FROM THE PHYSICIANS INSURANCE BLOG
www.phyins.com/taking-care
Patty could tell that something seemed different about Frank. As they walked their favorite trail around the lake, she noticed that her father was moving more slowly and he seemed to be running out of breath faster than she had remembered. The buttons on his shirt seemed to be slightly strained, as if he had gained weight in his stomach, and he complained about having eaten something that must have disagreed with him.
“Have you seen Dr. Jones recently?” she asked her father. Her father scowled. “I had an appointment last week. But you know how it is with these young kids—in and out and here’s a bunch of pills. I’m just getting old.” Patty frowned. “He prescribed medication? For what?”
“I don’t know,” Frank said, shrugging his shoulders. “He talks too fast. All those big words. They make no sense.” He spied a nearby bench. “Can we sit down for a bit? I’m so tired.” Worried, Patty sat with her father, and they watched the ducks without speaking.
A week later, Patty received a call from the hospital. Her father was in the emergency room and appeared to have had a heart attack. As she drove to the hospital, thoughts swirled in her head. What had gone wrong? Did the doctor miss a diagnosis? Had her father misunderstood the doctor’s instructions? Most importantly, what could have been done to change this?
WHAT COMES TO MIND WHEN YOU THINK OF YOUR ELDERLY PATIENTS?
You might imagine fragile people who have thin white hair and are hard of hearing. Perhaps their minds have begun to slip, and their memories aren’t what they once were. Maybe they walk with canes or walkers. You might think first of the health complaints that become more common as people age—congestive heart failure, osteoporosis, arthritis, and dementia. Do you bring these images to work with you? You might be inadvertently stereotyping your patients, forcing them to fit a mold they don’t necessarily belong in. It’s crucial to remember that each patient—including each elderly patient—is different and has different goals, different health concerns, and different needs.
Research has shown that patients who feel like they have a relationship with their health-care provider are less likely to bring a lawsuit if a mistake is made or things go wrong. In today’s health-care model, patient satisfaction is absolutely crucial. Building relationships with your patients—including your elderly patients—can be challenging, but the payoffs are immeasurable and include improved health outcomes and happier patients.
IT MIGHT BE HELPFUL TO TAKE A STEP BACK AND CONSIDER WHAT YOUR OLDER PATIENTS EXPECT FROM THEIR HEALTHCARE PROVIDERS.
Many of these patients grew up with family doctors who provided care for each member of the family and were an active part of the community. They took their time getting to know their patients and may have even made house calls.
Over the years, the medical model has changed considerably. Many providers feel forced into spending less and less time with their patients, and the provider-patient relationship sometimes gets pushed aside because of the limitations imposed by third-party billing and the need to see a large number of patients every day.
But now the pendulum has begun to swing back in the other direction. We’re recognizing (again) the value of provider-patient relationships and the importance of taking the time to connect with and understand your patient. For your older patients, it may feel like coming back full circle, and it’s important to honor that. While every elderly person has different needs, there are some concerns that, statistically, are more frequent in the elderly. For instance:
- Only 3% of adults ages 65 and over are considered proficient in health literacy, according to the National Assessment of Adult Literacy. Research has also connected lower health literacy with poorer physical and mental health.
- 12.7% of adults ages 60 or over report increased confusion or memory loss.
- Approximately half of all adults ages 65 and over report that they have been diagnosed with arthritis.
- Nearly half of Americans ages 65 and over have at least one major eye impairment. Visual impairment often leads to other concerns, including increased risk of fall and fracture, increased risk of depression, difficulty identifying medications, and difficulty participating in daily activities such as bathing and dressing.
- More than 80% of those diagnosed with lung cancer are over the age of 60, and COPD prevalence in those ages 65 and over is estimated to be 14.2%.
These concerns may require you to adapt your conversation style. For instance, a patient with low health literacy will require explanation of health conditions and medications, along with explanations of why and how things happen. Jargon will confuse this patient, and some patients may not admit to their confusion. A patient with hearing loss may require you to speak louder and more slowly or to write down instructions clearly (or type if your handwriting is hard to decipher). Patients with confusion or memory loss will also benefit from written instructions, and it may be helpful to ask them to bring someone else along, an adult child for instance, who can answer your questions more fully and help them remember your instructions. A person with lung disease may speak quietly, be difficult to understand, or become exhausted from a lot of speaking. It’s important to be patient and allow them to tell their story on their terms. What other steps can your office take to connect with your elderly patients? You may find that these steps go over well with all your patients, not just the older ones!
