Communicating Effectively with Health Care Providers Finger Lakes Geriatric Education Center Communicating Effectively with Health Care Providers Welcome and thank you for coming. Introduce yourself. Depending on size of group, ask participants to introduce themselves. If it is of interest, distribute the pre-workshop questionnaire and ask participants to take a few moments to complete the form.

Health Literacy: A Universal Problem Only 12% of adults are proficient in understanding health information 12% Proficient We are not alone. Everyone struggles with health information sometimes. In fact, only 12% of adult English speaking Americans are truly proficient in understanding health information according to a study done by the U.S. Department of Education in 2003. This study is only done every 10 years. Or in other words more than 1/3 of adult English speaking Americans are at basic or below basic health literacy skills. This is not hard to believe when you think about it. Think of a time when you or someone you know has had trouble understanding something important to their health. What about trying to fill out Medicare applications, knowing if you should get the flu shot or the H1N1 shot, or what about learning that you have a heart condition? To learn more about the study referenced go to http://www.nifl.gov/webcasts/NAAL2003.html or http://nces.ed.gov/naal/ Source: National Assessment of Adult Literacy (NAAL), U.S. Department of Education, 2003

Why are We at Risk? Reliance on the written word for patient instruction Increasingly complex healthcare system More medications More tests and procedures Growing self-care requirements Esoteric language Why are we/patients at risk? The health care industry relies heavily on the written word for health communication. Patients are handed information as they leave a doctor’s office, health plan information is mailed out, and waiting rooms are often filled with brochures. The average American reads at an 8th grade level, yet health information is often communicated at a 12th grade level or even higher. This creates a disconnect between the information and those who need it most. And the health care system isn’t getting any easier. There are more medications, tests, and procedures. Patients are given more options and expected to be able to choose the best one for them. Patients are expected to do more on their own, to be able to take care of things at home – self-care requirements. In terms of patient education, 35 years ago a new diabetic patient would have been hospitalized for 3 weeks and would have received 2 hours of patient education a day. So by the time they were discharged, they would have received about 15 classes or 30 hours of instruction before leaving the hospital. Now new patients with diabetes are treated as outpatients with limited instruction before returning home. Finally, the language of health care is esoteric. Does anyone know what this means? Give them a few seconds to think about it. Esoteric actually means mysterious - confined to and understandable by only an enlightened inner circle, intended for understanding by only a particular group, not publicly disclosed. Think about words used in health care: angioplasty, endocrinologist, hypertension, analgesic, prn, bid, glucometer….and we could go on.

#1: Ask Questions What Can You Do? So, what can you do as a patient? One of the best things that you can do is to ask questions!

Questions Are the Answer ? Have you asked your doctor a question and not understood the answer? Have you stopped yourself from asking a question because you were embarrassed or scared? Have you ever asked you doctor a question and not understood the answer? You may want to allow for a few minutes of discussion. Or have you ever stopped yourself from asking a question because you were embarrassed or scared or just didn’t feel like you could ask? Again, you may want to allow for a few minutes of discussion. Have you ever felt like the people in the commercials? I know I have. These people definitely know how to ask questions, so why do you think they aren’t asking questions at their doctor visits? Asking questions is key to good communication with your doctor. If you don't ask questions, your doctor may think you do not need or want more information. Asking questions helps your doctor know what is important to you. It also lets your doctor know when something he or she says is unclear.

Questions Are the Answer Asking questions helps put you in charge of your health care Asking questions helps put you in charge of your health care. There are many types of questions you may want to ask your doctor. For example, you can ask questions when you do not know the meaning or spelling of a word, like aneurysm or infarct. This will help you find additional information. Also, it is important to ask questions when instructions are not clear. For example, what does taking medicine with food mean -- before, during, or after a meal? NO question is too stupid or unimportant to ask. Asking questions now can help you avoid confusion and problems in the future. When you leave the doctor’s office, all of your questions should be answered.

