Key elements in an effective doctor-patient relationship
Honesty. Be honest with your doctor. Hiding information could harm your health, and your relationship with your health care provider. In a landmark research study published in 1993, 72% of people in the study who used unconventional therapies (eg, vitamin and herbal supplements, acupuncture and chiropractic care) did not tell their doctors despite the fact that these therapies can have a significant impact on treatment decisions and drug safety. Multiple studies have also shown that what people think are "harmless" vitamins and supplements may well have dangerous interactions with a variety of medications that older adults take for multiple conditions from high blood pressure to diabetes. To get the best care, you must tell your doctor about all your health concerns and treatments.
And of course, you should expect absolute honesty from your doctor regarding all matters of your health, as well as any available health care resources.
Be a Good Listener. Try to listen as carefully as you can to what your doctor is saying. You want to be able to respond clearly to his/her questions and to ask your own questions about points you may not understand. Remember that good communication includes being able to both speak and listen effectively.
Have the doctor speak directly to the older person (the patient) in the room, if you are the family member or friend. If the visit is for an older adult, and the older person is able to hear and understand, the doctor should speak directly to him or her. As the "third" person in the room, you are there to observe the interaction and share your thinking with the older person if he or she asks you to do so.
Shared responsibility. Remember that it is not your doctor's job to completely take over your health and make you better. The part you play in improving your health is at least as important as that of your doctor.
Attention to physical, mental, and emotional health. Make sure you and your doctor pay attention to not only your physical health, but also your mental and emotional health. Talk with your doctor about the issues that have an effect on your life, including stress, anxiety, and depression; a loss, such as divorce, separation, or death; and other issues, including family and financial problems. Your feelings can have a major effect on and can't be separated from your health.
Accessibility of the doctor. If you feel it is difficult and frustrating to try to get your doctor's attention when you need it, be sure to tell your doctor this. Ask what is the best way and the best time to contact your doctor.
Planning for specialty care and communications with a specialist. If you and your doctor decide you need to see a specialist, talk with your doctor about how to provide the information that the specialist will need. Should the specialist call your doctor, or would your doctor prefer to make the call? Make a plan together about when you will come back and talk to your doctor about your progress and/or any problems you're having with the specialty care.
Mutual respect. Even if you and your doctor don't always agree, do you feel there is a sense of mutual respect? This is very important, so that you can benefit from both your and your doctors ideas on the best choices for your treatment. If you feel a sense of mutual respect is missing from your relationship with your doctor, you may want to consider establishing a relationship with a new doctor.
Trust in your doctor's knowledge. Your doctor has many years of training and experience. You should feel confident in his or her level of knowledge. If you don't, you may want to ask questions to determine whether your doctor understands your concerns. If you still feel uncomfortable, you might want to consider working with a different physician.
Use humor as a gateway to better health. Remember that humor can take both you and your doctor a lot closer to your mutual goals. Don't be afraid to inject some humor into the visit - this opens the door for your doctor to do so as well. You'll both feel better!
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Ways to prepare for a visit with your doctor or other health care professional
- Use check lists. One geriatrician, Dr. Robert Stall, in Williamsville, New York, has posted several "patient information sheets" on his Web site (http://www.acsu.buffalo.edu/~drstall/index.html) that include forms for patients to take to the office visit. These include checklists for medications, symptoms, a form for listing emergency contacts and other vital information, and nutritional information. You'll find some of Dr. Stall's checklists at the end of this section. You can even call the office first and ask if your doctor would like you to send this information ahead of your visit to save time. But keep a copy for yourself and take it with you, just in case.
There are many other sources for these types of checklists. Some checklists address a specific health condition such as depression, urinary incontinence, or memory loss, and can be found on the Web sites of organizations or professional medical societies that focus on a particular health issue. Your doctor may ask you to complete one or more checklists or "assessment tools" before or during an office visit. The tools your doctor provides may include general questions about your medical history and/or specific questions about a particular condition.
- Write down your questions. While we may think we have all the questions for our doctor in our heads, it's important to write them down. It's amazing how quickly we can forget our questions when we feel nervous, rushed, or distracted at the doctor's office. Start with the most important, so if you run out of time you will have discussed what you really need to discuss.
