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Caregiving Chronicles will present news and analysis on caregiving topics in MetroWest and around the world, in-depth Q&As with experts in fields related to caregiving and updates and announcements about caregiving resources available in MetroWest from CaregivingMetroWest.org Program Director Douglas Flynn.


Caregiving Chronicles Q&A: What to ask before, during and after your loved one's visit to the doctor
By Douglas Flynn / September 25, 2014
Editor’s note: The Caregiving Chronicles blog has partnered with Century Health Systems to bring additional expert information and advice to the MetroWest caregivers we strive to serve at CaregivingMetroWest.org.

Century Health Systems, the parent corporation of Distinguished Care Options and the Natick Visiting Nurse Association, allowed Caregiving Chronicles to get some valuable insight from several of its staff nurses for our ongoing series of Q&A sessions with caregiving experts. In this entry, we cover what caregivers should know to ask about before, during and after a visit to the doctor with their loved one.


Going to a doctor can be overwhelming. There’s the “doctor speak” we may not understand or the recent diagnosis that’s stressful and confusing. Maybe it’s the new regimen of medications that’s stumping you or your loved one. Whatever the case, making a list of things you want to discuss with your doctor – or that of your loved one – can be a very useful tool at appointments.

Patricia St. Martin is a wound care nurse and Care Transitions Coordinator at the Natick VNA and its affiliate, Distinguished Care Options. Before choosing a doctor, there are several questions St. Martin recommends asking of the candidates. The answers can help you determine the best and most appropriate doctor for your loved one based on your loved one’s needs as well as your own schedule and peace of mind.

- What affiliations do you have? Are you part of a group practice? Hospitals, urgent care centers? Where are x-rays and lab tests done?  
Why is this important? Patients should be comfortable with not only the doctor and his partners but the hospital in which they may be treated.

- How are referrals handled? Do you refer within a certain network of physicians?

- Do you have after-hours appointments?

Why is this important? This helps to accommodate people who are working or attending school.

- Do you use electronic medical records?
Why is this important? This allows the doctor to easily obtain and provide up to date information.

- What is the typical amount of time it takes to get an appointment? Do you have same-day urgent appointments available?

- How much time does the doctor typically spend with each patient?

- Does the doctor support alternative medicine?

Why is this important? It’s important that a doctor understands the risks and benefits of alternative medicine and how it affects traditional medical treatment so these risks/benefits can be communicated to the patient and/or the caregiver.

- How does the doctor communicate with a patient? Is there a website that provides education/advice and can the doctor or staff be reached by email?
Why is this important? It may be easier for a busy caregiver to send an email with a quick question rather than trying to reach an MD office by phone. 

- Does the doctor have a Nurse Practitioner (NP) or Physician Assistant (PA). When and how often is the patient seen by the NP or PA instead of the MD?

- What specialties does the doctor have?

Why is this important? If your loved one has a specific medical condition, you may want to know if the doctor either specializes in that condition or has an appropriate amount of experience in treating it.

The following are some of the topics several of the nurses at the Natick VNA recommend discussing with your loved one’s doctor.

Q: Why is it important to ask questions when seeing a doctor?
A:
As a caregiver, you are your loved one’s most important advocate. In addition to your myriad caregiving duties, the doctor’s visits may be most stressful, as you will need to keep track of changes in your loved one’s health, lifestyle, medications, upcoming tests and/or recent test results and more.

During the exam, it can be overwhelming to not only digest what the doctor is saying but also to remember the things you want to discuss. Having notes to refer to can be very helpful.

Q: Is there anyone who can help prepare those questions or ask them during the visit?

A: As the person responsible for overseeing the health and well-being of a family member or friend, a caregiver can play a vital role in helping their loved one communicate with their doctors and get the information they need during a visit.

Consider bringing a pad of paper so you can take notes during the conversation. Caregivers are huge assets in the exam room, serving as note-takers and an extra set of ears for the conversation patients do have with their doctors. Caregivers also are in tune with the patient’s health issues – and maybe other issues – that the patient may feel too overwhelmed to think of or to ask on his own.

