The unbiased reporting of symptoms to healthcare providers is essential for optimization of treatment and outcomes, as well as for the minimization of spending. For many patients, especially the elderly, communicating for effective health care is difficult. The elderly, who utilize healthcare services more than younger age groups, are often burdened with diminished mental skills, decades of doctor-patient relationships that discouraged communication, and fears associated with possible end-of-life health scenarios coloring their symptom reporting.
The elderly today grew up in a time when communicating with a healthcare provider was kept to a minimum (time is money). They were conditioned to accept all care decisions put forward by their doctors. Before the internet brought us easy access to medical information and health records, the patient had a limited ability to gain the knowledge necessary for communicating for effective health care. This situation is especially a problem with doctors who use medical jargon to discourage discussion.
Reporting symptoms accurately (an important aspect of patient- engagement), is extremely important. Without it, everything from insufficient care to too much care (i.e., over-testing, and over-treatment) is likely to happen. Trusted family members or patient advocates can help to fill any gaps in communicating for effective health care.
Communicating For Effective Health Care–A Couple of Insights
Communicating to uncover the truth with any person requires time, patience, and respectfully asking the right questions. Asking the right questions requires an understanding of the person’s motivations and concerns and should be done at different times and using different words to look for any inconsistencies in reporting. Developing an accurate and complete picture is a process over time and does not need to be burdensome.
I have learned over the years that asking healthcare questions that can be answered with yes or no responses will not uncover the true healthcare picture. As an educator working with students from foreign countries, I learned that many of these students will simply answer yes to questions when they do not understand the questions. The answer might be no, but these students did not want to reveal their lack of English language skills to me so they answered as if they understood the question. If I wanted to communicate effectively with them, I had to adjust my questions to take this into account.
With my 80+ year old mom (Donna), I don’t ask “Are your blood sugar numbers good?”, but rather “What was your blood sugar reading today?” I ask what she had for dinner today rather than “Are you eating a balanced diet?”. My questions are aimed at getting a more accurate picture of my mom’s health situation that her short descriptions don’t always reveal. In addition, I use our health care discussions to impart some up-to-date health and nutritional information (from the internet) that my mom does not get anywhere else.
By accompanying my mom to doctor’s appointments, I have learned that my mom does not communicate symptoms accurately and is easily manipulated to exaggerate her health situation. In the time-is-money atmosphere of most healthcare provider examination rooms, the shortest route to billable testing and treatments does not invite the communication for effective health care I described above. It is the rare healthcare provider who truly listens for the story behind the yes and no responses.
I am fortunate that my mom allows me to serve as her patient advocate when I am able. Not all elderly parents welcome a child’s intrusion in what they feel is private business. Many elderly parents are too proud to ask for help. Although I live far (1000 miles away) from my mom, I phone several times a week and I can sense tiredness, sadness, and when something is wrong in her voice. I have called her doctor directly to ask questions or give information. I relate any concerns with a brother who lives near my mom and together we watch out for her.
Example of Communicating For Effective Health Care
I just got back from visiting my mom and would like to share with you an example of the need for accurate communication in health care. Within hours of arriving at my mom’s house, my mom sat down next to me and, with a concerned look on her face, announced “I am bleeding from the rectum again”. I was initially shocked because I had just spoken to her on the phone before I got there and she sounded normal.
Rushing through my head were the events from three years earlier when my mom had a severe case of rectal bleeding. She had ended up in the hospital back then and spent five days while they evaluated her for the cause of her rectal bleeding. After a colonoscopy, two EKGs, and one chest xray, it was determined that the source of the rectal bleeding was a diverticular hemorrhage. The bleeding stopped by itself and my mom when home. My mom had also had other times when rectal bleeding was associated with her diverticula.
Sitting in my mom’s living room in the present, I processed her history of rectal bleeding through my mind. I asked my mom how much blood she saw and her answer, again with concerned eyes, was “a lot”. Earlier words from my gastroenterologist popped in my head as I looked on my mom’s concerned face “a teaspoonful of blood in the stool looks like you are dying”.
Our discussion continued and I discovered that my mom had no other symptoms apart from the blood in her stool so I questioned her recent diet for clues. I asked what my mom had been eating over the past day or two. I discovered that she had consumed a whole pound of strawberries, one of her favorite fruits. My mom was not aware of the connection between diverticular complications and seeds (strawberries are coated with them).
Even with her history of rectal bleeding from diverticula, my mom still thought that the bleeding could only be caused by the dreaded cancer (a disease she fears only second to stroke). I explained to her that colon cancer is a slow growing cancer, we have no family history of it, and her colonoscopy (in 2013) revealed no pre-cancerous polyps. Therefore, I assured her that the bleeding was not likely to be caused by cancer. At this point in our discussion, my mom’s face appeared more relaxed. As our discussion continued, my mom’s description of the amount of bleeding had diminished to “not that much”.
Because my mom had previously scheduled a doctor’s visit in two days time to arrange for a blood test, I told her that we would discuss her bleeding concerns with the doctor. In my next blog post, I will describe visiting the doctor.
The Bottom Line
Often burdened with diminished mental skills, decades of doctor-patient relationships that discouraged communication, and fears associated with possible end-of-life health scenarios coloring their symptom reporting, the elderly have difficulty communicating for effective health care. It is very easy for healthcare professionals in time-is-money medical practices to steer the elderly into unnecessary (and lucrative) over-testing and over-treatment.
The elderly need the help of family members (who know them best) or trusted patient advocates to fill any gaps when communicating for effective health care. This communication happens before, during, and after any encounters with the healthcare community. Patient advocates need to patiently listen, ask respectful questions, and afterward make sure the patient understands all that was said.
For those not yet in this age group (if you live long enough), you too may find yourself needing extra help in communicating your health care needs. Do you have a willing (and able) family member or patient advocate to help you out? How about visiting mom or dad and seeing if they are open to patient advocacy?