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Can
I Really Talk About That?
Discussing Sensitive
Subjects
Much of the
communication between doctor and patient is personal. To have a good partnership
with your doctor, it is important to talk about sensitive subjects, like
sex or memory problems, even if you are embarrassed or uncomfortable.
Doctors are used to talking about personal matters and will try to ease
your discomfort. Keep in mind that these topics concern many older people.
For more information on the topics discussed below, see the resource list
at the end of this book.
It is important
to understand that problems with memory, depression, sexual function,
and incontinence are not normal parts of aging. If your doctor doesn't
take your concerns about these topics seriously or brushes them off as
being part of normal aging, you may want to consider looking for a new
doctor.
Sexuality--Most
health professionals now understand that sexuality remains important in
later life. If you are not satisfied with your sex life, don't automatically
assume it's due to your age. In addition to talking about age-related
changes, you can ask your doctor about the effects of an illness or a
disability on sexual function. Also, ask your doctor what influence medications
or surgery may have on your sexual life. If you aren't sure how to bring
the topic up, try saying, "I have a personal question I would like
to ask you..." or, "I understand that this condition can affect
my body in many ways. Will it affect my sex life at all?"
Incontinence--About
15 to 30 percent of older people living at home have problems controlling
their bladder--this is called urinary incontinence. Often, certain exercises
or other measures are helpful in correcting or improving the problem.
If you have trouble with control of your bladder or bowels, it is important
to let the doctor know. In many cases, incontinence is the result of a
treatable medical condition. When discussing incontinence with your doctor,
you may want to say something like, "Since my last visit there have
been several times that I couldn't control my bladder. I'm concerned,
because this has never happened to me before."
Grief, mourning,
and depression--As people grow older, they experience losses of significant
people in their lives, including spouses and cherished friends. A doctor
who knows about your losses is better able to understand how you are feeling.
He or she can make suggestions that may be helpful to you.
Although it
is normal to feel grief and mourning when you have a loss, later life
does not have to be a time of ongoing sadness. If you feel down all the
time or for more than a few weeks, let your doctor know. Also tell your
doctor about symptoms such as lack of energy, poor appetite, trouble sleeping,
or lack of interest in life. These could be signs of medical depression.
If you feel sad and withdrawn and are having trouble sleeping, give your
doctor a call. Depression can be a side effect of medications or a sign
of a medical condition that needs attention. It often can be treated successfully--but
only if your doctor knows about it.
Memory problems--One
of the greatest fears of older people is problems with their ability to
think and remember. For most older people, thinking and memory remain
good throughout the later years. If you seem to have problems remembering
recent events or thinking clearly, let your doctor know. Try to be specific
about the changes you have noticed; for example, "I've always been
able to balance my checkbook without any problems, but lately I'm finding
that I get very confused." The doctor will probably want you to undergo
a thorough checkup to see what might be causing your symptoms.
In many cases,
these symptoms are caused by a passing, treatable condition such as depression,
infection, or a side effect of medication. In other cases, the problem
may be Alzheimer's disease or a related condition that causes ongoing
loss of skills such as learning, thinking, and remembering. While there
currently is no way to determine for sure if a person has Alzheimer's
disease, a careful history, physical evaluation, and mental status examination
are still important. They help the doctor rule out any other, perhaps
treatable, causes of your symptoms and determine the best plan of care
for you.
An
advance directive is a document that allows you to state
your preferences about your care if you were to become too seriously
ill to make your wishes known. Examples of advance directives include
living wills and durable health care powers of attorney.
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Care in the
event of a serious illness--You may have some concerns or wishes
about your care if you become seriously ill. If you have questions
about what choices you have, ask your doctor. You can specify your
desires through documents called advance directives such as a living
will or durable power of attorney for health care. Advance directives
allow you to say what you'd prefer if you were too ill to make your
wishes known. In an advance directive you can name a family member
or other person to make decisions about your care if you aren't able.
In general,
the best time to talk with your doctor about these issues is when
you are still relatively healthy. If you are admitted to the hospital
or a nursing home, you will be asked if you have any advance directives.
If the doctor doesn't raise the topic, do so yourself. To make sure
that your wishes are carried out, write them down. You also should
talk with family members so that they understand your wishes.
Problems
with family--Even strong and loving families can have problems,
especially under the stress of illness. Although family problems
can be painful to discuss, talking about them can help your doctor
help you. Your doctor may be able to suggest steps to improve the
situation for you and other family members.
If you feel
you are being mistreated in some way, let your doctor know. Some
older people are subjected to abuse by family members or others.
Abuse can be physical, verbal, psychological, or even financial
in nature. Your doctor may be able to provide resources or referrals
to other services that can help you if you are being mistreated.
