A man goes to the doctor. The doctor walks in and asks, "What's wrong?" The man replies, "You're the doctor. You tell me."
It's an old joke, but that's how many people still view their relationship with their physician. And the National Institute on Ageing (NIA) wants to change that notion, particularly for elderly patients.
"When doctors are trained, they're always told the most important information [about the patient] that they get is from the history, not from the physical exam or lab tests," says Dr Stanley Slater, NIA's deputy associate director for geriatrics. "Most diagnoses are made on the basis of talking to the patient, finding out what has happened, how they feel, health problems in the past and in their families. This is all based on communication."
That's gotten tougher in recent years as doctor visits have gotten shorter, Slater adds, so it's important for patients to prepare for an appointment by writing down the questions they need answered.
"Things move very quickly in medicine today," he says. "Making a list before you go in is very helpful."
For elderly patients, he says, the entire process starts with finding a doctor they can talk to about every aspect of their physical and emotional health. That includes such sensitive topics as sexuality, depression and incontinence.
"There are things that can be done, but doctors have to know about it to help you," Slater says. "Part of it is choosing a doctor who's interested in hearing you talk to him. Not every relationship works. You have to find a doctor you're comfortable talking to."
Dr Robert Warren, clinical assistant professor at Temple University School of Medicine and a specialist in geriatrics, says that because the doctor-patient partnership is so important, he encourages patients to keep looking until they find a doctor with whom they can speak freely.
"You should be involved in your individual health care," he says. "If you don't like your accountant, you get a new one. The same thing happens with a physician. You have to be comfortable with him."
The most common mistake patients make, he adds, is not asking questions.
"For every test done or medication prescribed, the patient has a right to understand why a test is performed or [why] they're on that medication," he says. "Don't be afraid to ask the physician as many questions as you need."
Sometimes, he adds, the issue is more forgetfulness than fear. That's why he encourages patients to bring a family member with them and write down their questions ahead of time.
"It's that stage fright," he says. "As soon as they're sitting in my office, they forget everything they wanted answered. Then there's a phone call later, but I can't follow up as well on the phone."
Having a spouse or adult child along helps because, like the old saying goes, two heads are better than one.
"I found that a husband-and-wife team ask more appropriate questions than the single person alone," Warren says.