How well you and your doctor talk to each other is one of the most important parts of getting good health care. Unfortunately, this isn't always easy. It takes time and effort on your part as well as your doctor's.

In the past, the doctor typically took the lead and the patient followed. Today, a good patient-doctor relationship is more of a partnership, with both patient and doctor working together to solve medical problems and maintain the patient's good health.

This means asking questions if the doctor's explanations or instructions are unclear, bringing up problems even if the doctor doesn't ask, and letting the doctor know when a treatment isn't working. Taking an active role in your health care puts the responsibility for good communication on both you and your doctor.

Choosing Doctor You Can Talk to

The first step in good communication is finding a doctor with whom you can talk. Having a main doctor (often called your primary doctor) is one of the best ways to ensure your good health. This doctor knows you and what your health normally is like. He or she can help you make medical decisions that suit your values and daily habits and can keep in touch with other medical specialists and health care providers you may need.

If you don t have a primary doctor or are not at ease with the doctor you currently see, now may be the time to find a new doctor The suggestions below can help you find a doctor who meets your needs.

1. Decide what you are looking for in a doctor-A good first stepis to make a list of qualities that are lmportant to you. Then, go back over the list and decide which are most important and which are nice, but not essential.

2. Identify several possible doctors-After you have a general sense of what you are looking for, ask friends and relatives, medical specialists, and other health professionals for the names of doctors with whom they have had good experlences. A doctor whose name comes up often may be a strong posslblhty. Rather than just getting a name, ask about the person's experiences. For example, say "What do you like about Dr. Smith?" It may be helpful to come up with a few names to choose from, in case the doctor you select is not currently taking new patlents.

3. Consult reference sources-The Directory of Physicians in the United States and the Official American Board of Medical Specialties Directory of Board Certified Medical Specialists are available at many libraries. These references won't recommend individual doctors, but they will provide a list to choose from. Doctors who are "board certified" have had training after regular medical school and have passed an exam certifying them as specialists in certain fields of medicine. This includes the primary care fields of general internal medicine, family medicine, and geriatrics. Board certification is one way to tell about a doctor's expertise, but it doesn't address the doctor's communication skills.

4. Learn more about the doctors you are considering-Once you have selected two or three doctors, call their offices. The office staff can be a good source of information about the doctor's education and qualifications, office policies, and payment procedures. Pay attention to the office staff-you will have to deal with them often! You may want to set up an appointment to talk with a doctor. He or she is likely to charge you for such a visit.

5. Make a choice-After choosing a doctor, make the first appointment. This visit may include a medical history and a physical examination. Be sure to bring your medical records and a list of your current medicines with you. If you haven't interviewed the doctor, take time during this visit to ask any questions you have about the doctor and his or her practlce. After the appointment, ask yourself whether this doctor is a person with whom you could work well. If you are not satisfied, schedule a visit with one of your other candidates.

Summary: Choosing a Doctor You Can Talk to
+ Decide what you are looking for in a doctor.
+ Identify several possible doctors.
+ Consult reference sources, current patients, and colleagues.
+ Learn more about the doctors you are considering.
+ Make a choice.

Tips for GoodCommunication

A basic plan can help you communicate better with your doctor, whether you are starting with a new doctor or continuing with the doctor you've been visiting. The following tips can help you and your doctor build a partnership.

Getting Ready for Your Appointment

Be prepared: make a list of your concerns-Before going to the doctor, make a list of what you want to discuss. For example, are you having a new symptom you want to tell the doctor about? Did you want to get a flu shot or pneumonia vaccine? If you have more than a few items to discuss, put them in order so you are sure to ask about the most important ones first. Take along any information the doctor or staff may need such as insurance cards, names of your other doctors, or your medical records. Some doctors suggest you put all your medicines in a bag and bring them with you, others recommend bringing a list of medications you take.

Make sure you tan see and hear as well as possible-Many older people use glasses or need aids for hearing. Remember to take your eyeglasses to the doctor's visit. If you have a hearing aid, make sure that it is working well, and wear it. Let the doctor and staff know if you have a hard time seeing or hearing. For example, you may want to say, "My hearing makes it hard to understand everything you're saying. It helps a lot when you speak slowly."