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Feeling
unhappy with your doctor--Misunderstandings
can come up in any relationship, including between a patient and his or
her doctor. If you feel uncomfortable with something your doctor or the
doctor's staff has said or done, be direct. For example, if the doctor does
not return your telephone calls, you may want to say something like, "I
realize that you care for a lot of patient and are very busy, but I feel
frustrated when I have to wait for days for you to return my call. Is there
a way we can work together to improve this?" Being honest is much better
for your health than avoiding the doctor. If you have a long-standing relationship
with your doctor, working out the problem may be more useful than looking
for a new doctor.
Summary
If you have
questions or worries about a subject that your doctor does not talk about
with you, bring them up yourself. Practice with family or friends what
you will tell or ask the doctor. If there are brochures or pamphlets about
the subject in the doctor's waiting room, use them as a way to begin to
talk. Talking with your doctor about sensitive subjects is important .
Although talking about these subjects may be awkward for both you and
your doctor, don't avoid it. If you feel the doctor doesn't take your
concerns seriously, remember that you can always change doctors.
Who
Else Will Help?
Involving Your
Family and Friends
It can be helpful
to take a family member or friend with you when you go to the doctor's
office. You may feel more confident if someone else is with you. Also,
a friend or relative can help you remember what you planned to tell or
ask the doctor. He or she also can help you remember what the doctor says.
But don't let your companion take too strong a role. The visit is between
you and the doctor. You may want some time alone with the doctor to discuss
personal matters. For best results, let your companion know in advance
how he or she can be most helpful.
If a relative
or friend helps with your care at home, having that person along when
you visit the doctor may be useful. In addition to the questions you have,
your caregiver may have concerns he or she wants to discuss with the doctor.
Some things caregivers may find especially helpful to discuss are: what
to expect in the future, sources of information and support, community
services, and ways they can maintain their own well-being.
Even if a family
member or friend can't go with you to your appointment, he or she can
still help. For example, the person can serve as your sounding board,
helping you to practice what you want to say to the doctor before the
visit. And after the visit, talking about what the doctor said can remind
you about the important points and help you come up with questions to
ask next time.
What's
Next?
Some Closing
Thoughts
Good health
care always depends on good communication with your doctor and other health
professionals. We hope this book will help you take an active role in
your health care.
If you have
suggestions to add to future editions of this book or other ideas for
making it more helpful, please write to Freddi Karp, Editor, National
Institute on Aging, Public Information Office, Building 31, Room 5C27,
31 Center Drive MSC 2292, Bethesda, MD 20892-2292.
Getting
More Information
You can make
the best of your time with your doctor by being informed. This often includes
drawing on other sources of health information such as home medical guides,
books and articles available at libraries, organizations such as the American
Heart Association and the Arthritis Foundation, other institutes within
the National Institutes of Health, and self-help groups.
The National
Institute on Aging (NIA) has information about a variety of issues related
to aging, including menopause, incontinence, and pneumonia. Large-print
Age Pages are available on topics such as depression, stroke, safe use
of medications, and types of doctors you may see.
To order publications
or to request a publications list, call the NIA Information Center at
1-800-222-2225; TTY 1-800-222-4225. You also may want to encourage
your doctor to order these publications for his or her office.
For a fact sheet
and other publications about Alzheimer's disease, contact the NIA Alzheimer's
Disease Education and Referral (ADEAR) Center at 1-800-438-4380.
| Additional
Resources
Sexuality
Sexuality Information
and Education Council of the United States
Suite 2500
130 West 42nd Street
New York, NY 10036
1-212-819-9770
Incontinence
Help for Incontinent
People (HIP)
P.O. Box 544
Union, SC 29379
1-800-BLADDER
The Simon Foundation
P.O. Box 835
Wilmette, IL 60091
1-800-237-4666
Grief,
Mourning, and Depression
NIMH Depression
Awareness, Recognition and Treatment Program
Room 10-85
5600 Fishers Lane
Rockville, MD 20857
1-800-421-4211
Memory
Problems
Alzheimer's
Association
Suite 1000
919 North Michigan Avenue
Chicago, IL 60611
1-800-272-3900
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Alzheimer's
Disease Education and Referral (ADEAR) Center
P.O. Box 8250
Silver Spring, MD 20907-8250
1-800-438-4380
National Stroke
Association
Suite 1000
8480 East Orchard Road
Englewood, CO 80111-5015
1-800-367-1990
Care
in the Event of a Terminal Illness
National Hospice
Organization
Suite 901
1901 North Moore Street
Arlington, VA 22209
1-800-658-8898
Problems
With Family
Children of
Aging Parents
Suite 302-A
1609 Woodbourne Road
Levittown, PA 19057-1511
1-215-945-6900
Eldercare Locator
Service
Suite 100
1112 16th Street NW
Washington, DC 20036
1-800-677-1116
National Center
on Elder Abuse
Suite 500
810 First Street NE
Washington, DC 20002
1-202-682-2470
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