Understanding your patient is as important as understanding your specialty. Working with older adults presents rewards and challenges unique to their demographic. They have numerous ailments and medications, see several specialists, and are reluctant to share much. They will want to know everything or be afraid to ask anything. They watch Dr. Oz and enlist WebMD to diagnose their condition and come up with a few new ones. And they want a pill with no side effects that’s covered by Medicare to cure them. Don’t even suggest a lifestyle change or they won’t come back. Why do they do that and how do you work around it?
Put them at ease as soon as they walk in the door. Make sure your staff is welcoming and the waiting room is comfortable. Forget Sports Illustrated and Family Circle. They are rarely interested in overpaid athletes or recipes for Halloween. A newspaper, Fox news or a game show on TV and an accessible bathroom are key. Don’t think getting them out of the waiting room and into an examining room to wait alone for another 40 minutes is going to make them feel better. It will irritate them more.
Be present in your appointment. Ask questions about their symptoms if they don’t know where to start. They may tell you every symptom they’ve had in the past year or they may neglect to tell you something because they don’t think it’s relevant. Find out if they have a medical background or if they’ve cared for a sick spouse or parent. Either of those situations may greatly influence what they share with you. Ask about their home situation. Help them understand what you’re looking for and how they can help you help them. If you’re a specialist, don’t ask them why their doctor sent you there. If information wasn’t provided with the referral, ask their doctor before you see them. If you’ve ever accompanied a parent to a specialist to have the doctor impatiently declare they don’t know why they were referred then hand them a bill for the hour in the waiting room and five minutes of distracted consultation, you’ll know why this is important.
Encourage family involvement. Strongly suggest they talk with their children or siblings about what is going on with them. Some are reluctant to talk with family out of fear, concern or difficult relationships. Unfortunately, when the time comes when they can’t manage on their own, it becomes very difficult to help them because they haven’t trusted anyone with information, power of attorney, or personal wishes. Secrecy and lack of trust will hurt them in the end. Sharing the burden with a loved one will help them make good choices.
Ask if they understand what you’ve discussed. Provide a plan and options for when they leave. Make sure they have an understanding of their condition, treatment options, potential outcomes, responsibilities and support. Older adults don’t make changes easily. They often need direction and access to outside resources (family, transportation, education, caregivers, support) to accommodate a safer or healthier environment. Offer resources to help them. It shows you understand and care about them. Most importantly it will build trust.
