Q. What can a patient do about it?
A. Your default posture should be: Assume that information is going to get lost. Be the repository of your own medical information. And don't think that President Obama's push for electronic medical records (EMRs) will fix this.
Q. Why not? Isn't greater efficiency and transmission of your information among the promised benefits?
A. Someday that might be true, but we're not there yet. First, very few primary care practices have adopted EMRs because the cost of adoption is significant. Big, fabulous academic medical centers like the one where I work are very computerized; that's true. But if I care for you in my practice, and then you get chest pain and someone takes you to another medical center across town, guess what? The two offices don't speak to each other. So I tell patients to keep a "biggest hits" list with them. That includes your five or six major medical situations, such as diabetes or coronary artery disease. Obviously it's not practical to walk around with your entire medical record. But a few key pieces of paper can work.
Q. What would those be?
A. For my patients who have normal resting cardiograms, for example, I photocopy it and give it to them. It's a piece of paper the size of an index card, and it provides a baseline. As we get older we tend to accumulate not only conditions and diagnoses, but some abnormalities on medical tests, including x-rays, scans and stress tests. Also, keep a list of medications you're taking. A number of companies now, including Google Health and Microsoft HealthVault, have created tech-savvy online ways for patients to do this, depending on how you feel about medical privacy. You just never know where you're going to get sick or who's going to treat you.
Q. How does an older patient advocate appropriately for himself or herself, without overstepping the line?
A. That's the sweet spot, isn't it? You can advocate appropriately, and most physicians will respect that. Discuss your day-to-day activities with your doctor. Tell us how you move about, how you conduct your life, what you expect and hope to do in the future. The partnership is critical. But there is another issue here, and it has to do with the caregiver's role in the interaction. Very often, the caregiver accompanies the patient to the appointment.
Q. Right. So how should that be handled, ideally?
A. It's much more difficult, I think. On the one hand, you want to give the older patient space to have dignity. That person needs to be autonomous in the interaction. On the other hand, you're concerned. If you're like many boomers caring for older parents today, your parent comes back from the doctor, and you want to know how the visit went. You say, "Mom, Dad, what happened?" And like many people, they clam up. You can't figure out what went on in the visit.
Q. Why does that happen — what's at work here?
A. Boomers today are used to getting all kinds of things and all kinds of service, no matter where they go. Not true of their parents. I see many people in their 70s, 80s and 90s who are reverential to physicians to a fault. But we physicians are human beings. We're God's children, and we make mistakes.
Q. What do you suggest?
A. I tell the boomer child of an older parent to role-play with his or her parent before the visit. You might say, "OK, Dad, you're going to see Dr. Smith about your knee pain. He's probably going to ask you when the pain started, what makes it worse, and how about your other knee." This helps create a sense of what's going to happen at the visit. If the parent is willing to let the boomer child go with them on a visit, that's an opportunity to become a participant in the visit.