Consider bringing a tamily member or friend-Sometimes it is helpful to bring a family member or close friend with you. Let your family member or friend know in advance what you want from your visit. The person can remind you what you planned to discuss with the doctor if you forget, and can help you remember what the doctor said.

Plan to update the doctor-Think of any important information you need to share with your doctor about things that have happened since your last visit. If you have been treated in the emergency room, tell the doctor right away. Mention any changes you have noticed in your appetite, weight, sleep, or energy level. Also tell the doctor about any recent changes in the medication you take or the effect it has had on you.

Your doctor may ask you how your life is going. This isn't just polite talk or an attempt to be nosy. Information about what's happening in your life may be useful medically. Let the doctor know about any major changes or stresses in your life, such as a divorce or the death of a loved one. You don't have to go into detail; you may just want to say something like, "I thought it might be helpful for you to know that my sister passed away since my last visit with you," or "I had to sell my home and move in with my daughter."

Summary: Getting Ready for Your Appointment
+ Be prepared: make a list of concerns.
+ Make sure you can see and hear as well as possible.
+ Consider bringing a family member orfriend.
+ Plan to update the doctor.

Sharing Information With Your Doctor

Be honest-It is tempting to say what you think the doctor wants to hear; for example, that you smoke less or eat a more balanced diet than you really do. While this is natural, it's not in your best interest. Your doctor can give you the best treatment only if you say what is really going on.

Stick to the point-Although your doctor might like to talk with you at length, each patient is given a limited amount of time. To make the best use of your time, stick to the point. Give the doctor a brief description of the symptom, when it started, how often it happens, and if it is getting worse or better.

Ask questions-Asking questions is key to getting what you want from the visit. If you don't ask questions, your doctor may think that you understand why he or she is sending you for a test or that you don't want more information. Ask questions when you don't know the meaning of a word (like aneurysm, hypertension, or infarct) or when instructions aren't clear (e.g., does taking medicine with food mean before, during, or after a meal?). You might say, "I want to make sure I understand. Could you explain that a little further?" It may help to repeat what you think the doctor means back in your own words and ask, "Is this correct?" If you are worried about cost, say so.

Share your point of view-Your doctor needs to know what's working and what's not. He or she can't read your mind, so it is important for you to share your point of view. Say if you feel rushed, worried, or uncomfortable. Try to voice your feelings in a positive way. For example, "I know you have many patients to see, but I'm really worried about this. I'd feel much better if we could talk about it a little more." If necessary, you can offer to return for a second visit to discuss your concerns.

Summary: Sharing Information With Your Doctor
+ Be honest.
+ Stick to the point.
+ Ask questions.
+ Share your point of view.

Getting Information From Your Doctor and

Other Health Professionals

Take notes-It can be difficult to remember what the doctor says, so take along a note pad and pencil and write down the main points, or ask the doctor to write them down for you. If you can't write while the doctor is talking to you, make notes in the waiting room after the visit. Or, bring a tape recorder along, and (with the doctor's permission) record what is said. Recording is especially helpful if you want to share the details of the visit with others.

Get written or recorded information-Whenever possible, have the doctor or staff provide written advice and instructions. Ask if your doctor has any brochures, cassette tapes, or videotapes about your health conditions or treatments. For example, if your doctor says that your blood pressure is high, he or she may give you brochures explaining what causes high blood pressure and what you can do about it. Some doctors have videocassette recorders for viewing tapes in their offices. Ask the doctor to recommend other sources, such as public libraries, nonprofit organizations, and government agencies, which may have written or recorded materials you can use.

Remember that doctors don't know everything-Even the best doctor may be unable to answer some questions. There still is much we don't know about the human body, the aging process, and disease. Most doctors will tell you when they don't have answers. They also may help you find the information you need or refer you to a specialist. If a doctor regularly brushes off your questions or symptoms as simply part of aging, think about looking for another doctor.

Talk to other members of the health care team-Today, health care is a team effort. Other professionals, including nurses, physician assistants, pharmacists, and occupational or physical therapists, play an active role in your health care. These professionals may be able to take more time with you.

