How to Talk to Your Doctor

If you want better treatment, you need to speak up.

4 min read

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.

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.

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.

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.

Don't hesitate to bring up emotional issues, including fears and anxieties about your illness, as well as any problems you may have with substance abuse, such as alcohol or painkillers, Callahan says.

''Your health care provider should ask about your lifestyle and emotional issues,'' Hallberg says. ''If he or she doesn't, it might be because they aren't picking up on subtle cues, and you should bring it up.''

You should expect your doctor to have positive expectations of you, too. ''An older person is as capable of changing his diet, exercise habits, and so on as a younger one,'' Callahan says. ''Older people need just as much health education, and a doctor shouldn't assume they can't learn.''

Be as knowledgeable as you can be. ''Learn everything about your condition,'' Lien advises. Ultimately, you have to take responsibility for your own well-being and comply with your doctor's advice. Says Hallberg, ''You and your doctor should be on the same wavelength and work as a team to achieve the same goal: your health.''

It's your job to keep your doctor informed about your condition and any problems you may be having with medications or treatments.

And if a doctor shoos you out of the office before your list of questions is answered? Experts and active patients agree: It's time to find a new doctor.

Sharon Cohen is a senior editor at Shape and Fit Pregnancy magazines.