek health information. They may actually prefer not to know the details and rely instead on the doctorís expertise. They may also view asking questions as an annoyance to the doctor. They may not realize they can get reliable information from other health professionals. The changes in the delivery of medical care during their lifetime only add to the problems.
- Physician training and demands. Many doctors say they are uncomfortable with counseling patients, feeling that patients often ignore their advice on matters such as smoking and losing weight. When they do provide information, they may use words that patients cannot understand. Communication takes time, and insurance companies rarely pay for as much time with the doctor as patients may want.
- Ageism. This problem is common among all types of health professionals, who often share the negative attitudes of the rest of society. Many providers expect older people to be frail, confused, depressed, overly talkative, needy, or quarrelsome. An older patient may feel like an invisible person at a medical visit, as the health care professional speaks exclusively to the adult child. Without specific training in working with older people, health professionals may simply be unaware of their specific needs.
What You Can Do Respect your parentsí wishes about how much they want to communicate with health professionals and how much they want to tell you about their health. Talk frankly with them about the importance of communication for safe and effective care. Your parents may want you to know about their health, but are unable or unwilling to talk directly to the doctor. With their permission, talk with their doctor or nurse yourself. If your parents are going to the doctor alone, you could share the following tips with them to ensure they get the most out of the visit.
- Ask lots of questions. Many people come to the doctor with a list of questions and concerns on paper and/or bring a tape recorder for capturing the answers: What illness do I have? What are the drug and nondrug treatment options? What is likely to happen with and without treatment? What costs can we expect? Does our insurance cover the treatment? What is the name of the medicine you are prescribing? What is its benefit? Is a generic drug available? What are the risks and side effects? How often should I take it? For how long? What foods, other medicines, or activities should I avoid while taking it? Do you have any written information I can take home? If I think of questions later, how can I contact you?
- Give lots of information. The doctor needs information about a patient to make proper diagnoses and prescribe safe and effective treatment. Because many older people see more than one physician, their medical records donít always contain all the facts the doctor needs to know. Itís important for each doctor to know all about the patientís health, particularly recent hospitalizations. So, give the doctor information on all drug allergies; chronic illnesses and relevant test results, such as blood pressure and recent blood sugar levels; and the names and doses of all medicines taken regularly, including over-the-counter medicines, vitamins, and herbal remedies. Share lifestyle issues with the physician, such as drinking alcohol, smoking, not sleeping well, or the inability to drive. Bring up any previous side effects from medications or barriers to following a treatment plan, such as forgetting to take medicines or worrying about money.
- Beyond the doctor: Talk to other health professionals. Nurses are trained in patient education and counseling. They can explain a diagnosis and can teach patients how to follow treatments, measure their blood pressures at home, and give themselves injections. Pharmacists are the drug experts. They answer questions about how to take a medicine properly, and some may even offer broader counseling and assistance. Social workers can help people navigate the medical care and social service systems. Dietitians can provide information on meal planning, cooking for one, and special meal plans for various medical conditions.
Older patients are less likely than younger ones to ask questions of their doctors and nurses . . .
- Do your own research. Bookstores, libraries, health organizations, and the Internet have a wealth of materials that can make you and your parent more informed partners in treatment.
- Be a strong advocate for your parent. Health professionals hold the medical expertise you need, but the service, attention, and quality of care required donít always come automatically. You or your parent must take an active role in getting the best service. So go get a second opinion before choosing surgery or treatment for a serious illness, and check to see if your parent's insurance covers the cost. Consider changing doctors if the current one doesnít listen or explain things well. Be persistent with managed care or specialist visits. Donít accept diagnoses or treatment options that could be based on ageist stereotypes. Find out why the doctor or nurse is proposing treatment, and keep asking if you are not satisfied with the answers.
- Use legal tools. Legal documents called advance directives are an effective, binding way to communicate a patientís wishes to health professionals and hospitals. The most common one, the living will, records a personís wishes regarding-life sustaining medical care in end-of-life situations. Health care proxies, also known as durable medical powers of attorney, give an appointed person the power to make decisions on behalf of a patient when needed, interpret written instructions from the patient, and respond to changing medical situations.
- Be a team player. Just as you and your parent deserve respect, so do the health professionals with whom you interact. No matter how frustrating a situation becomes, you are more likely to get what your parent needs if you remain constructive, polite, and involved.
© 2003, 2004, 2007 AARP. Reprinting by permission only.