 Treat Me, Not My Age (Penguin, 2010) |
Dr. Mark Lachs, M.D., is a physician, scientist, and gerontologist at Weill Cornell Medical College in New York City. His research has been published in the New England Journal of Medicine and the Journal of the American Medical Association, and he has appeared on The Today Show, NPR's All Things Considered, and many other national and local media outlets. The following is an excerpt from his book Treat Me, Not My Age: A Doctor's Guide to Getting the Best Care as You or a Loved One Gets Older (Penguin, 2010).
Since the forces that have led to "the incredible shrinking office visit" are unlikely to end soon, and since we're all getting older and need the best care we can get, the question is: What's a boomer to do?
Answer: Plan accordingly. You wouldn't go to your accountant, your lawyer, or even your hairdresser without a sense of what you wanted from the transaction. Why would you be any less prepared for a visit to the doctor? Here are some tips to help you get the most out of what is increasingly likely to be a time-pressured encounter. Underlying every piece of advice is a simple edict: Get organized. The visit will be more productive for you and more efficient for your physician.
1. Articulate your chief complaint.
The cornerstone of med students' training is the "chief complaint" — the reason you sought medical attention ("It hurts here" or "I have a cough"). But as we age, chief complaints often become nebulous or difficult to put your finger on. If you can't tick off specific symptoms, note whatever functional problems you're having. For example, "I can't put on my overcoat" or "I keep losing things." If you don't have a chief complaint (perhaps you're here for an annual physical and everything is hunky-dory), that's fine, too. Say that.
2. Organize your thoughts before the visit.
Geriatricians (and all primary-care docs, for that matter) don't have scalpels. The tool of our trade is what we call the medical history. Understanding your story is the key to making an accurate diagnosis. So think about what's troubling you in some detail before coming to the doctor to tell your story. For example, if you have pain, when did it start? What makes it worse? Is there anything that makes it better — perhaps position, ice, or Tylenol? Does it move or radiate anywhere? Providing as much accurate detail as you can about what's troubling you will likely lead to a better outcome. You're not a doctor, and you're not going to be able to anticipate all the questions you'll be asked, but a good doc should leave no nit unpicked in probing you about specific symptoms. If you are accompanying a loved one who typically "clams up" during a doctor visit, I'd interview him or her beforehand to practice responding — maybe try a little role-playing, with you starring as the doctor.
3. Prioritize your complaints.
Many patients I see have a laundry list of issues that they find overwhelming. Believe me, it can be overwhelming for us, too, as we do our best to help you with 10 problems in the 15 minutes the system may have allotted us. (You can see why meds get dispensed and specialists are invoked indiscriminately.) The expression, "Rome wasn't built in a day" applies in this case. You need to be practical. If you wind up spending only a minute or two of your precious office-visit time on each of a smorgasbord of issues, none of them will get solved. My suggestion — a top-three list. I encourage new patients to do this. I might say something like, "I see from your list, Mrs. Smith, that a number of things are bothering you. If you were forced to pick the top three things I could most help with, what would they be?" Or I might provide orientation myself: "Today I'm going to focus on the arthritis pain you've been calling about, and if we have time, I'll explain the results of the cholesterol tests you had when you were here last visit. Does that sound reasonable?" Everybody's happier when expectations are managed.
4. List all "interval events."
By this, I mean major things that have happened to you since you last saw your doctor. Examples include hospitalizations, surgeries, bad infections, a trip to the ER for a cut, or visits with other doctors, who may have offered advice or changed your medications. Big life events count, too — a divorce, the birth of a grandchild, loss of a job, or unusual financial reversals, if you feel comfortable discussing these. As I said earlier, the medical and social components of our lives become more inextricably linked as we age and conspire to influence health. Basic rule of thumb: If you're not sure if something constitutes a significant event, include it.
5. Bring a list of your medications.
The list should be up-to-date and complete, including dosages and frequencies. (Even better, bring the medicines themselves in a bag.) Know beforehand what you’re running out of so you can ask for any renewals you might need. Ask the office staff for these after the visit, or by phone, so your time with the doctor is not usurped by an administrative task. One of the biggest areas of medical error, with patients of any age, is what medical quality experts call medication reconciliation, which is the process of comparing a patient's medication orders to all of the medications that the patient has been taking. For older people, this is especially critical, because of the ways medications can interact with one another; more important, they can interact with or have unexpected effects on the chronic conditions you have (so-called drug-disease interactions).
6. Get a specific follow-up plan.
At the end of the visit, you should leave with several "action items" that need to be followed up on. These could be blood tests or X-rays, a referral to another doc, or a change of medication. Go over with your doctor what's going to happen, and when, once you walk out the door. Example: "So I'm going to get an MRI of my head for these headaches. Will you be calling me with the results even if they're normal, or should I call you?" Or: "So I start taking the medication for my knee arthritis tomorrow. When should I come back to see you to assess whether or not it's been effective?" Or: "Will you be calling Dr. Jones, the lung doctor, to explain why you're sending me?" Again, getting the follow-up plan clear and setting expectations goes a long way toward avoiding miscommunication and trouble down the road.
7. Get the doctor to be transparent.
If you're reading this, I assume that you're pretty darn intelligent (and have good taste to boot). That being the case, there's something seriously wrong if you walk out of the doctor's office without understanding what he or she is trying to tell you. If it's because he's using medical jargon, remind him kindly that you're not a doctor (assuming that's true) and you need it in lay terms. If you're anxious about something specific, let the doctor know that. Perhaps he can list the things he believes might be causing your symptom, and you'll be relieved to learn that mad cow disease, swine flu, or the Ebola virus is not at the top of the list, even if it might be on the top of yours. If, after making this request several times, it still feels like you're at the Tower of Babel, then you might need to start looking for another doctor.
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