Did You Get a Prescription? Ask… What is the name of the medicine? How do you spell the name? Can I take a generic version? What is the medicine for? How am I supposed to take it? When should I take it? How long do I need to take it? Can I stop taking it if I feel better? What are the side effects? Here are some examples of lists of questions to ask when you get a new medicine. Go through the list of questions. You might find the information below helpful as you review this slide. Asking Questions - Asking About Your Medications Your doctor may prescribe a medicine for your health problem. Make sure you know the name and spelling of the drug and understand why your doctor wants you to take it. Ask your doctor to write down how often and for how long you should take it. If you will need to get more of the medicine once you have used it up, ask how to get the medicine refilled. It is important to ask your doctor what changes you need to make when taking the medication. For instance, ask "Are there foods, drinks, other medications, or activities I should avoid while taking this medication?" Many medicines have special instructions for how to take them. For example, there may be a certain time of the day that you should take the medicine. You may want to ask your doctor, "Should I take my medicine at meals or between meals?" and "Do I need to take the medicine on an empty stomach or with food or a whole glass of water?" Also, ask your doctor what you should do if you forget to take your medicine and miss a dose. Sometimes medicines affect older people differently than younger people. You may want to ask when the medicine will begin to work. Also, ask your doctor what are common side effects or unwanted feelings or symptoms you may have while taking the medicine. Let your doctor know if the medicine does not seem to be working or is causing you problems. If you want to stop taking a medicine, check with your doctor first. Call to let your primary doctor know as soon as possible if another doctor prescribes a medication for you. Also, call to check with your doctor before taking any over-the-counter medications. It may be helpful to keep a list of all the prescription and over-the-counter medicines you take and when you take them. Your pharmacist also can help answer your questions about medications, including what the label on the medicine bottle means. Also, if asked, your pharmacist can put your medicines in easy-to-open containers and may be able to use large-print labels. Because the pharmacy keeps a record of the prescription medications you get there, it may be helpful to get all your prescriptions from the same pharmacy. That way, they have a complete record of all your prescription medicines.

Did Your Doctor Suggest Surgery? Ask… Why do I need the surgery? What kind of surgery do I need? What will you be doing? What are the benefits and risks? Have you done this surgery before? How successful is this surgery? Different situations require different questions. Here are some questions to help you know more about a surgery that your doctor may have suggested. Again, go through the list of questions. You can go to www.ahrq.gov/questionsaretheanswer to find a tool to help you create your own question list. You might want to have copies of one of the Questions Are the Answer brochures or something that has the website URL on it to pass out to participants.

#2: Be Prepared What Can You Do? Another very important piece to making the most of the time you have with your doctor, nurse or otherihealth provider is to be prepared.

Create a Visit Plan Medicines Symptoms Lifestyle Changes / Life Events Concerns Questions My visit plan… Creating a visit plan will help you stay on track and keep you organized during your appointment. Write down your visit plan and bring it with you to your appointment. Your visit plan can also help you remember information that is important for your doctor to know. There are several parts to a thorough visit plan and we will go through them in detail.

Make a List of All Your Medicines Prescription medicine Over-the-counter medicine Vitamins Herbal supplements Include… What you take How much How often What it is for Medication allergies and any bad side effects you have had Make a list of ALL the medicines you take. You might as participants to give examples of the different types of medicines below. It is important to help them understand that all of these types count as medicines and need to shared with their doctor. Prescription medicine (medicine you get from a doctor) Over-the-counter medicine (like cold medicine, pain killers, acid reducers, tums) Vitamins (calcium, multi-vitamins) Herbal supplements (ginko, fish oil, St. Johns Wort) Include what you take, how much you take, how often you take and why you take it. Tell them about any drug allergies you have.

Make a List of All Your Symptoms Physical Thoughts & Feelings Include… What the symptom is When it started When it happens How long it lasts How often if happens If anything helps or makes it worse Make a list of all your symptoms. You might keep a notebook out during the day to write down the details. Think about both your physical symptoms such as pain, fever, a lump, weight change, energy level change, sleeping problems, as well as any thoughts or feeling type symptoms such as if you feel confused, sad or irritated. Writing these down before the visit really does help you when they ask about your symptoms. There is nothing wrong with looking at your notes when you talk with your doctor.

