Talking with your doctor: a guide for older people

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.

Questions to ask your doctor about prevention: • Should I get a flue shot, pneumonia shot, and/or other immunizations? • How often should I have a breast or prostate examination? • Would changing my diet or exercise habits help me avoid specific diseases? A symptom is evidence of a disease or disorder in the body. Examples of symptoms nclude pain, fever, unexplained weight loss or gain, or disrupted sleep.

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?), or 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 Medical 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 screening 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.

Questions to ask yourself about your symptoms: • What exactly are my symptoms? • Are the symptoms constant? If not, when do I experience them? • Do the symptoms affect my daily activities? Which ones? How? Questions to ask your doctor about medical tests: • What will we know after the test? • How will I find out the results? How long will it take to get the results? • What steps does the test involve? How should I get ready? • Are there any dangers or side effects?

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.

A diagnosis is the identification of a disease or physical problem. The doctor makes a diagnosis based on the symptoms the patient is experiencing and on the results of his or her examination, laboratory work, and other tests. Questions to ask your doctor about the diagnosis: • What may have caused this condition? Will it be permanent? • How is this condition treated or managed? What will be the long-term effects on my life? • How can I learn more about it?

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 questions. 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.

Questions to ask your doctor about treatment: • How soon should treatment start? How long will it last? • Are there other treatments available? • How much will the treatment cost? Will my insurance cover it? • Are there any risks associated with the treatment?

Making the Most of Medications 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 prescriptions in easy-to-open containers and may be able to provide large-print prescription labels.

Questions to ask your doctor and pharmacist about medications: • What are the common side effects? What should I pay attention to? • What should I do if I miss a dose? • Are there foods, drugs, or activities I should avoid while taking this medicine?

For Your Use

Name of Drug	What It's For	Color/ Shape	Date Started	Doctor	Dosage	Instructions

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. This allows your primary doctor to keep track of your medica 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.

Questions to ask your doctor about changing your habits: • How will this change help me? • Do you have any reading material or videotapes on this topic? • Are there support groups or community services that might help me? Questions to ask your specialist: • What is your diagnosis? • What treatment do you recommend? How soon do I need to begin the new treatment? • Will you discuss my care with my primary doctor?

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 outpatient basis. Minor surgeries that don't require an overnight stay can sometimes be done at medical centers called "ambulatory surgical 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.

Questions to ask your surgeon about surgery: • What is the success rate of the operation? How many of these operations have you done successfully? • What problems occur with this surgery? What kind of pain and discomfort can I expect? • Will I have to stay in the hospital overnight. How long is recovery expected to take? What does it involve?

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 specific times 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.

Questions to ask medical staff in the hospital: • How long can I expect to be in the hospital? • When will I see my doctor? What other doctors and health professionals will I see? • What is the daily routine in this part of the hospital?

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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.

Questions to ask medical staff in the emergency room: • Will you talk to my primary doctor about my care? • Do I need to arrange any further care? • May I get instructions for further care in writing?