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Who looks out for you? Being your health care advocate

As a physician, I think the health care system is a mess. I admit we are disorganized, make mistakes, and the system only gets more complex, leaving our patients at risk!

As people age, they tend to see more medical specialists and take more medications due to chronic diseases. Care can become fragmented and lead to more mistakes due to a lack of communication between medical providers, electronic medical records, and patient understanding of the situation.

Geriatricians who work as primary care providers are physicians trained to care for older adults and manage multiple diseases. As a Geriatrician, I take a holistic approach to care, coordinate care with specialists, check for medication interactions, and discuss patient goals, risks, and benefits before medical procedures. I also spend time educating my patients and their loved ones. My patients usually call me on my phone, and I am grateful to have the opportunity to practice medicine in a way where I can be my patients' advocate.

But not everyone has access to a geriatrician!

Research from the American Geriatrics Society (AGS) shows that 30% of people 65 years and older need care from a geriatrician; however, only about 13% have access to one. Additionally, based on data from the AGS, the supply of geriatricians is projected to increase by 45% from 2013-2025. The United States is expected to need up to 30,000 Geriatricians by 2029 when the last of the baby boomers turns 65. However, there are just under 7000 geriatricians, and only half work full time.

A 2016 Johns Hopkins study shows that more than 250,000 deaths yearly are due to medical errors. 10% of all U.S. deaths are due to medical errors, and in 2013, medical errors were the third leading cause of death.

Now that I have your attention, the rest of this blog post will review how you can be a health care advocate for yourself and or someone that you love.

A Successful Advocate

  • Takes Control of their health care

  • Speaks up

  • Voices their health care concerns and preferences

  • Reflects on their health goals

  • Feels confident about the choices

  • lives a longer and healthier life

First, start by considering your relationship with your doctor! Your connection should be open, honest, and trusting.

Your doctor should know and understand your

  • Symptoms

  • Current medications include prescriptions, herbs, vitamins, or supplements

  • Past medical records, including labs, X-rays, other imaging, and studies

  • personal history

  • family history

  • Drug allergies

If you need a new doctor, consider the following.

  • What are you looking for in a doctor?

  • Do you prefer a female or male doctor?

  • Do office location, hospital affiliation, and practice size matter to you?

  • Can you call the doctor directly?

  • Does the doctor's office same day appointments?

  • In the office, does the doctor perform specific procedures such as administering IV fluids, joint injections, etc.?

  • Other Considerations that are important to you!

Once you have made a list of what you are looking for, start your search. Word of mouth, internet search, call your insurance carrier. Do your research, does the doctor see older patients? what is the doctor's philosophy?

Get Organized!

Prepare for your visits before going to the doctor. Most doctors have a limited time to spend with patients, about 10-15 minutes for routine visits. In my private practice, most visits are 30-60 minutes long. New patient visits are up to two to three hours long. I find this time precious; it gives me the time to listen to my patients, think, answer their questions, and summarize the visit with written instructions that my patient can take home.

To get the best out of your visits, consider the following.

If you are seeing a new primary care doctor for the first time, take a list or a bag containing your medications or supplements. I cannot stress enough how important it is to have an accurate list of medications. Have a list with the name of your medications, what they are for, who prescribed them, and how often and when you take them. Keep this list updated and on you at all times.

Write down and have the following items ready.

  • Past medical history: do you have high blood pressure, diabetes, etc.? include a year of diagnosis, changes, and any failed medications.

  • Family history: the doctor will want to know if your siblings, parents, and other family had any diseases that may put you at risk.

  • Allergies: Write down your allergies to medications. It is also essential to list the reaction. You can also include other allergies, such as to certain foods.

  • Habits: Do you smoke, have you ever smoked, how long, and how many packs? Do you drink alcohol? What/how much do you drink, and how often? Do you use any other substances, either legal or illegal?

  • Living situation: are you living alone? Do you live in a house, how many flights of stairs, or in an apartment?

  • Exercise: Do you exercise? What do you do, and how often?

  • Daily Activities: do you need help with any of your daily activities, such as getting groceries, and rides, is it challenging to make it to the doctor's office?

When you see your doctor for follow-up visits, stay organized!

Before you see the doctor write down a list of the most important things you want to discuss, you may not be able to discuss all of your concerns in one visit, make sure you get what is most important covered. Write down your concerns. If there is a new problem, write down the symptoms, when they started, what makes it better, and what makes it worse.

Write down what the doctor says. At every visit, I review everything that my patients and I discussed. I write it all down, print it, and give it to my patient. I also make it a permanent part of my patient's records that they can access if they lose the printed copy of their visit summary and instructions. Not all doctors do this, so have a notebook with you, write down the date, which doctor you saw, and bullet points of what you discussed and instructions. I also advise You to speak up and tell the doctor what you heard so that the communication loop closes without errors.

A good healthcare advocate knows what they want and prepares for the unexpected.

Do you have an advance directive or a living will? Check out the GeriAcademy on advance directives to learn more. Designate a health care power of attorney (HCPOA), someone you trust to make decisions if you are ever in a position when you cannot. For example, if you are unconscious. A HCPOA needs to be someone who will respect your wishes and do what you ask of them. You can generally find state-specific forms online by doing a google search. These documents usually need to be notarized.

If you get hospitalized,

make sure the hospital has your doctor's name, medication list, the contact information for your HCPOA. Also, I advise having your HCPOA aware of health care issues they may need to make decisions about in the event you are unable to. Family members and friends should bring everyday items such as photos, hearing aids, and glasses to help prevent confusion in the hospital. A trusted loved one can also be your advocate by spending time with you at the hospital.

I hope your enjoyed reading this blog post on being a health care advocate. You can find more information on GeriAcademy on aging-related topics.


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