Q: What questions should a caregiver ask if/when they accompany their elder loved one to an appointment? When should a caregiver ask questions?
A:
As a caregiver, you are a great asset to have in the exam room. Some of the things you can discuss with your loved one’s doctor include:

- Your loved one’s diet, medications and lifestyle
- Significant changes in appetite
- Changes in weight
- Chest pains
- Hospitalizations since last visit
- Changes in sleeping patterns
- Changes in cognitive ability, memory
- Skin changes
- Exercise regimen
- Accidents, falls and injuries
- Memory issues
- Changes in hearing or vision

Q: What should you bring to an appointment?
A:
The following items will ensure that your loved one’s doctor has a comprehensive picture of your loved one’s health status:

- Blood pressure card with history of readings
- Medical history and family history. (The Surgeon General provides a tool to help keep track of your family medical history.)
- List of medications – both prescription and over-the-counter (OTC)
- Insurance information
- Health Care Proxy and Advance Directive
- List of allergies
- List of other doctors/specialists caring for your loved one

Q: What questions should your loved one ask about any procedures he/she may be undergoing?
A:
Some questions that will help your loved one prepare for a medical procedure may include:

- Will I need to fast or eat certain foods prior to or after the procedure?
- Is this procedure routine, and has the doctor/surgeon had experience conducting it?
- Will I need anesthesia?
- Are there alternatives to the procedure?
- What will my recovery be like, and how long will it take?
- Will a follow-up procedure need to be done, or is this the only one?
- Why now? Can it wait?

Q: What should you ask about treatment options?
A:
Ask the doctor about the different treatment options available for your loved one’s specific condition. Find out the measures of success for those options. Ask the doctor for her recommendation for your loved one; maybe there are co-existing conditions that can hinder the success of a particular treatment. Find out if there are side effects of any of the treatment options being presented.

Q: What should you ask about medications?
A:
This is an important subject, as many older adults have issues taking medications properly. It’s good practice to bring a list of current medications and dosages with you to a doctor’s appointment so that when prescribing a new medication, the doctor can determine which one is most appropriate – and safest. Some good questions to ask:

- What are the potential side effects of the medication/s my loved one will be taking?
- Are there known interactions with any food (like dairy) or other medications?
- What is the schedule for taking the medication?
- Does the medication need to be taken with or without food?
- Is there a generic alternative to the brand?
- Do I need to take all of the medication or only until I feel better/when I need it?
- Does the medication need to be refrigerated? If not, how should I store it?
 
Q: What should you ask about costs and insurance coverage?
A:
Doctor’s visits and medical treatments can be very expensive, and those expenses add up quickly for those whose insurance doesn’t cover certain procedures, medications or supplies over the course of care. Some important questions to ask may include:

- Are the tests my loved one will undergo covered under insurance?
- Can I go to a specialist directly, or do we have to see you (primary physician) for a referral?
- Is your affiliated hospital in my network?
- My loved one is over the age of 65. If his primary insurer doesn’t cover something, will Medicare cover it as a secondary insurer?

Q: What should you ask after the appointment?
A:
It can be helpful to know what your next steps are in the course of your loved one’s care so that you both know what to expect at a later date and you both can be ready when that time comes.

- Will I need a follow-up test? If so, when?
- When will I receive my test results? Will it be via phone call or letter?
- Can I schedule the next appointment today?
- When should I schedule the next mammogram, prostate/PSA test, colonoscopy, bone density test?
- Should I be aware of any imminent health events as they relate to my loved one’s current condition?
- Based on my loved one’s family history and current health, is there anything we should be concerned about?
- Do you recommend any significant changes in lifestyle?

Jean Sniffin, RN, Community Health Nurse, Century Health Systems and Natick Visiting Nurse Association, recommends asking the following general questions:

What vitamins/supplements do you recommend?
- Multi-vitamin
- Calcium, D3
- Omega/Fish Oil
- CoQ10

What stool softener/laxative do you recommend?
- Miralax
- Probiotics
- Fiber products

Do you have a copy of my health care proxy?
- The doctor should know who to consult for medical treatment if your loved one is unable to speak for him/herself.

Am I due for any of the following:
- Shingles shot
- Pneumonia vaccine
- Tdap (tetanus, diphtheria, pertussis)

Am I on any high-risk medications? What do I need to know about them? Do any of them have any known interactions with food or other medications?

I’m tired all the time. What could be causing this?  

Have my specialists (heart doctor, neurologist, gynecologist, diabetes doctor, etc.) forwarded their findings and/or recommendations to you?



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