Summary: Getting Information From Your Doctor and Other Health Professionals
+ Take notes.
+ Get written or recorded information.
+ Remember that doctors don't knoweverything.
+ Talk to other members of the health care team.

Getting Started With New Doctor

Your first meeting is the best time to begin communicating positively with your new doctor. When you see the doctor and office staff, introduce yourself and let them know how you like to be addressed. The first few appointments with your new doctor also are the best times to:

Learn the basics of the office-Ask the office staff how the office runs. Learn what days are busiest and what.times. Ask what to do if there is an emergency, or when the office is closed.

Share your medical history-Tell the doctor about your illnesses or operations, medical conditions that run in your family, and other doctors you see. You may want to ask for a copy of the medical history form before your visit so you have all the time and information you need to complete it. Your new doctor may ask you to sign a medical release form to get copies of your medical records from doctors you have had before. Be prepared to give the new doctor your former doctors' names and addresses, especially if they are in a different city.

Give information about your medications-Many people take several medicines. It is possible for medicines to interact, causing unpleasant and sometimes dangerous side effects. Your doctor needs to know about ALL of the medicines you take, including over-the-counter (nonprescription) drugs, so bring everything with you to your first visit, including eye drops, vitamins, and laxatives. Tell the doctor how often you take each and describe any drug allergies or reactions you have had and which medications work best for you. Be sure your doctor has the phone number of your regular drug store.

Tell the doctor about your habits-To provide the best care, your doctor must understand you as a person and know what your life is like. The doctor may ask about where you live, what you eat, how you sleep, what you do each day, what activities you enjoy, your sex life, and if you smoke or drink. Be open and honest with your doctor. It will help him or her to understand your medical conditions fully and recommend the best treatment choices for you.

Summary: Getting Started With a New Doctor
+ Learn the basics of how the office runs.
+ Share your medical history.
+ Give information about your medications.
+ Tell the doctor aboutyour habits.

Talking About Your Health

Talking about your health means sharing information about how you feel both physically and emotionally. Knowing how to describe your symptoms, discuss treatments, and talk with specialists will help you become a partner in your health care. Here are some issues that may be important to you when you talk with your doctor.

Preventing Disease and Disability

Until recently, preventing disease in older people received little attention. But things are changing. It's never too late to stop smoking, improve your diet, or start exercising. Getting regular checkups and seeing other health professionals such as dentists and eye specialists help promote good health. Even people who have chronic diseases, like arthritis or diabetes, can prevent further disability and in some cases, control the progress of the disease.

If a certain disease or health condition runs in your family, ask your doctor if there are steps you can take to help prevent it. If you have a chronic condition, ask how you can manage it and if there are things you can do to prevent it from getting worse. If you want to discuss health and disease prevention with your doctor, say so when you make your next appointment. This lets the doctor plan to spend more time with you as well as to prepare for the discussion.

Sharing Any Symptoms

It is very important for you to be clear and concise when describing your symptoms. Your description helps the doctor identify the problem. A physical exam and medical tests provide valuable information, but it is your symptoms that point the doctor in the right direction.

Tell the doctor when your symptoms started, what time of day they happen, how long they last (seconds? days?), how often they occur, if they seem to be getting worse or better, and if they keep you from going out or doing your usual activities. Take the time to make some notes about your symptoms before you call or visit the doctor. Concern about your symptoms is not a sign of weakness. It is not necessarily complaining to be honest about what you are experiencing.

Learning More About Medital Tests

Sometimes doctors need to do blood tests, x-rays, or other procedures to find out what is wrong or to learn more about your medical condition. Some tests, such as Pap smears, mammograms, glaucoma tests, and screenings for prostate and colorectal cancer, are done on a regular basis to check for hidden medical problems.

Before having a medical test, ask your doctor to explain why it is important and what it will cost, and, if possible, to give you something to read about it. Ask how long the results of the test will take to come in.

When the results are ready, make sure the doctor tells you what they are and explains what they mean. You may want to ask your doctor for a written copy of the test results. If the test is done by a specialist, ask to have the results sent to your primary doctor.

Discussing Your Diagnosis and What You Can Expect

If you understand your medical condition, you can help make better decisions about treatment. If you know what to expect it may be easier for you to deal with the condition.