Don’t Forget Lifestyle and Life Events List any assistive devices Things that help you see, hear, stand, balance, and get around Lifestyle changes Changes in activities, ability to function or do things Life events Retirement, death of a loved one, moving, financial change Lifestyle Tobacco use, alcohol consumption, social activities, physical activity To provide the best care, your doctor must understand you as a person and know what your life is like. So, don’t forget about lifestyle and life events. These can take a toll on us even if we are feeling well. Let your doctor know: If you use any assistive devices (things that help you see, hear, stand, balance, get around) If you’ve had any changes in activities or your ability to do things, If you’ve had any big events in your life such as you recently retired, or moved or had a financial change. Also, be sure to include things like if you smoke or drink alcohol, and how active you are.

Write Down Concerns & Questions Remember to bring along your question list Rank your list of concerns & questions Talk about the most important ones first Finally, take some time to think about what questions you have. Write down any concerns then rank them and make sure you talk about the most important ones first! You can use the question tool we just talked about to help get you started on your list of questions. Remember questions are the key to you and your doctor understanding each other.

#3: Be Open and Honest What Can You Do? It is also important that you be open and honest, both when writing down your visit plan and when you are in the office.

Be Open and Honest Do not just say what you think the doctor wants to hear The doctor cannot help you if you do not talk about what is going on You may want to say what you think your doctor wants to hear, like you are smoking less or eating healthier foods. My favorite is when I go to the dentist and they ask me if I’m flossing…. It took me years to fess up and admit that I hate to floss. It is important to tell your doctor the truth, even if you feel it is embarrassing. Your doctor can best help you only when he or she knows that is really going on.

Sensitive Topics Driving Incontinence Alcohol Use Sexuality Grief and Depression Family Problems It is important for you to discuss sensitive topics with your doctor because they can affect your health. Sensitive health issues, like sexual problems or memory loss, concern many older people, but they are not just normal parts of aging. Again, you may find some of these topics embarrassing, but remember, your doctor is used to talking about personal matters. Below is some information to help you if you want to highlight any of the sensitive topics in the list. If discussion arises, give them a few minutes to share. Alcohol - Anyone at any age can have a drinking problem. As the body ages, alcohol can have a greater effect. Someone whose drinking habits have not changed may find over time that he or she has a problem. Also, people should not drink when taking certain medications. Tell your doctor if: alcohol is affecting you differently; you are drinking more than usual; you feel like you want to drink alcohol earlier and earlier in the day; it is hard to stop after one or two drink; you use alcohol to help cope with sadness. Falling or fear of falling - A fall can cause injury and short- or long-term loss of independence. It is normal to fear falling, but you do not want to let your fear affect your daily activities. You can talk to your doctor about things you can do to lessen your chances of falling, such as exercises to improve balance and strength. Driving - Driving is an important part of everyday life for many people. Deciding to stop driving can be hard. Tell your doctor if you or people close to you are worried about your driving and why. Your doctor can see if there are health problems that may be affecting your driving. Vision and memory tests are important. Your doctor may also know of a driver's education refresher class for older drivers. Grief, mourning, and depression - As people grow older, they may lose friends and family to death or illness. Also, sometimes older adults have to move away from home or cannot do a favorite activity anymore. Talking to your doctor about these types of events can help him or her suggest things to help you cope with the losses. It is normal to feel sad and mourn when you have a loss. However, tell your doctor if you feel sad all the time or for more than a few weeks. Also, tell your doctor if you have less energy, are not hungry, have trouble sleeping, or have little interest in life. These could be signs of depression, a health problem that your doctor can help you with. Sexuality - Most doctors understand that sexuality remains important in later life. If you are not happy with your sex life, do not just assume it is due to your age. Talk to your doctor about this issue. You can also ask your doctor about how a health problem, medication, or surgery may change your sexual function. Sexually transmitted diseases - Practicing safe sex is important at any age. The death of a spouse, divorce, or separation can lead some older people to date again and possibly have sex with a new partner. Your doctor can discuss with you how safe sex can reduce your risk of sexually transmitted diseases such as HIV/AIDS. Incontinence - Older people sometimes have problems making it to the bathroom. Problems controlling your bladder or bowel are called incontinence and it can often be treated. Your doctor may suggest exercises, ways to change your bathroom habits, medications, or surgery to help with this problem. Memory problems - Many older adults worry about not being able to think and remember as well as they did when they were younger. For most older adults, these abilities do not change too much with age. Let your doctor know if you have been confused or have problems remembering recent events. Be specific about the changes you have noticed. This will help your doctor find the cause for these problems. Problems with family - Even strong and loving families can have problems because of stress caused by illness. It can be painful to talk about family problems, but if your doctor knows about them, he or she may be able to help you and your family. Talk to your doctor if you think you are being mistreated or neglected by a family member or caregiver. Abuse can be physical, verbal, mental, or even financial. Your doctor can help you get help if you are being mistreated. Feeling unhappy with your doctor - Sometimes people become unhappy with their doctor. You may feel upset by something your doctor or the doctor's staff has said or done. Do not avoid your doctor. Be honest with him or her about your feelings so that you both can work out the problem. Falling or Fear of Falling Memory Problems