1. Train your team
Before you even come into contact with each patient, they will have already met with several members of your team—your front desk, a medical assistant, and perhaps an RN. What impression is your team making? Are they being compassionate to the needs of your patient, or are their own biases showing? Problems interacting with the team may cause the patient to be less, well, patient, and will feel misunderstood before you even begin speaking.
2. Schedule extra time and avoid interruptions
Your patient may need more time to tell his or her story or you might need more time for explanation and instruction. Either way, allow more time for the appointment and train your team not to interrupt you when you are with patients. This will help you communicate more effectively and build a patient-provider relationship.
3. Use decision aids such as anatomy models, images, and written instructions
Make your discussion as memorable as possible by using decision aids to help explain. A model of a mobile joint, an image of the circulatory system, and instructions that are printed in a larger size font will go a long way toward increasing patient understanding and improving compliance.
4. Check your nonverbal communication
Speaking is only one aspect of communication. What is your body saying to your patients? You might think you’re ready to listen to your patients’ concerns, but if you are looking at a computer screen, checking the clock on the wall, or sitting in a closed-off position, your patients may pick up on the fact that you are feeling impatient. They may feel like they are bothering you and will be less likely to share important information.
5. Document your communication
Make sure that your chart notes include the communication you had with your patient—everything from the patient’s health history to the instructions you gave and the medication you prescribed. Let’s go back to Patty and Frank. What happened at Frank’s appointment with Dr. Jones that could have been done differently? Listen to what Frank had to say: “You know how it is with these young kids—in and out and here’s a bunch of pills.”
It’s clear that Dr. Jones missed an opportunity. Frank did not feel valued or listened to. He felt rushed and didn’t feel comfortable expressing his discomfort. He was provided with a prescription for medications, and he didn’t understand why he needed them. “He talks too fast. All those big words. They make no sense.”
Dr. Jones likely hit Frank hard with a lot of jargon. Frank may also be having hearing difficulties, but Dr. Jones didn’t take a moment to find out. His rapid-fire speech delivery likely frustrated Frank.
Simply by slowing down the appointment, checking to see if Frank was understanding, and discussing the diagnosis and recommended medication, an unfortunate outcome might have been prevented.
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References
1 Mark Kutner, Elizabeth Greenberg, Ying Jin, and Christine Paulsen, The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy, National Center for Educational Statistics, September 2006, accessed June 30, 2016, https://nces.ed.gov/pubs2006/2006483.pdf.
2 Michael S. Wolf, Julie A. Gazmararian, and David W. Baker, “Health Literacy and Functional Health Status Among Older Adults,” Archives of Internal Medicine, vol. 165, no. 17, September 26, 2005, 1946–1952, accessed June 30, 2016, doi: 10.1001/archinte.165.17.1946.
3 Mary L. Adams, Angela A. Deokar, Lynda A. Anderson, and Valerie J. Edwards, “Self-Reported Increased Confusion or Memory Loss and Associated Functional Difficulties among Adults Aged ≥60 Years—21 States, 2011,” Morbidity and Mortality Weekly Report, vol. 62, no. 16, May 10, 2013, 347–350, accessed June 30, 2016, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6218a1.htm.
4 Kamil E. Barbour, Charles G. Helmick, Kristina A. Theis, Louise B. Murphy, Jennifer M. Hootman, et al., “Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation—United States, 2010–2013,” Morbidity and Mortality Weekly Report, vol. 62, no. 44, November 8, 2013, 869–873, accessed June 30, 2016, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6244a1.htm?s_cid=mm6244a1_w.
5 Paul P. Lee, Zachary W. Feldman, Jan Ostermann, Derek S. Brown, and Frank A. Sloan, “Longitudinal Prevalence of Major Eye Diseases,” Archives of Opthalmology, vol. 121, no. 9, September 1, 2003, 1303–1310, accessed June 30, 2016, doi:10.1001/archopht.121.9.1303.
6 N. Howlader, A. M. Noone, M. Krapcho, J. Garshell, D. Miller, S. F. Altekruse, et al., (eds), SEER Cancer Statistics Review, 1975–2013, (Bethesda, MD: National Cancer Institute), accessed June 30, 2016, http://seer.cancer.gov/csr/1975_2013/, based on November 2015 SEER data submission, posted to the SEER website, April 2016.
7 Nicola A. Hanania, Gulshan Sharma, and Armin Sharafkhaneh, “COPD in the Elderly Patient,” Seminars in Respiratory and Critical Care Medicine, vol. 31, no. 5, 2010, 596–606, accessed June 30, 2016, http://www.medscape.com/viewarticle/730813.