Ask the doctor to tell you the name of the condition and why he or she thinks you have it. Ask how it may affect your body, and how long it might last. Some medical problems never go away completely. They can't be cured, but they can be treated or managed. You may want to write down what the doctor says to help you remember.

It is not unusual to be surprised or upset by hearing you have a new medical problem. Questions may occur to you later. When they do, make a note of them for your next appointment.

Sometimes the doctor may want you to talk with other health professionals who can help you understand how to manage your condition. If you have the chance to work with other health professionals, take advantage of it Also, find out how you can reach them if you have questions later.

Talking About Treatments

Although some medical conditions do not require treatment, most can be helped by medicine, surgery, changes in daily habits, or a combination of these. You will benefit most from treatment when you know what is happening and are involved in making decisions. If your doctor suggests a treatment, be sure you understand what it will and won't do and what it involves. Have the doctor give you directions in writing, and feel free to ask questlons.

If your doctor suggests a treatment that makes you uncomfortable, ask if there are other treatments to consider. For example, if the doctor recommends medicine for your blood pressure, you may want to ask if you can try lowering it through diet and exercise first. If cost is a concern, ask the doctor if less expensive choices are available. The doctor can work with you to develop a treatment plan that meets your needs.

Making the Most of Medications associated with the

Your doctor may prescribe a drug for your condition. Make sure you know the name of the drug and understand why it has been prescribed for you. Ask the doctor to write down how often and how long you should take it. Make notes about any other special instructions such as foods or drinks you should avoid. If you are taking other medications, make sure your doctor knows, so he or she can prevent harmful drug interactions.

Sometimes medicines affect older people differently than younger people. Let the doctor know if your medicine doesn't seem to be working or if it is causing problems. Don't stop taking it on your own. If another doctor (for example, a specialist) prescribes a medication for you, call your primary doctor to let him or her know. Also call to check with your doctor before taking any over-the-counter medications. You may find it helpful to keep a chart of all the medicines you take and when you take them.

The pharmacist also is a good source of information about your medicines. In addition to answering questions, the pharmacist keeps records of all the prescriptions you get filled at that drug store. Because your pharmacist keeps these records, it is helpful to use a regular drug store.

A pharmacist also can help you select over-the-counter medicines that are best for you. At your request, the pharmacist can fill your prescrlphons in easy-to-open containers and may be able to provide large print prescription labels.

Changing Your Daily Habits

Doctors and other health professionals may suggest you change your diet, activity level, or other aspects of your life to help you deal with medical conditions. Sometimes the doctor's suggestions may not be acceptable to you. For example, the doctor might recommend a diet that includes foods you cannot eat or do not like. Tell your doctor if you don't feel a plan will work for you and explain why. There may be other choices. Keep talking with your doctor to come up with a plan that works.

Seeing Specialists

Your doctor may send you to a specialist for further evaluation. You also may request to see one yourself, although your insurance company may require that you have a referral from your primary doctor.

When you see a specialist, ask that he or she send information about further diagnosis or treatment to your primary doctor. Thls allows your primary doctor to keep track of your medical care. You also should let your primary doctor know at your next visit about any treatments or medications the specialist recommended.

A visit to the specialist may be short. Often, the specialist already has seen your medical records or test results and is familiar with your case. If you are unclear about what the specialist tells you, ask him or her questions. For example, if the specialist says that you have a medical condition that you aren't familiar with, you may want to say, "I don't know very much about that condition. Could you explain what it is and how it might affect me?" or, "I've heard it's painful. What can be done to prevent or manage the pain?" You also may ask for written materials to read or call your primary doctor to clarify anything you haven't understood.

Surgery

In some cases, surgery may be the best treatment for your condition. If so, your doctor will refer you to a surgeon. Knowing more about the operation will help you make an informed decision. It also will help you get ready for the surgery, which, in turn, makes for a better recovery. Ask the surgeon to explain what will be done during the operation and what reading material or videotapes you can look at before the operation. Find out if you will have to stay overnight in the hospital to have the surgery, or if it can be done on an outpatlent basls. Minor surgeries that don't require an overnight stay can sometimes be done at medical centers called "ambulatory surglcal centers."

