If you want better treatment, you need to speak up.
April 10, 2000 (Los Angeles) -- If you are getting less attention and help from your doctor than you might like, the findings from a recent study might help you to improve the relationship -- especially if you are 65 or older.
The study, published in January in the Journal of the American Geriatrics Society, compared the interactions that older patients and younger patients had with their doctors. Researchers, with the consent of patients and doctors, videotaped the visits of 509 outpatients seen by medical residents in a clinic and then asked patients to complete questionnaires about the appointments.
Things to Consider
Select the number (on a scale of 1 - 3) that best describes your situation for each item or issue. You can total your scores if you wish to get a big picture of the situation. Lower scores indicate less manageable situations -- situations requiring additional support beyond the primary caregiver -- and higher scores indicate situations that may be more readily managed.
The care receiver is usually:
_____ (1) Confined to the bed
_____ (2) Homebound, but not bed bound
Older patients -- those 65 and older -- had longer appointments, more return visits, and reported higher levels of satisfaction than the younger ones aged 18 to 64. Yet, even though the older patients had lengthier conversations with their doctors, they were given less counseling, asked their doctors fewer questions, had fewer discussions about their use of tobacco, alcohol, and other substances, and were asked to change their unhealthy behaviors less often than the younger patients.
Be Active, Not Passive
There are several implications here for older people, says the study's lead author, Edward J. Callahan, PhD, associate director of the Center for Health Services Research in Primary Care at the University of California, Davis, Medical School in Sacramento.
First, realize that you are entitled to speak up. ''Many older people were raised to place doctors on a pedestal,'' Callahan says. ''They need to let go of that vision and to realize that it's their right to ask questions and be assertive. The more actively a patient participates in his or her care, the better he or she does in terms of health.''
''Don't leave the office until you get answers to all your questions, '' says Jim Lien, 68, a retired high school teacher in Minneapolis who has congestive heart failure. Lien, who has also battled a cancer that's now in remission and undergone two coronary artery bypass surgeries, says he is sure that being an active patient had a lot to do with his survival. There's no need to be aggressive or rude, says Lien, but it is important to ask for what you want.
Make the Most of an Office Visit
There are several simple measures older people can take to improve their overall care. When you schedule an appointment, ask how long it will be, just to be sure you get the time you need, suggests family physician John Hallberg, MD, a clinical assistant professor at the University of Minnesota Medical School in Minneapolis. ''If you have a lot of concerns, ask for a longer appointment or [if that's not possible] just focus on the most important few.''
Both Callahan and Hallberg also recommend bringing a written list of questions, and Lien advises prioritizing them. As long as it doesn't encourage passivity, you might also want to bring someone with you to serve as a second pair of ears and, if necessary, act as an advocate.
Take notes if you have trouble remembering what your doctor says. ''This also forces you to listen carefully,'' Lien says. Or bring a tape recorder, first asking your physician for permission to record.