Part of the Age-Friendly Health Care Special Report
(Editor’s note: This story is part of a series for The John A. Hartford Foundation.)
We’ve all been there. After waiting endlessly for a doctor’s appointment, your physician breezes in and out of the exam room, seems rushed and leaves you little time to ask questions. Before you know it, your appointment is over, and you feel like little more than a series of medical tests and health conditions. You don’t feel seen or heard.
“We lose a lot the moment we compartmentalize and objectify [people] as patients,” says Dr. Michael Wasserman, a Los Angeles-based geriatrician and board member of the Health in Aging Foundation — a nonprofit established by the American Geriatrics Society. “I want to look at them as a human being. I want to find out about their qualify of life, function and what matters to them. I don’t want to think of them as a disease or set of diseases.”
Communication is a key part of delivering effective care and maximizing quality of life. It allows doctors, nurses and others who work in health care to see the person behind the condition.
Harmful Stereotypes Cause Harmful Communication
Health care has a longstanding tradition of viewing and treating patients in terms of procedures and health conditions. There aren’t yet major initiatives focused specifically on improving doctor-patient communication on a larger scale.
“The way we train physicians isn’t set up to train them to understand and get to know the person,” says Wasserman. “By the second year [of medical school], students are already thinking of people as patients and diseases because the first two years are focused on basic science, anatomy and pathology.”
But people don’t want to be defined by their condition, says Donna Fick, director of the Center of Geriatric Nursing Excellence at Penn State.
“[People] want to be healthy and find the best way to treat their condition, but you miss important things when you don’t know the context of the whole patient,” she says.
Fick, a nurse since the 1980s, experienced firsthand what she calls “the power of words” when doctors saw her son, a child with Down syndrome, solely as his medical condition, she says. The experience prompted her to think about language differently, which she describes in an article for the Journal of Gerontological Nursing.
Fick says stereotypes about older adults influence how health care providers communicate with, and care for, aging patients.
“Part of the stereotype is the myth we push about aging as inevitable decline,” she says. “This can lead to a fatalistic approach.”
As a result, older patients might dismiss symptoms as an inevitable a part of getting older and choose not to seek medical care. Or doctors might view all older adults as miserable and may not pick up signs of depression or other mental health concerns.
“In many ways, my patients are my friends. When they feel that way about you, not only are they going to be more cooperative and adhere to treatment, they are going to share more with you.”
Doctors who use patronizing or childish expressions like “dearie” or “sweetie” when speaking with older adults can also hinder doctor-patient relationships, says Jake Harwood, communication professor at the University of Arizona whose research on communication and aging informed The Gerontological Society of America’s evidence-based review of communicating with older adults.
“The language you use can help shift the paradigm and change some of the ageist stereotypes about older adults,” says Fick.
What’s called “person-centered communication” is a communication style that focuses on getting to know someone first as a person and then incorporating that information into care planning.
To foster person-centered and age-friendly communication, health care providers gather information about a patient’s concerns, expectations, needs and feelings. They ask about daily activities, living conditions and spirituality, as well as the family, friends and pets in their lives. This broader context can provide clues to what’s behind underlying health care issues.
Studies have found that this approach improves health outcomes like improved blood pressure control — especially when a patient’s emotional and psychosocial needs are considered.
“In many ways, my patients are my friends. When they feel that way about you, not only are they going to be more cooperative and adhere to treatment, they are going to share more with you,” says Wasserman. “A doctor’s ability to deliver care and get good outcomes is so much higher.”
Ways to Forge Stronger Relationships With Doctors and Nurses
While it can feel impossible to take the conversation with a doctor into your hands, there are things you can do to help ensure the discussion focuses on you as a whole person. Here are a few tips:
Write things down. Before your appointment, jot down your questions. Then, bring a copy of what you’ve written to your doctor. “This way you won’t skip what’s important to you,” says Harwood. During the conversation, repeat back what you’ve heard in your own words. If you’re unsure of what your doctor said, ask the physician to pause and explain. “These things help ensure that when you leave the appointment, you got what you needed,” says Harwood.
Tell your doctor if you have trouble hearing. Changes in hearing are a reality and not something to be embarrassed about. By making your doctor aware, the physician can make some simple adjustments in communicating to make the appointment run smoothly.
Share your strengths and preferences: Within the traditional health care system, it’s easy to focus on problems: what’s wrong and what needs to be fixed. But Fick and Wasserman say it’s just as important to share your biggest health concerns and personal concerns related to your condition. Tell your doctor about everything from your work and daily activities to your friends and pets to your spirituality. “It’s important for doctors to know the things that really matter to the patient,” says Wasserman.
If you’re caring for an older adult, ask that person what’s important, too. “Oftentimes, if an older adult is in the hospital and becomes confused or delirious, the spouse or child suddenly has to speak for them,” says Fick. “It can be frightening and confusing to have to make a decision that you haven’t discussed before.” Fick suggests having these conversations and documenting an aging adult’s preferences before there’s an emergency.
Ask about your medications. Wasserman recommends revisiting your medications at every doctor’s visit. Why are you on it? Do you still need it? What would happen if you went off the medication? Most prescription and non-prescriptions drugs have a myriad of side effects, says Wasserman, which can affect a person’s quality of life, especially older adults.
Tell your doctor about the little things. Big changes or concerns aren’t the only topics to broach with your physician. Tell them about changes in your day-to-day life. “It’s important to let doctors know if something that’s been normal for you has changed, even if it doesn’t seem related to your health. It can be anything like your diet or how much you’re walking or socializing,” says Wasserman. “Every change in function can be related to an underlying disease or side effect from a medication.”
Stick with the same doctor. If you see a different one every visit, it’s hard to feel comfortable with your doctor. “It’s fairly critical that people see a consistent health care provider” to build a positive relationship, says Harwood. “Be willing to change doctors if you don’t feel comfortable or if you don’t see a consistent person.”
Involve older adults. If you’re a caregiver, you may find yourself accompanying a parent or family member to the doctor. Your role? Make sure your parent or family member is involved in the conversation and decision-making. If a doctor addresses a question to you, readdress the question to the patient. And ask for permission to share your thoughts when appropriate. “Before going into the exam room, the caregiver needs to say, ‘Can I have your permission to speak freely to the doctor?’” says Wasserman. “You don’t want to chime in without permission.”
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