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Seniors' Guide Closes In on Information Gap


My father is an incurably polite man. So it wasn't entirely surprising that when he went to a doctor for a checkup regarding a chronic condition, he neglected to mention a new, excruciating pain that had made it difficult for him to walk or lie down.

The fact that he entered the office on crutches seemed to have escaped the notice of the doctor, whose specialty, after all, was blood problems, not bone and nerve problems. The pain--which turned out to be related to his chronic condition--became so bad my father ended up spending the next day in the emergency room.

This kind of lack of communication is "a giant issue in health care," said Stanley Slater, deputy associate director for geriatrics at the National Institute on Aging, part of the National Institutes of Health. Pressures from managed care that reduce visits to 15 minutes, the constant turnover in doctors and health plans, and increased specialization make it hard for doctor and patient alike to have a conversation that will yield all the information each might need to exchange.

"You almost have to be like a lobbyist on television," Slater said. "You have your one sound bite to get your point across."

But the problem is especially acute among older patients, Slater said, who tend to have more health problems, take more medications and, like my father, may be from a generation that doesn't feel comfortable being pushy.

That's why the Institute on Aging came out with a booklet, Talking With Your Doctor: A Guide for Older People, Slater said. It is full of good advice for anyone seeing a doctor: "Be honest, stick to the point, ask questions and share your point of view," the guide says.

But the booklet also has sensible advice targeted to older people.

For instance, in getting ready for an appointment, don't forget your glasses or hearing aide, the guide says. If you have several concerns, write them down in order of priority. If you're seeing a new doctor, write down all your medications, or put all your prescription and over-the-counter medications, including vitamins and supplements, into a paper bag and bring them to the doctor.

If you're not sure you will be able to state your concerns adequately or to remember everything later, take notes or bring someone with you. The booklet also lays out the questions you might have about prescriptions, diagnostic tests, surgery or hospitalization.

And it gives guidance about how to broach subjects such as sexuality, incontinence, grief and depression, memory problems, care if there's a serious illness or what to do if you're unhappy with your doctor.

To get a copy of the booklet, you can call (800) 222-2225. The NIA also has fact sheets on many age-related issues; check out the Web site at

Some states and municipalities also offer such guidance. The New York City Department for the Aging, for instance, offers a "Health Record for Older New Yorkers."

The idea, explained the department's commissioner, Herbert Stupp, is to give elderly people a handy place to record health information when they visit the doctor or pharmacist.

Perhaps more important, such booklets, if displayed on the refrigerator, also give emergency medical workers immediate and vital information about what medical conditions or allergies he or she might have, medications and insurance information.

Amy Bernstein, director of the health insurance information and counseling assistance program in the department, worked hard to design one specific to the needs of New Yorkers.

Most to the point is Page 3, which includes a list of languages the person might speak. "This is especially important in immigrant communities," Stupp said.

With the booklet, emergency workers know something about the person's medical history and can immediately alert the hospital to have someone on hand to translate if needed.

"I'm absolutely convinced somewhere down the line it will save a life," Bernstein said.

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