#4: Make Sure You Understand What Can You Do? You are the only one who can determine if you understand the information your doctor is giving you, so make sure you do understand before you leave the doctor’s office.

Practice in Front of Your Doctor “What I hear, I forget; what I see, I remember; but what I do I understand.” ~ Confucius in 451 B.C. We remember: 10% of what we read 20% of what we hear 30% of what we see 50% of what we see and hear 80% of what we say 90% of what we say and apply

Make Sure You Understand Always ask about anything that is unclear Repeat what your doctor says in your own words Take notes Bring a friend If you still don’t understand, ask again! Be an effective listener. Pay attention to what the doctor is saying. Always ask about anything that is unclear. Repeat what your doctor tells you in your own words to make sure you understand what he or she is saying. For example, say something like “As I understand it…” or “So what you’re saying is…” or “In other words…” Or “You want me to do…”. Don’t be embarrassed and don’t worry about appearing confused. Your doctor wants to help you understand. Sometimes it can be helpful to take notes during your appointment. Doctors and nurses give a lot of instructions and it is hard to remember everything. You can also ask your doctor to write things down for you or put them in your after visit summary if your clinic does that. Brining a friend can also help you feel more empowered to ask questions and help you remember what the doctor said. And always remember. If you still don’t understand. Ask again!

#5: Know the Answer to Three Questions What Can You Do? #5: Know the Answer to Three Questions And finally, know the answer to 3 simple, but important questions by the end of your visit.

Know the Answer to 3 Questions Why is it Important for Me to Do This? What Is My Main Problem? What Do I Need to Do? Why is it Important for Me to Do This? The 3 questions are: What is my main problem? (helps you understand your diagnosis, what’s wrong) What do I need to do? (helps you know what the treatment is, what do you need to do) Why is it important for me to do this? (helps you know why it’s important for you….not everyone else) If you find that you can’t answer one of these questions, ask your doctor to answer it before you leave the office. Sometimes doctors try to answer the questions, but don’t use words that we as patients really understand. For example…. Diagnosis Treatment Context

Ask Me 3 Example Let’s see if we’d be able to answer the questions after this visit with our doctor. Read slide The Doctor Says…. “Your LDL is elevated and your HDL is lower than we would like. You need to cut back on saturated fatty acids and trans fats and begin an exercise regimen.”

