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By Morey Stettner

How to strike a balance between assertiveness and tact

We often hear about ageism in the doctor's office: Physicians and nurses may disregard your health complaints and pin any problems on your advanced age.

But even if your doctor dignifies your comments and resists ageism, there's no guarantee you will receive attentive care. You still need to advocate for yourself.

Ideally, you prepare for every visit. Perhaps you bring a friend or family member to take notes, reinforce key points and offer relevant information and observations. And you bring a printed list of questions or concerns that you want to address--prioritized by importance--to guide your conversation.

Read:Are you a hypochondriac? It's a fine line between vigilance and fear

When drafting your list, don't just describe your symptoms. Focus on how they affect your daily life.

"Quantify your pain," said Caitlin Donovan, senior director at the National Patient Advocate Foundation. Rather than say you have knee pain, describe how it impacts you ("I can't walk the dog anymore").

Specific "impact statements" work better then general characterizations of symptoms. Giving physicians a clear sense of how your condition affects you helps them grasp its severity.

Speaking with concision helps as well. While you're talking, doctors are thinking of questions to ask so that they can nail down a diagnosis.

In their mind, they see a flow chart. They need your help to guide them in the right direction.

"Be more precise in explaining your symptoms," Donovan said. "Don't tell your whole story," because rambling makes the doctor's job harder.

Your stress can spike if you feel rushed. Some nurses and doctors scurry in and out of the exam room with such officiousness that you cower amid their authority.

"You need a certain doggedness," said Dena Feingold, co-director of the Alliance of Professional Health Advocates.

When her doctor was heading for the door after a consultation, she said, "I have one more thing to ask you."

"His shoulders dropped and his body language implied that he was not happy I was asking him," she recalled. "But I felt I needed more time. I said something like, 'This is important. I know you're busy.' It's important to be respectful."

Her gambit paid off. The doctor listened and addressed her concern.

If your medical provider seems distracted, use an attention-grabbling question to underscore what you say next. For example, pause and ask, "Can I level with you?" or "Can you keep a secret?"

Some doctors repeatedly reply to an older patient's health concerns by saying, "Oh, that's just your age." Don't accept that.

Instead of picking a fight, offer a hypothetical. Prod the doctor to see you as a whole person, not a senior citizen.

"Say you have restless legs and trouble sleeping," Donovan said. "If the doctor says it's because you're getting older, ask, 'If I weren't older, what would you advise for restless legs?' You shouldn't just accept discomfort or pain as your status quo," especially if you're told it's due to your age.

Assertiveness and self-assuredness go hand-in-hand. Confident patients convey their concern succinctly and probe for answers, as opposed to going overboard trying to seem agreeable.

"Some of us want to be the 'good' patient who doesn't want to push back," Donovan said. "But the worst thing you can do is to discount your own experience because you want to be an easy patient."

A "good" patient isn't necessarily a pushover. The key is striking a balance between assertiveness and politeness.

"When you greet your provider, begin the visit by asking, 'How's your day?' or 'How are you?'" said Susan G. Schneider, MD, program director at UF Geriatric Medicine Fellowship in Gainesville, Fla. "That allows people to speak to each other as adults. And you start off with a tone of caring."

Schneider, a geriatrician, anticipates the physical barriers that some older patients face. She begins by confirming that they can hear her; if not, she offers to use an amplifier. She also prints handouts and other medical information in a 20-point size font so that it's easier to read.

If you cannot hear your physician or see printed materials, speak up.

"You have the right to ask for an amplifier if you can't hear or larger print to compensate for visual deficits," Schneider said.

-Morey Stettner

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June 02, 2023 14:10 ET (18:10 GMT)

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