When surgery is recommended, it is common for the patient to seek a second opinion. In fact, your insurance company may require it. Doctors are used to this practice, and most will not be insulted by your request for a second opinion. Your doctor may even be able to suggest other doctors who can review your case. Hearing the views of two different doctors can help you decide what's best for you.

If You Are Hospitalized

If you have to go to the hospital, some extra guidelines may help you. First, most hospitals have a daily schedule. Knowing the hospital routine can make your stay more comfortable. Find out how much choice you have about your daily routine, and express any preferences you have about your schedule. Doctors generally visit patients during speclfic tlmes each day. Find out when the doctor is likely to visit so you can have your questions ready.

In the hospital, you may meet with your primary doctor and various medical specialists, as well as nurses and other health professionals If you are in a teaching hospital, doctors-in-training, known as medical students, interns, residents, and fellows, also may examine you. Many of these doctors-in-training already have a lot of knowledge. They may be able to take more time to talk with you than other staff. Nurses also can be an important source of information, especially since you will see them on a regular basis.

If You Have to go to the Emergency Room

A visit to the emergency room is always stressful. If possible, take along the following items: your health insurance card or policy number, a list of your medications, a list of your medical problems, and the names and phone numbers of your doctor and one or two family members or close friends. Some people find it helpful to keep this information on a card in their wallets or purses.

While in the emergency room, ask questions if you don't understand tests or procedures that are being done. Before leaving, make sure you understand what the doctor told you. For example, if you have bandages that need to be changed, be sure you understand how and when it is to be done. Tell your primary doctor as soon as possible about your emergency room care.

Discussing Sensitive Subjects

Much of the communication between doctor and patient is personal. To have a good partnership with your doctor, it is important to talk about sensitive subjects, like sex or memory problems, even if you are embarrassed or uncomfortable. Doctors are used to talking about personal matters and will try to ease your discomfort. Keep in mind that these topics concern many older people. For more information on the topics discussed below, see the resource list at the end of this book.

It is important to understand that problems with memory, depression, sexual function, and incontinence are not normal parts of aging. If your doctor doesn't take your concerns about these topics seriously or brushes them off as being part of normal aging, you may want to consider looking for a new doctor.

Sexuality-Most health professionals now understand that sexuality remains important in later life. If you are not satisfied with your sex life, don't automatically assume it's due to your age. In addition to talking about age-related changes, you can ask your doctor about the effects of an illness or a disability on sexual function. Also, ask your doctor what influence medications or surgery may have on your sexual life. If you aren't sure how to bring the topic up, try saying, "I have a personal question I would I like to ask you..." or, "I understand that this condition can affect my body in many ways. Will it affect my sex life at all?"

Incontinence-About 15 to 30 percent of older people living at home have problems controlling their bladder-this is called urinary incontinence. Often, certain exercises or other measures are helpful in correcting or improving the problem. If you have trouble with control of your bladder or bowels, it is important to let the doctor know. In many cases, incontinence is the result of a treatable medical condition. When discussing incontinence with your doctor, you may want to say something like, "Since my last visit there have been several times that I couldn't control my bladder. I'm concerned, because this has never happened to me before."

Grief, mourning, and depression-As people grow older, they experience losses of significant people in their lives, including spouses and cherished friends. A doctor who knows about your losses is better able to understand how you are feeling. He or she can make suggestions that may be helpful to you.

Although it is normal to feel grief and mourning when you have a loss, later life does not have to be a time of ongoing sadness. If you feel down all the time or for more than a few weeks, let your doctor know. Also tell your doctor about symptoms such as lack of energy, poor appetite, trouble sleeping, or lack of interest in life. These could be signs of medical depression. If you feel sad and withdrawn and are having trouble sleeping, give your doctor a call. Depression can be a side effect of medications or a sign of a medical condition that needs attention. It often can be treatedsuccessfully-but only if your doctor knows about it.

Memory problems-One of the greatest fears of older people is problems with their ability to think and remember. For most older people, thinking and memory remain good throughout the later years. If you seem to have problems remembering recent events or thinking clearly, let your doctor know. Try to be specific about the changes you have noticed, for example, "I've always been able to balance my checkbook without any problems, but lately I'm finding that I get very confused." The doctor will probably want you to undergo a thorough checkup to see what might be causing your symptoms.