Do You Know the Answer to… What is my main problem? Answer: High Cholesterol Do you know how to answer the first question? What’s my main problem? If yes, that’s great! If not, what do we need to do to get the answer? You could just ask, so what is my main problem? Your doctor might explain “You have high cholesterol. Cholesterol is found in our diet and made by our liver.  It is important for many functions in our body.  High levels of cholesterol can lead to a heart attack or stroke. Now can you answer the question? Yes, you’re main problem is high cholesterol.

Do You Know the Answer to… What do I need to do? Answer: Watch what I eat, stay away from fatty foods and be more active What about the second question? What do I need to do? If you’re like me, I’m struggling to even remember what the doctor said at this point. So, I think I’d need to ask again. So doctor, what do I need to do? Your doctor might explain “Foods from animals such as meat, eggs and cheese contain cholesterol. Since cholesterol is in all foods from animals, you should try to eat no more than six ounces of lean meat, fish and poultry a day and to use fat-free and low-fat milk products. You should also start to think about being more active. These steps can help lower your cholesterol” Again, we could make this simpler and say that “I need to watch what I eat, stay away from fatty foods and be more active”

Do You Know the Answer to… Why is it important for me to do this? Answer: Having high cholesterol can lead to problems with my heart What about the third question? I don’t remember the doctor even mentioning why it was important for you to follow her instructions? This is a critical component of us being motivated as patients to follow through with treatment. We need to understand why so that we really want to do it. So, ask again… Doctor, why is it important for me to do this? The doctor will explain that having high cholesterol can cause problems with your heart and may lead to a heart attack or a stroke. Ok, so it’s important because having high cholesterol can lead to problems with my heart.

Why is it Important for Me to Do This? What Are the 3 Questions? What Is My Main Problem? What Do I Need to Do? Why is it Important for Me to Do This? Remember, it is important for you to be able to answer these 3 questions before you leave your doctor’s visit. These questions also remind me of what family members ask after I come back from the doctor. How many of you have had a son or daughter ask you similar questions once you got home from your visit? Give a little time for discussion if you can. Diagnosis Treatment Context

After Your Visit Review what you need to do Tell a friend or family member what the doctor told you Follow through with any instructions you received Know where to go if you have questions or want more information After your visit, take a minute to review what you need to do. Talk to a friend or family member about what the doctor told you. Follow through with your treatment plan and get and take your medicine. Also, know where to go if you have questions or want more information. (such as a clinic nurse line or website).

For More Information Additional information about talking with your health care providers can be found at: NIH Senior Health:  Talking with Your Doctor   https://www.nih.gov/institutes-nih/nih-office-director/office-communications-public-liaison/clear-communication/talking-your-doctor American Medical Association Guide to Talking to Your Doctor Check it out at your local public library! A lot of the information provided in this workshop was taken from the NIH Senior Health Talking with Your Doctor website and the American Medical Association Guide to Talking with your Doctor, which can be found at most public libraries. I highly recommend both of these resources if you want to learn more about communicating effectively with your health care provider. You can also find some good ways to prepare for your doctors visits at these websites

Questions? I believe we have some time for questions. After hearing all of this information what questions do you have?

“Understanding is a two-way street.” Eleanor Roosevelt Remind them of your contact information or a place where they can learn more or ask more questions. If relevant, ask participants to fill out the post-workshop questionnaire. Thank you.

more information, see: http://creativecommons.org/licenses/by-sa/3.0 HeLP NY Seniors is brought to you in partnership with the University of Minnesota Health Sciences Libraries and the Minnesota Health Literacy Partnership. Funding was provided through a subcontract from the National Library of Medicine National Network of Libraries of Medicine under contract number N01-LM-6-3503. HeLP NY Seniors is made possible through grant funding from the Health Resources and Services Administration (HRSA) Geriatric Workforce Enhancement Program Grant # U1QHP28738 This work is protected by an Attribution Share Alike (cc by-sa) license. Under this license, others are able to remix, tweak, and build upon the original work even for commercial reasons, as long the original source is cited and derivative works are licensed under identical terms. For more information, see: http://creativecommons.org/licenses/by-sa/3.0 Feel free to read slide or simply have it displayed at the end of the presentation.