- Research your questions. Now that you know where some sources are for health information (see FIND) and how to understand the information you find (see EVALUATE), try to do some reading about your questions. That way, you may already be familiar with some of the terms or treatments that your doctor discusses with you. But if you don't understand - by all means ask! Your doctor won't know that you don't understand something unless you ask.
- If you like, ask a family member or friend to go with you. Especially when dealing with medical issues that are upsetting to you, having someone else in the room can be both reassuring when you're there, and a big help after you leave. That person may hear and remember information that you didn't. Afterward, you can talk about your impressions and the information together.
- Ask your doctor if you can record the visit. This is always a helpful tool, especially when it comes to discussing difficult diagnoses. You may be in physical or emotional distress while you're in the doctor's office, so having an audio record of the visit could be quite helpful. Make sure you know how the machine works and check the batteries before you go to your appointment. And always ask the doctor for permission before you record.
-- or take notes. If you don't record the visit, it's helpful to take notes. After the doctor is finished explaining things, you can quickly review the notes and ask questions about the things you're unsure of. And, having the notes after you return home will help you identify unanswered questions and/or explain things to a family member or friend.
- If you don't understand something the doctor is talking about, ask her or him to explain. If you have done some reading in advance, the terms will, of course, be more familiar to you. But the pronunciation may be strange. Ask your healthcare professional to write down the terms you don't understand, so you can study them further. Or, as noted above, you can take notes during the visit and ask for clarification.
- If you are thinking about seeing another doctor for a medical problem, tell your primary care doctor. Be certain to mention if you plan to use complementary or alternative therapies. A large percentage of patients don't tell their doctors about their use of complementary or alternative therapies. Your doctor needs to know so that not only can he or she follow your progress, but also consider any potential interactions with your other medications or medical problems. You may want to ask your doctor if he or she can recommend a doctor or practitioner skilled in the treatment you are seeking. If health insurance coverage is a concern, call the other doctor or practitioner's office and ask if they accept the insurance you have (eg, Medicare, Medicare+Choice, Medicare/Medicaid, and/or any other managed care plans).
- Remember to get copies of other tests or charts that you have had in the past. The more information your doctor has about previous tests and results, the better a picture he/she will have of your current health status. Call the offices of other health care providers you've seen or who have ordered tests, and find out how you can get a copy of the results to your current doctor. You frequently need to provide something in writing, but most offices keep a medical record request form on hand; in this case, all you'll need to do is sign it and return it to the office staff. Then make sure you give your current doctor's name, address, and telephone and fax numbers. Remember to ask if there is a charge for these services.
- Ask for help in your further research. Although you have learned many skills from the Health Compass program, your doctor may know of specific support groups in your area or organizations that have information about your health issues.
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Create a plan of action with your doctor. Remember that if you need treatment, you and your doctor should work together to decide on a plan of action, based on the best available information.
Forms to print out and use for office visits
Below are some forms to print and fill in before you go to your doctor's office. Several of them ask for details that you may have to research. Use the ones that are important and apply to you.
Dr. Stall's Checklists
- Patient Information Sheet -- Medication List
This includes space for prescription and non-prescription medications, as well as any vitamins or other supplements or non-prescription drugs you may take. It's important to write them all down and share the information with your doctor.
- Patient Information Sheet -- Symptom Checklist
This lists common symptoms that you should tell your doctor about and includes columns where you can make note of when you have them.
- Patient Information Sheet -- Emergency Contact, Hospitalization, Surgeries, Allergies, and Whether or Not You Have Prepared Any Advance Directives: http://www.acsu.buffalo.edu/~drstall/ptemerg.html
- Nutrition Checklist for Older Adults
Dr. Stall adapted this list from The Nutrition Screening Initiative, a project of the American Academy of Family Physicians (AAFP), the American Dietetic Association (ADA), and the National Council on the Aging (NCOA) (Washington, D.C. 1992).
Using the letters from the word, "Determine," the form asks you to fill in the answers to questions like, "Disease: Do you have an illness or condition that makes you change the kind and/or amount of food you eat?" The nine questions are directed toward gathering important information about your nutrition and eating habits.
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