Jul 27, 2016

Interview Transcript

Interviewer: How to help and what to watch for when you accompany an older adult to a medical appointment - that's next on The Scope.

Announcer: Health tips, medical news, research, and more, for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: Dr. Mark Supiano is a Geriatrician and the Executive Director for the University of Utah Center on Aging. Dr. Supiano, I've read that when people go to the doctor, it's common that you don't really comprehend and retain a lot that's talked about, and it can be even more difficult for the elderly. That's why it's a good idea for anybody to really take somebody with them to the doctor to pay attention, especially in the case of the elderly. But what do I do when I'm there? Can you help give me some guidance? I'm in the room, what next?

Dr. Supiano: You're correct, Scott, that the communication between doctors and patients has long been a concern, not just in older people but across all ages. And given sensory loss and potentially cognitive challenges in older people, their ability to retain information from what the doctor's telling them may not be that good.

Now, I don't want to put the blame on the patient, in fact more often it's the case the blame should be on us physicians or health care providers who are not doing a good job in attending to the needs of our patients. So, being sensitive to those communication needs, and also being sensitive to health literacy, and making sure that patients can comprehend the medical terms and language that we're using, is a skill that is not fully developed in all physicians. Geriatricians are trained to be adept in those communication skills and be attentive to health literacy, so those are some of the things that we need to focus on.

One resource I can highly recommend is the public education arm of The American Geriatric Society, this is known as The Health in Aging Foundation. They have a great website, with a number of resources for patients and their family members and caregivers to point to, to get this kind of information. In that regard, the types of things that would be helpful to better prepare an individual for going to that doctor's appointment is, first of all, making sure that there's good communication of medical information. And if this is the first time you're seeing this healthcare provider, being certain that your medical records, your health history, is communicated and available for that healthcare provider to review.

Interviewer: Yeah, so it happens before you even show up, really, you should sit down with that person and perhaps make sure we have a complete medical history.

Dr. Supiano: Well, these days it's not a sit down. It's often a questionnaire, or increasingly we're going to web-based questionnaires to address that information, but making sure that there's that transfer of information. You don't want to expose yourself to unnecessary duplicated tests, not just the costs associated with that but putting yourself at risk for having more tests done, and so forth. So, the more information you can equip the provider with, the better.

Secondly, making your own list, what are your concerns? Going in with your agenda for that appointment, making sure that the healthcare provider knows what your agenda is, and can address those concerns as appropriate.

Interviewer: And that's even a bit of a paradigm change, a lot of times, for a lot of older adults, from the standpoint that my understanding is doctors used to direct the care, and now we're starting to switch towards more patient interaction.

Dr. Supiano: Exactly, so the catchword now is "patient-centered care."

Interviewer: Yeah, okay.

Dr. Supiano: It's not so much what the doctor is interested in, but rather what your concerns are and what your main priorities are for that visit.

Interviewer: And knowing that before you go in, it's just a huge paradigm shift, I think, but a good one to be aware of.

Dr. Supiano: So being prepared for that is key, and if you wish to engage your family members to help in generating that list, find out if they have concerns, might be another good way to help in that preparation.

Another key feature is, because so many problems are associated with medications in older people, either too many medications or medication interactions, it's important that you accurately communicate to your doctor exactly what medications you're taking. That should be all your prescribed medications as well as over-the-counter medications, supplements, anything that you are using.

And ideally, bring those medications in with you, it's called "the brown bag," you fill up a shopping bag of your medications. The other term for this, since there are very few procedures in geriatric medicine, this is called a "medicine chest biopsy." So you put the needle in the medicine chest and take a biopsy of all the medications that are in that person's medicine chest. But it's really critical that your health care provider know all of the medications that you're taking, and that those are carefully reviewed, and also that you tell your doctor how you're taking those medications, because it's not only what you're taking but are you taking the medications on time, on schedule, not taking duplicate medications, not missing doses, etc.

Interviewer: As somebody in the room during the procedure, if I'm in there with a parent or grandparent, what's my role? Is it just to listen? Is it to ask questions? Is it to take over the visit, I mean what am I supposed to do?

Dr. Supiano: Good question, and probably not the latter, but again it needs to be a patient-centric focus. So talking with your parent or family member and getting their lead, what role they would want you to have. I think, at a minimum, what anyone can do with the permission of the patient is to be another set of ears and eyes, and taking notes, and prompting questions when appropriate to make sure that, again, that information is adequately communicated.

Interviewer: So, it sounds like doing a little work beforehand, coming up with what [are] your concerns, what you would like to talk about, also perhaps going to the Health in Aging Foundation website and take a look at some of the resources there to get you more prepared for that trip to the doctor, having somebody with you that can maybe help be another set of eyes or ears, or come up with questions that you might not think of. Is there one more tip that you might have to making that visit as productive as possible?

Dr. Supiano: The last point is to make sure that there's good communication that follows the visit. So it is a requirement, you should set an expectation that you don't leave the visit without written instructions for what the physician or healthcare provider is asking you to do, whether that's a change in your medications, a change in lifestyle, additional tests that need to be done, what additional follow up needs to be done. Make sure that that is clearly explained to you, and that it's available in writing, so that you have that to refer to. And then, using that in terms of follow up information, that there's good after-visit communication, you want to get the results back from your tests, and being able to get feedback from your healthcare provider about the interpretation of those test results and what the next steps or additional follow up might be, based on the outcome of those results.

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