Older people need to talk comfortably with their MD

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Patients can benefit by developing a dialogue with physicians. (STEVE HELBER / THE ASSOCIATED PRESS ARCHIVES)

CHANGING physicians can be wrenching for older patients. My mother never got over it when her longtime doctor retired. The "new" doctor took care of Mom for more than 15 years, but she would still tell him what she thought he wanted to hear. Ironically, the frailer Mom grew, the less forthright she became.

Now, my 70-something aunt, who has diabetes and Parkinson's disease, is going through a similar change. Her longtime physician is shifting to an endocrinology-only practice and has asked patients to find another primary care doctor.

As is widely recommended, she brought to her first appointment a list of all the medications she's taking. But she also brought a sheet of paper on which she briefly described her youth, marriage, motherhood and other seminal life events, things essential to her personhood that she wanted her new physician to know.

Did my aunt talk about her fear that she'll become progressively disabled because of her Parkinson's? I suspect not. That's a hard thing to share with a total stranger, even one who has a thick file containing your medical history on her desk.

For others going through something similar, the National Institute on Aging has a helpful publication, "Talking With Your Doctor: A Guide for Older People." (For an online version: www.nia.nih.gov/HealthInformation/Publications/TalkingWithYourDoctor.) The aging institute is part of the National Institutes of Health.

The guide's fundamental message is clear: "When you're older, it becomes even more important to talk often and comfortably with your doctor."

Don't be rushed: It's up to you to intervene if you feel a physician is rushing through an appointment without really taking the time to address your concerns. The guide has a script that an older person can use: "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."

Discuss medications: Too often older patients don't talk about their medications, even when they feel the drugs aren't working. A 2007 study in the Journal of General Internal Medicine found that 27 per cent of seniors who decided to skip doses or stop taking a drug because of side effects hadn't discussed the matter with their physicians.

The report also found that 24 per cent of seniors with three or more chronic medical conditions hadn't talked about their complicated drug regimens with physicians. And older patients who discuss prescription drugs with doctors are more likely to be switched to low-cost generic versions, the research found.

-- Chicago Tribune

Take checklist with you

What are the common side effects? What should I pay attention to?

When will the medicine begin to work?

What should I do if I miss a dose?

Do I take it at meals or between meals? Do I need to drink a glass of water with it?

Are there foods, drugs or activities I should avoid while taking this medicine?

Source: Talking With Your Doctor, from the National Institute on Aging

Republished from the Winnipeg Free Press print edition November 7, 2009 C19