Changing the Subject
Difficult but Necessary Conversations
Much of the communication between a doctor and a patient is personal. To have a good partnership with your doctor, it is important to talk about difficult subjects like sex or memory problems, even if you are embarrassed or uncomfortable. Doctors are used to talking about personal matters and will try to ease your discomfort. Keep in mind that you’ re not alone— these topics concern many older people. It is important to understand that problems with memory, mood, sexual function, and urinary or bowel function are not a normal part of aging and may be treatable. A good doctor will take your concerns about these topics seriously and not brush them off. If you think your doctor isn’ t taking your concerns seriously, talk to him or her about your feelings or consider looking for a new doctor.
The following subjects are examples of difficult but necessary conversations to have with your doctor.
* Planning for care in the event of a serious illness
* Driving * Falling and fear of falling
* Moving to assisted living or a skilled nursing facility
* Paying for medications * Alcohol use * Feeling unhappy with your doctor * Grief, mourning, and depression
* Sexuality * Incontinence * Memory problems * Problems with family
We will discuss each of these in this chapter and provide suggestions for ways to bring them up with your doctor.
Planning for Care in the Event of a Serious Illness
You may have some concerns or wishes about your care if you become seriously ill. If you have questions about what choices you have, ask your doctor. You can specify your desires through documents called advance directives, such as a living will or health care proxy. One way to bring up the subject is to say:
I’ m worried about what would happen in the hospital if I were very sick and not likely to get better. Can you tell me what generally happens in that case?
In general, the best time to talk with your doctor about these issues is while you are still relatively healthy. If you are admitted to the hospital or a nursing home, a nurse or other staff member may ask if you have any advance directives.
26 Difficult but Necessary Conversations