It used to be that doctors were considered god-like, the keepers of life-and-death knowledge and abilities. This view of the medical profession is intimidating — and in light of the troubling findings of a recent Dutch review study, it appears that many older individuals still feel that way. Researchers reviewed three studies with a total of 433 older patients to determine whether personal face-to-face coaching or printed materials would better help them become savvier consumers of health care, specifically at doctor visits. Not surprisingly, personal coaching (face-to-face, either group or individual) was found more effective, but even when coached it seemed that many elderly patients remained stubbornly passive about their care. One study showed that after being educated about the importance of preparing for the visit and asking questions, when study participants next saw their doctor, more than half still didn’t identify specific issues to discuss and more than 80% failed to bring a list of questions, problems and/or medications with them. In fact, very few asked the doctor any questions about their illness, tests or procedures. Here’s the problem: The more passive patients are about health issues, the lower the likelihood of successfully solving their problems.
Gerontologist Audrey Chun, MD, director of the Martha Stewart Center for Living at the Mount Sinai School of Medicine, had some interesting ideas on how to help older patients understand how they’ll benefit by preparing for their visits. She points out that doctor/patient visits are limited to about 15 minutes, so it’s more effective and efficient to come with an agenda. It’s a good idea to bring along a son, daughter or other relative to visits — mostly to offer support and strength, but also to ask questions and make note of details that are easily forgotten.
To get other suggestions about how older adults can be taught to become more active health care consumers, I also spoke with Robert N. Butler, MD, president and CEO of the International Longevity Center and professor of geriatrics and adult development at Mount Sinai School of Medicine, both in New York City. He agreed that it is crucial for all patients, regardless of age, to know as much as they can about their health issues. Since doctors now have, on average, more than 1,000 patients, it’s far less likely they’ll know patients’ medical histories well — though that is the way it used to be and older folks may not realize how much things have changed.
The ideal way to gather information is, yes, the Internet — and happily many older adults are comfortable using it today. But even those who spend lots of time on-line may not understand how important it is to filter advice by researching only credible sites — Dr. Butler recommends www.mayoclinic.com and medlineplus.gov as good starting points for in-depth background information on health issues.
In order to better the odds of success at your doctor’s visit, Dr. Chun urges all elderly patients to bring the following to every appointment:
At the end of the visit, Dr. Chun suggests asking the doctor to briefly summarize the content of their time together. Patients may also want to ask about other sources of information they can explore on their own, along with resources such as support groups for those who have a chronic condition.
Don’t expect that one conversation will get an elderly parent or relative over the hurdle of being a passive patient. Given that many have spent a lifetime thinking they should never question a doctor, you’ll likely need to reframe the issue. Dr. Chun notes that an important aspect of patient/doctor relations is good communication — and a vital ingredient of communication is the patient’s willingness to ask questions. Showing respect is a value that previous generations emphasized — she says that many older patients worry their questions might send a message of doubt and disrespect. Try explaining that, in fact, when a patient asks questions, it lets doctors know whether they understand the information they’ve been given. Not infrequently, misunderstandings cause problems down the road that a question or two might have cleared up right away.
Patients can ask when is a good time to call the doctor if they have further questions. Even better though, say both Dr. Butler and Dr. Chun, is to schedule a follow-up visit several weeks later. This additional time enables the doctor and patient to understand what’s happening, how treatment is going and for questions to arise naturally. Also, the additional time together may increase the patient’s comfort with the doctor, as well as allow the doctor to get to know the patient a little bit better. As a rule, insurance pays for the second visit and it is time — and money — well spent to maximize personal health care.
