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When my 83-year-old mother's primary-care doctor asked her if she'd had any recent falls, she didn't hesitate: "Oh, no."
But I knew better. "Uh, yes, she did!" I interjected.
"No, I didn't!" my mother shot right back. Then she fixed her doctor with a stare and said, "Whose appointment is this — his or mine?"
Her doctor squirmed uncomfortably on his stool.
My mother and I generally cooperate during these medical visits, which I've accompanied her to for the last three years or so. But sometimes we run into disagreements. I didn't enjoy ratting her out on this occasion, but I felt it was my job to disclose her balance problems; how could her doctor help unless he knew about them? Still, there was fallout: an irate mother, an irritated son.
This is one of the many challenges that concerned caregivers face when they "audit" the medical visit of an aging adult. Most guides to the subject advise caregivers on what to bring (medication lists, questions, notepad and pencil) and which roles they should play (clarifier, interpreter, recorder). But they steer clear of the awkwardness of injecting oneself into the doctor-patient relationship. Now, however, these interpersonal difficulties are addressed head-on in a new guide from the United Hospital Fund of New York.
The Family Caregiver Guide to Doctor Visits draws on gerontologist Jennifer Wolff's research on "medical visit companions." It offers advice for three phases of an accompanied doctor visit:
Before the visit
The caregiver and aging adult should strategize about what they want to accomplish during their meeting with the physician: Are you seeking information about medication side effects or the outcomes of prescribed treatments? Do you plan to report new symptoms or concerns? Or is your goal merely to ask questions about general health and lifestyle issues?
Some of this previsit strategy session may amount to a negotiation about what the older person will and won't bring up, as well as how he or she will handle sensitive issues. The idea is to agree on the session's agenda as much as you can before arriving.
Generally, my mother and I talk during the car ride to the doctor's office about what we intend to raise with him. I go over what we will report from her recent appointments with her medical specialists and remind her of questions that have arisen since her last primary-care visit. We don't create a detailed script of how the session will run. We do, however, come up with a sort of game plan to guide us.
During the visit
The United Hospital Fund's Family Caregiver Guide suggests that caregivers and aging adults decide beforehand who will bring up which topic with the physician. It also suggests that caregivers help the physician better understand an aging adult's personality and state of mind. That may mean picking up on nonverbal cues and emotional reactions from the aging adult that the doctor might miss.
When I first started attending my mother's primary care and specialty medical visits, we met with doctors who would speak only to me, ignoring my mother. Understandably, that hurt her feelings and made her feel dismissed. Other physicians spoke only to her, practically ignoring my presence in the room; that hurt my feelings, and made me feel dismissed! So my mother and I reached an accommodation: I now attend the beginning of a session to share information that I think is important, then leave to sit in the waiting room. This gives my mother unmediated time alone with her doctor. Occasionally he'll invite me back into the exam room at the end of the visit so the three of us can review a change in her treatment plan.
After the visit
Caregivers and aging adults should compare notes after the medical appointment to see if each is satisfied with how the visit went. The caregiver should feel free to ask the aging adult for feedback: Does he or she think the caregiver did a good job? Spoke too much? Too little? In this way, The Family Caregiver Guide recommends, the two partners can improve their working relationship with each other — and with the physician.
Always striving to arrive at a common understanding, my mother and I often use the car ride home to review the physician's instructions and discuss any disagreements that arise. Sometimes, I have to admit, we wind up simply agreeing to disagree.
She still says she didn't fall. I persist in saying she did. We soldier on, together, from here.
Barry J. Jacobs, Psy.D is an AARP caregiving expert.
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