Talking with your doctor: a guide for older people

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. Mrs. Brooks and her doctor had a similar way of showing discomfort around sensitive subjects. 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 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 treated successfully--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 serious illness--You may have some concerns or wishes 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 still 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.

An advance directive is a document that allows you to state your preferences about your care if you were to become too seriously ill to make your wishes known. Examples of advance directives include living wills and durable health care powers of attorney.

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 patient 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.