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How to Talk to Your Doctor About Sensitive Issues

Don't let embarassment get in your way

Adapted from NIH/National Institute on Aging | May 7, 2012

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.

Most 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.

It is important to understand that problems with memory, depression, sexual function and incontinence are not necessarily normal parts of aging. A good doctor will take your concerns about these topics seriously and not brush them off as being “normal.”

If you think your doctor isn’t taking your concerns seriously, talk to him or her about your feelings or consider looking for a new doctor.

Here are some of the medical issues some people find hard to discuss with their doctor.

Alcohol Consumption

Anyone at any age can have a drinking problem. Alcohol can have a greater effect as a person grows older because the aging process affects how the body handles alcohol. Someone whose drinking habits haven’t changed may find over time that he or she has a problem. People can also develop a drinking problem later in life due to major life changes like the death of loved ones. Depression in older adults often goes along with alcohol misuse. Talk to your doctor if you think you may be developing a drinking problem. You could say: “Lately I’ve been wanting to have a drink earlier and earlier in the afternoon and I find it’s getting harder to stop after just one or two. What kind of treatments could help with this?”

Falling and Fear of Falling

A fall can be a serious event, often leading to injury and loss of independence, at least for a while. For this reason, many older people develop a fear of falling.  Studies show that fear of falling can keep people from going about their normal activities, and as a result they may become frailer, which actually increases their risk of falling again. If fear of falling is affecting your day-to-day life, let your doctor know. He or she may be able to recommend some things to do to reduce your chances of falling. Exercises can help you improve your balance and strengthen your muscles, at any age.

Grief, Mourning and Depression

As people grow older, they may lose significant people in their lives, including spouses and cherished friends. Or they may have to move away from home or give up favorite activities. 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 mourn when you have a loss, later life does not have to be a time of ongoing sadness. If you feel sad all the time or for more than a few weeks, let your doctor know. Also tell your doctor about such symptoms as lack of energy, poor appetite, trouble sleeping or little interest in life. These could be signs of depression, which is a medical condition.

Depression may be common, especially when people experience losses, but it is also treatable. It should not be considered “normal” at any age. Let your doctor know about your feelings and ask about treatment.

HIV/AIDS

The death of a spouse, divorce or separation can lead some older people to find themselves dating again and possibly having sex with a new partner. It’s a good idea to talk to your doctor about how safe sex can reduce your risk of sexually transmitted diseases, like HIV/AIDS. It’s important to practice safe sex, no matter what your age.

Incontinence

Older people sometimes have problems controlling their bladder. This is called urinary incontinence and it can often be treated. Depending on the type of incontinence you have, the doctor may recommend exercises, suggest helpful ways to change your habits, prescribe useful medications or advise surgery. If you have trouble controlling your bladder or bowels, it is important to let the doctor know. To bring up the topic, you could say something like: “Since my last visit there have been several times that I couldn’t control my bladder.”

Memory Problems

Many older people worry about their ability to think and remember. For most older adults, thinking and memory remain relatively intact in later years. However, if you or your family notice that you are having problems remembering recent events or thinking clearly, let your doctor know. Be specific about the changes you’ve noticed; for example, you could say, “I’ve always been able to balance my checkbook without any problems, but lately I’m very confused.” Your doctor will probably want you to have a thorough checkup to see what might be causing your symptoms. In many cases, memory problems are caused by such conditions as depression or infection, or they may be a side effect of medication.

Sometimes, the problem is a type of dementia, such as Alzheimer’s disease. With a careful history, physical exam, medical tests, and tests of memory and problem solving, specialists can diagnose Alzheimer's with a high degree of accuracy. Determining the cause of memory problems is important to help the doctor, patient and family choose the best plan of care. Although there is no cure for Alzheimer's, medicines can help for a while, especially in the early stages of the disease. Medications also can ease serious behavioral symptoms such as agitation, anxiety and depression. Support groups and education are important and can help patients and caregivers.

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 that a family member or caregiver is taking advantage of you or mistreating you, 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 if you are being mistreated.

Sexuality

Most health professionals now understand that sexuality remains important in later life. If you are not satisfied with your sex life, don’t just 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 about the influence medications or surgery may have on your sex 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 or medication can affect my body in many ways. Will it affect my sex life at all?”

Other Types of Issues to Discuss

Apart from medical conditions there are other issues related to health or life chnages that some find hard to discuss. It helps the doctor — and you — if he or she knows about the non-medical parts of your life. Where you live, how you get around, what activities are important to you: these are all things that can make a difference in decisions about your health care. The following are some examples of practical matters you might want to discuss with your doctor.

Planning for 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, like a living will or health care proxy. One way to bring up the subject is to say: “I’m worried about what would happen in the hospital if I were very sick and not likely to get better. Can you tell me what generally happens in that case?”

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, a nurse or other staff member may ask if you have any advance directives.

Driving

Driving is an important part of everyday life for many people and making the decision to stop driving can be very difficult. Tell your doctor if you or people close to you are concerned about your driving and why. He or she can go over your medical conditions and medications to see if there are treatable problems that may be contributing to driving difficulties. Vision and memory tests are important. The doctor also may be able to suggest a driver’s education refresher class designed for older drivers.

Moving to Assisted Living

Another hard decision that many older people face is whether or not to move to a place where they can have more help — often an assisted living facility. If you are considering such a move, your doctor can help you weigh the pros and cons based on your health and other circumstances. He or she may be able to refer you to a social worker or a local agency that can help in finding an assisted living facility.

Paying for Medications

Don’t hesitate to ask the doctor about the cost of your medications. If they are too expensive for you, the doctor may be able to suggest less expensive alternatives. If the doctor does not know the cost, ask the pharmacist before filling the prescription. Then call your doctor and ask if there is a generic or other less expensive choice. You could say, for instance: “It turns out that this medicine is too expensive for me. Is there another one or a generic drug that would cost less?”

Your doctor may also be able to refer you to a medical assistance program that can help with drug costs.

Feeling Unhappy With Your Doctor

Misunderstandings can come up in any relationship, including between a patient and doctor or the doctor’s staff. If you feel uncomfortable with something your doctor or his or her 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 this: “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 longstanding relationship with your doctor, working out the problem may be more useful than looking for a new doctor.

Help From 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 relative or friend can help remind you about things you planned to tell or ask the doctor. He or she also can help you remember what the doctor says.
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. If you are alone with the doctor during or right after the physical exam, this might be a good time to raise private concerns. Or you could ask your family member or friend to stay in the waiting room for part of the appointment. 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, bringing 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 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 of the important points and help you come up with questions to ask next time.

Resource: 
Worksheet: Prepare for your doctor's visit

More:
Finding a doctor you can talk to
How to talk to your doctor
Questions to ask before treatment begins


Based the NIH/National Institute on Aging publication, "Talking With Your Doctor: A Guide for Older People."

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