Doctor visits can be stressful for older adults. Between arranging for transportation, filling out paperwork and waiting to be seen, they may become anxious. By the time the physician rushes in, they might even forget why they came. Add hearing loss, dementia or additional time needed to process information and respond to questions, and you have a recipe for frustration.
Appointments can go by in a flash, and before you know it, the opportunity to talk about a symptom or have a question answered has passed. Without all the clues, the doctor, like any good detective, cannot reach an accurate conclusion. This does not bode well for the patient: Proper diagnosis, appropriate care and follow-up are all at stake. But it doesn’t have to be that way.
To get the most from a doctor’s visit, bring a patient advocate or companion with you, preferably someone with a clinical background who understands the process and can easily interpret medical terminology. After all, having one more person on the team can make for a more positive experience.
According to a Johns Hopkins survey about health care companions, Medicare beneficiaries who were accompanied to doctors’ visits by spouses, adult children, nurses or other professionals were more satisfied with the care they received than those who went alone- because their companions facilitated better communication. A patient advocate can:
- Tell the doctor about your medical needs.
- Take notes.
- Refer to those notes later when you have questions.
- Ask questions.
- Verify the treatment plan is realistic.
- Make sure you follow through with it.
“I tell people we’re a cross between an advanced practice nurse, a lawyer and a guard dog,” said Teri Dreher, RN, CCM, board-certified patient advocate and owner/CEO of NShore Patient Advocates in Chicago. “We know a lot about patients’ rights and help prevent medical error, to avoid patients’ rights being violated.” Don’t worry about privacy laws getting in the way; all they have to do is sign a HIPAA form.
Treat the appointment like a business meeting and prepare notes ahead of time, said Beth Myers, CEO and founder of 2X2 Health, a private health care concierge in Chicago. She sets expectations for the visit with the patient by writing down any problems they have and how long they’ve had them. That way, she can ask the doctor why it’s happening and get a diagnosis and/or treatment plan.
Simply state your case
“Doctors think in bullet points,” Dreher said. “If you bring in a problem to them with specific symptoms and don’t go off on long stories and tangents, doctors can get to the heart of the problem quickly and properly diagnose and treat you faster.”
She has caregivers consult with patients and write six or seven questions down in a notebook; putting the most important ones at the top.
“If you get to the other ones later, that’s great. If you don’t get to them, maybe the nurse can help answer the questions.” Most doctors have nurse practitioners or physician assistants, Dreher explained. “To be respectful and keep a positive relationship with doctors, it’s important to respect their time because to them, time is more valuable than money.”
Also, make a list of recent tests and ask about the results. If any are abnormal, she will tell the doctor to explain what they found.
“Sometimes doctors talk in medical language and assume you know what they mean, and people are embarrassed to admit they don’t know what something means,” Dreher said. If the caregiver or patient doesn’t stop them and ask for an explanation, she does it for them. It’s why she’s there.
A professional board-certified patient advocate, like an RN, will think of questions the caregiver and patient wouldn’t know to ask, Dreher explained.
“Nurses think like doctors in terms of differential diagnosis [multiple causes of a symptom], options for care, risk,” she said. “If procedures are suggested, make sure the doctor does a fully informed presentation…They need to give you educational information about procedures, risks and benefits.” You will want to know how long your care recipient will be in the hospital and anything about their condition that puts them at higher risk.
For example, patients in their 80s and 90s who get a cancer diagnosis won’t want aggressive chemotherapy-because it will shorten their life rather than prolong it.
Myers considers herself an extra set of eyes and ears for both the patient and doctor. Sometimes, the doctor decides on a plan of care that Myers realizes, after visiting the patient at home, won’t work for them-because they were not completely honest with the doctor. In those cases, she advises the doctor to come up with another plan. For this reason, she recommends caregivers always attend appointments because they are with patients every day and can tell the doctor what they see at home. As a rule, she said patient advocates should attend all doctor appointments because they need to communicate with every physician on the team what has been done, why it’s been done and next steps. So, everyone is on the same page and they’re not repeating tests unnecessarily.
After the appointment, Dreher reviews her notebook with the caregiver and patient because if they heard something differently than she did, she can clarify it for them. Once tests are completed, Myers notifies doctors on the patient portal to make sure they review them and follow up with her.
Find a patient advocate near you
To find a patient advocate for the older adult in your life, Dreher recommends visiting Greater National Advocates, Alliance of Professional Health Advocates, National Association of Healthcare Advocacy, Health Advocate X or Aging Lifecare Association. Although the cost of a patient advocate is out-of-pocket, patients can receive free advocacy services and other support from the nonprofit The Care Project.
When selecting an advocate, don’t hire someone who is adversarial, Myers said.
“We’re not looking to get something done like a bull in a china shop. We’re looking for someone who can work together as a team and bring everyone together.”
With someone present to make sure older adults understand their medical needs and how they’re being met, doctor appointments will be more productive and result in better outcomes for the patient.
“Most doctors are thrilled to have an RN patient advocate on the case, because they know we do extra education and support…” Dreher said. “And we keep them on the phone for a lot less time than a patient would.”