In many cases, these symptoms are caused by a passing, treatable condition such as depression, infection, or a side effect of medication. In other cases, the problem may be Alzheimer's disease or a related condition that causes ongoing loss of skills such as learning, thinking, and remembering. While there currently is no way to determine for sure if a person has Alzheimer's disease, a careful history, physical evaluation, and mental status examination are still important. They help the doctor rule out any other, perhaps treatable, causes of your symptoms and determine the best plan of care for you.

Care in the event of a serlous illness-You may have some concerns or wlshes about your care if you become seriously ill. If you have questions about what choices you have, ask your doctor. You can specify your desires through documents called advance directives such as a living will or durable power of attorney for health care. Advance directives allow you to say what you'd prefer if you were too ill to make your wishes known. In an advance directive you can name a family member or other person to make decisions about your care if you aren t able.

In general, the best time to talk with your doctor about these issues is when you are sbll relatively healthy. If you are admitted to the hospital or a nursing home, you will be asked if you have any advance directives. If the doctor doesn't raise the topic, do so yourself. To make sure that your wishes are carried out, write them down. You also should talk with family members so that they understand your wishes.

Problems with family-Even strong and loving families can have problems, especially under the stress of illness. Although family problems can be painful to discuss, talking about them can help your doctor help you. Your doctor may be able to suggest steps to improve the situation for you and other family members. If you feel you are being mistreated in some way, let your doctor know. Some older people are subjected to abuse by family members or others. Abuse can be physical, verbal, psychological, or even financial in nature. Your doctor may be able to provide resources or referrals to other services that can help you if you are being mistreated.

Feeling unhappy with your doctor-Misunderstandings can come up in any relationship, including between a patient and his or her doctor. If you feel uncomfortable with something your doctor or the doctor's staff has said or done, be direct. For example, if the doctor does not return your telephone calls, you may want to say something like, "I realize that you care for a lot of patients and are very busy, but I feel frustrated when I have to wait for days for you to return my call. Is there a way we can work together to improve this?" Being honest is much better for your health than avoiding the doctor. If you have a long-standing relationship with your doctor, working out the problem may be more useful than looking for a new doctor.

Summary
If you have questions or worries about a subject that your doctor does not talk about with you, bring them up yourself Practice with family or friends what you will tell or ask the doctor. If there are brochures or pamphlets about the subject in the doctor's waiting room, use them as a way to begin to talk. Talking with your doctor about sensitive subjects is important. Although talking about these subjects may be awkward for both you and your doctor, don 't avoid it. If you feel the doctor doesn 't take your concerns seriously, remember that you can always change doctors.

Who Else Will Help?

Involving Your Family and Friends

It can be helpful to take a family member or friend with you when you go to the doctor's office. You may feel more confident if someone else is with you. Also, a friend or relative can help you remember what you planned to tell or ask the doctor. He or she also can help you remember what the doctor says. But don't let your companion take too strong a role. The visit is between you and the doctor. You may want some time alone with the doctor to discuss personal matters. For best results, let your companion know in advance how he or she can be most helpful.

If a relative or friend helps with your care at home, having that person along when you visit the doctor may be useful. In addition to the questions you have, your caregiver may have concerns he or she wants to discuss with the doctor. Some things caregivers may find especially helpful to discuss are: what to expect in the future, sources of information and support, community services, and ways they can maintain their own well-being.

Even if a family member or friend can't go with you to your appointment, he or she can still help. For example, the person can serve as your sounding board, helping you to practice what you want to say to the doctor before the visit. And after the visit, talking about what the doctor said can remind you about the important points and help you come up with questions to ask next time.

What's Next?

Some Closing Thoughts

Good health care always depends on good communication with your doctor and other health professionals. We hope this book will help you take an active role in your health care.

If you have suggestions to add to future editions of this book or other ideas for making it more helpful, please write to Freddi Karp, Editor, National Institute on Aging, Public Information Office, Building 31, Room 5C27, 31 Center Drive MSC 2292, Bethesda, MD 20892-2292. National Institute on Aging