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Treat Me, Not My Age: A Doctor's Guide to Getting the Best Care as You or a LovedOne Gets Older

Treat Me, Not My Age: A Doctor's Guide to Getting the Best Care as You or a LovedOne Gets Older - Mark Lachs A bit put off by the title, but understood it in context. Doctors need to get to know the patient (whole lifestyle), not just the condition. Since they don't often do that, you need to take the initiative to give them this information. Age-related disability is reversible. Exercise will change the level of muscular strength. Doing nothing is not a solution. Avoid cookbook medicine. Sometimes a test or a preventive measure no longer makes sense given other factors. Make the most of your appointment:-- articulate your chief complaint.-- organize your thoughts before the doctor visit.-- prioritize your complaints-- list all interval events (major things, medical or otherwise), that have happened since your last appt.-- bring a list of your medications-- get a specific follow-up plan-- get the dr to be transparentAccessibilityBy phone, later that day or next.After office hours -- there should be some method of back-up communication besides waiting for the next day or going to the ER.Use physician extenders (nurse practitioners, physician's assistant) when possible -- develop a relationship, stay in touch. Seeing specialists:Don't assume that your medical information will travel with you from primary care physician to specialist.Make sure the specialist knows about your medications and your conditions.Make sure information from the specialist flows back to your primary care doctor.Be your own medical records and radiology department. You need a primary care physician in addition to specialists.One page summary to have available at all times (or a USB bracelet, etc):Complete list of medsList of allergiesList of all major medical problems and surgeriesPhotocopy of most recent cardiogram, EKGDescription of any abnormal lab findings you've had for some time. Hospital stays.1) Who are these people? Names, titles, what are they doing? Ask everyone. 2) Figure out if you are at high risk for hospitalitis. Cognitive problems, dementia, dehydration, vision problems, general level of illness. 3) If at risk:encourage regular visits -- substantive and regular visiting and visitors.Coordinate visits. Engage. Don't sit and watch television.Keep the patient orientated. Mobilize as soon as possible.Use nondrug approaches to restoring sleep.Bring eyeglasses and hearing aids.Plan visits around meals -- make sure the patient is eating.Bring in a few familiar soothing objects from home.Discuss any signs of delirium with medical staff immediately.ER visits - avoid them when possible. Are other options available? Call the physician first. Don't dawdle in calling if a problem is brewing. Address it sooner rather than later.Go to the ER if you mustIf possible< have the doctor call to alert the ER that you are coming.Speak up respectfully for the help that you need.Understand the game plan. Use goal-oriented questions.When being discharged:Know which doctors you are following up with and when. Get the name of the person to contact if a problem arises (this should not be your primary care, unless they were involved with the hospital stay). Make sure your follow-up doctors get copies of your discharge instructions and discharge summary.Consider getting a copy of your discharge summary yourself.Make sure those discharging you know your home environment.Reconcile your medications carefully.Before you leave, make sure you know where everything needed for discharge is coming from (equipment, oxygen, etc). Get advice on postdischarge symptoms that should give you real concern.Find out what tests are pending and who will follow up.Subacute care.Raise the issue soon after arriving in the hospital -- will you need subacute care?Begin scouting (have friends, family do this).Lower your expectations -- it's going to be very different than the hospital.Ask questions.Ask about nursing home discharge.Consider proximity to friends and family.Understand your rights regarding subacute care. You have some choice. Get a social worker involved if you need to, feel you are not being heard. Long term care.If all things look equal, choose a not-for-profit facility.Understand your care needs and how they're likely to increase.Interact with front-line staff. Visit at night and on the weekends. Look at state survey results and complaint logs. Don't be deceived by furniture, appearances.Know who you are doing business with. How old is the facility? How long have they been in business? What's the financial solvency of the place?Get references.Take a test drive -- have a meal, try adult day care if possible.Ask about access to medical services.Get the details on transitioning to another care or service level.Consider getting a lawyer for contracts, especially equity deals.Understand exactly what you are buying.Have an exit strategyWorth looking at again -- I didn't make notes on everything. Due back to the library. Very comprehensive.