There is abundant evidence that healthy aging in part depends on good communication between you and your primary care physician (or any of your doctors, for that matter). The purpose of this month’s column is to describe how to achieve this important feature of healthy aging.
Why is Good Communication Important?
It has been proven that good communication means patients are more likely to follow treatment plans if they have a thorough understanding of their disease and the medical regimen designed to keep the patient as healthy as possible. Clear communication prevents medical errors, improves health outcomes, and strengthens the patient-doctor relationship. All of this begins and ends with superb rapport, trust, and confidence in one’s doctor, which in turn comes from clear, effective communication between you and your physician. Medical students and resident physicians in training as well as practicing physicians are now being taught and tested on communication skills, but it takes two to communicate and this is where you, the patient, come in.
What the Patient Should Do to Establish Good Communication
The first thing the older patient must make clear is what he/she wants out of the remaining time in life. Death is generally an accepted fact in people as they age and the paramount issue is quality of life. It is important to be clear with one’s physician (and family) about advance directives, end-of-life decisions, assisted living desires, people who could function as care givers if needed, financial planning to accommodate desires, and, of course, an updated will. Copies of directives and end-of-life decisions should be part of your medical record. In other words, be sure you discuss all this with your primary care doctor and be certain that he/she has them in your medical record.
To maximize communication on every visit, it is a good idea to have a written list of specific concerns or questions that you want to discuss. When your physician answers the questions take notes to record the answers or repeat the answer so that he/she knows you understood what he/she said. Likewise when given instructions it is best to write them down or insist they be given in writing and/or with relevant printed literature.
It is important that your doctor know your family history, drug allergies, medications (prescribed and over the counter), your current lifestyle (with or without restrictions), and who you rely on for assistance. All these facts should be in your record and reviewed from time to time. Finally, and most importantly, always be sure to tell your doctor what the primary issues are in your life, medical as well as other stresses. Never think something is too embarrassing or trivial to bring up – this is about optimal communication. Remember the entire conversation and record is confidential so nothing is off-limits.
What the Physician Should Do to Establish Good Communication
The most important thing the doctor should do is listen to you and give you the time to get questions answered and be clear about your health and how best to maintain it. This is a mutual need that both have responsibility to fulfill.
There are certain questions that your doctor should ask on each visit but the most important is – has anything changed since the last visit. A review of whatever chronic disease you have and how it is being managed and your current status with it should be frankly reviewed including any problems with medications or quality of life. Changes may be very significant so speak about them.
Your physician will inquire about your exercise and diet and generally make recommendations. It is not unusual for a written prescription for exercise and diet to be given to you. Exercise benefits or prevents hypertension, type 2 diabetes, osteoporosis, obesity, colon cancer, breast cancer, and cardiovascular disease. Proper diet is also important and any recommended supplements should be discussed.
There is a time when you and your physician need to communicate about “bad news.” Inevitably in our lives there comes a time when a diagnosis is made that carries with it all sorts of emotion and fear. It is just as hard for a doctor to deliver the news as it is for the patient to receive it, especially in a relationship that has been long and good. Nevertheless the results of a biopsy, or another diagnostic test including cognitive function could bring dreaded news. When this conversation must occur it is very important for the physician to be compassionate, thorough, optimistic, but also realistic. Notes should be taken and questions answered, but the rule is there will be many unanswered questions during that first conversation and a need to follow-up. Some patients want to know everything and others only a little: your physician will be available for follow-up calls or visits. It is important that you and your doctor as well as family understand your desire on amount of information concerning your new diagnosis. It is important for the doctor to assure the patient that even if a referral specialist is required that the primary care doctor will still be available and able to continue the ongoing communication and to reach out to the family as the patient desires. This is a critical time in the relationship and continuing open communication is required for the patient to have the best outcome and support.
Other than those conversations about life-threatening disease, there are also subjects that your doctor may have with you that are also vitally important, like when is it time to give up driving because of limitations in physical condition that goes with aging like decreased night vision. This medical advice is not easy to receive, but necessary, and should be provided clearly and the reasons for it fully understood for best results.
The Bottom Line
There are few relationships in life that can be as meaningful as those of spouses, close friends, clergy, and physician-patient. In all of these, the key to a most effective relationship is good, honest, compassionate communication. It is a matter of proven science that a good patient-doctor relationship will enhance one’s life and lead to a longer and healthier life. This relationship depends on good communication.