MEDICAL VISITS:
SCHEDULING, PREPARATION AND SUPPORT

As a caregiver you can provide valuable assistance in preparing and accompanying your relative to a medical visit. You can mention concerns that your relative wanted to discuss with the doctor but may have forgotten to ask as well as record what was said for your relative to review later.

How can I assist my relative in preparing for initial visits with a physician?

• If your relative is visiting a physician for the first time, bring a list of names, addresses and telephone numbers of all treating health professionals along with dates of service that are most significant to your relative’s medical history.
• Make a list of the names and dosages of current medications, including over-the-counter drugs, herbals and vitamin supplements. However, many older persons bring their medications in a bag to the medical visit rather than making a list.

• The names and telephone numbers of emergency contact persons.

• A list of allergies to drugs, foods and other substances.

• The most recent Health Insurance Card(s): make sure your relative’s coverage is accepted by a particular physician BEFORE making the appointment.
• A description of current symptoms, including: when each first appeared, severity, whether symptoms are the same as before, self-care (what your relative is doing at home to treat the problems), and what, if anything, makes the symptoms better or worse.
• Questions about sensitive subjects that your relative may want to discuss such as: sexuality, depression, incontinence, memory problems, etc. Be aware that your relative may be uncomfortable about openly discussing these topics with you as well as the doctor. It may help if you explain to your relative that doctors are accustomed to talking about these subjects and will try to ease the embarrassment or discomfort that may arise when speaking of these personal concerns. If you are your relative’s designated health care agent (health care power of attorney) you may want to inform the physician about your relative’s concerns prior to the visit. A good doctor will take your relative’s concerns about these topics seriously and not dismiss them as a normal part of aging.
• Copies of advance directives, if any, including: living will, health care power of attorney and any other prehospital directives. Your relative’s primary physician, specialist and hospital should have a copy of any advance directives.
• Lifestyle factors that may affect treatment options such as: cigarette smoking, alcohol consumption, problems sleeping, appetite changes, poor concentration and driving difficulties.

What should my relative learn about the physician’s routine and medical office protocol to improve access to care when needed?

It is important for your relative to become familiar with the physician’s routine and office protocol in order to obtain timely care and information. Your relative may consider asking the office manager or other administrative staff the following questions:

• Will the physician accept your relative’s type of health insurance (Medicare, HMO, Blue Cross Blue Shield, Medicap policies, etc.) as payment for service? Will my insurance cover the entire cost of the visit?
• What days/hours is the office open? Most doctors are not available 24 hours a day, seven days a week so it is important that your relative find out who to call after hours or who is available to answer questions if the doctor is away.
• Are walk-ins seen? If urgent care is needed can your relative be seen within 24 hours? If routine care is needed can your relative be seen within a week? Is there a penalty fee for no shows or cancellation of visits less than 24 hours in advance? What is the typical length of time reserved for a routine office visit?

• What is the best time to make routine, non-urgent phone calls?

• If 911 has been called in a medical emergency, how is the physician notified of the emergency situation?
• Who should your relative call if they have questions about a treatment, procedure or side effects from a prescribed medication?
• Who will have a current copy of your relative’s medical file, including information about your relative’s conditions, medications and treatment plan?

How can I help my relative on the day of the medical visit? On the day of the medical visit make sure your relative is as relaxed as possible and feels “in control.” If you will be accompanying your relative, you may want to arrive at your relative’s residence at least one hour prior to the required travel time to the physician’s office. This extra time will give both you and your relative a chance to review the reasons for the visit, talk about expectations and prioritize the 3 most important concerns to be addressed. Remind your relative to consider both physical problems as well as emotional concerns. Also, ask how you can be of most help during the medical visit, i.e., what your relative would like and not like you to do. Make sure you arrive on time or come early if requested. Allow for extra time if you are unfamiliar with the location of the medical office and/or if your relative has a physical impairment that makes transferring or maneuverability difficult.

Can I discuss my relative’s health condition with the physician and other health professionals? Your relative must specify who is authorized to have access to his or her medical information. An individual has certain rights under federal privacy standards about how medical information may be used and made known to others, including:

• the right to request restrictions on the use and disclosure of your protected health information,

• the right to receive confidential communications concerning your medical
conditions and treatments,


• the right to inspect and copy your protected health information, and

• the right to an accounting of how and to whom your protected health

information has been disclosed.
If you are the designated health care agent (health care power of attorney) for
your relative, then you have authorization to discuss your relative’s health
condition with treating physicians and other health care practitioners. If you
are not the designated health care agent, your relative must tell treating
physicians and other practitioners that you may talk to them about your
relative’s medical condition and treatment.

Should my relative always speak directly with the physician regarding any health concern? Your relative may not always need to talk to the physician directly about basic questions. The nurse, nurse practitioner or physician assistant who may work with the doctor are usually more available and can spend more time answering questions. Also, they can look-up information in your relative’s medical file and consult with the doctor as needed. However, your relative should not hesitate to call the physician about any health concern. The doctor will return the call but it might take longer to obtain a response. Your relative should consider speaking directly with the physician or designated staff member to discuss:

• Diagnoses or a change in treatment.

• Concerns about a new symptom.

• How to use a new medication, i.e., how often and how long should the drug be taken, and what might happen if the medication is not taken as prescribed.
• Potential negative side effects from prescribed medications and adverse drug interactions (if any) when taken with other medications.

• Test results.

• Referrals to specialists (doctors in different areas of medicine).
Some practical considerations include:


• Ask the office receptionist when would be the best time to reach the doctor. Some doctors have specific hours when they take calls. Find out what these times are and call then.
• If your relative chooses to leave a message, it should state the number to call and the best times to be reached. Make sure your relative leaves all applicable telephone numbers, i.e., home, work, and cellular phone.
• Your relative may want to ask if it is possible to communicate with the physician by sending e-mails about non-urgent health concerns.

What should my relative say when contacting the physician about a health problem? Some general guidelines that your relative should follow when calling the physician about a health concern are:

• Be prepared before calling. Have your relative write down a short description of the problem, the reason for calling, a short symptom list and no more than three questions to ask the physician.

• Be concise and stick to the issues.

• If your relative does not understand something, ask the doctor to explain it again. Repeating what was said may help your relative make sure they heard it correctly.
• Your relative should call the physician if a new medication or an urgent refill of a current medication is needed or if the pharmacy will not refill a prescribed medication. Otherwise, your relative’s pharmacy will contact the prescribing doctor as necessary to refill current medications. Before calling the physician, your relative should have on hand the telephone number and location of the pharmacy that will be used. Call during regular office hours and before there is only one pill left.

Time and again, the doctor or the doctor’s staff does not return my relative’s telephone calls. What can my relative do to make sure the doctor or doctor’s staff responds in a timely manner? Depending on the type of relationship your relative has with the doctor, she/he may want to consider changing doctors. If your relative has formed a trusting and long-standing relationship with the doctor, working out the problem may be more useful than looking for a new doctor. Misunderstandings arise in any relationship, including between patient and doctor. Suggest that your relative be direct when speaking to the doctor or the doctor’s staff about the problem. For example, your relative may want to say something like, “I realize that you are very busy and take