Caring Currents

How to Get Real, Practical Help From Your Doctor When You Need It

Laughter: The Best Medicine
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How many times have you left the doctor's office with a suggestion or recommendation only to realize, once you get home, that you have no idea how to carry it out? It happens to me all the time. For instance, when accompanying an elderly friend to a recent medical appointment, we discussed his high blood pressure and the doctor reminded us again to cut down the salt in his diet. In the car, I mentioned the doctor's advice, and my friend shrugged; it was clear he had no idea what that meant in practical, day-to-day terms. After all, he's a lifelong bachelor who lives alone and tends to resort to canned soup and microwave meals when I'm not cooking him dinner.

When I got home, I googled "low salt diet" - and immediately felt overwhelmed. It would have been so nice to leave the doctor's office with some clear, simple instructions on how we could go about lowering salt intake.

Thinking about this, I realized it all comes down to one little word: How. As in, how do I do this - whatever this is? Of course, in some cases that might sound a little blunt; what you really want to know is what to do next.

Getting a referral to an additional expert, such as a nutritionist, social worker, physical therapist, or other specialist can make all the difference, but overwhelmed doctors often forget to mention that such services are available. Of course, It shouldn't be up to us, the patients, to ask if additional help is available, but all too often that's what it comes down to.

Here are some common doctor's office scenarios, along with follow-up questions we could use to get us the information we need.

Situation 1: Weight Loss. The doctor gently mentions that you or a family member could stand to lose some weight. What might you say?

A: "Which weight loss plan would you recommend?" "I'd really appreciate a referral to a nutritionist who could analyze my diet and help me make a plan I can stick to."

Situation 2: Back Pain. After a diagnosis of degenerative arthritis in your spine, the doctor recommends that you not sit for long periods of time, and do some exercises to strengthen your back. But how to accomplish this?

A: Ask for a referral to a physical therapist to learn back-strengthening exercises, and ask if your insurer would cover an ergonomic evaluation of your workstation or your home.

Situation 3: Blood Sugar. Blood tests reveal pre-diabetes, and the doctor advises keeping your blood sugar under control by changing your diet and getting more exercise. How can you make these changes seem less overwhelming?

A: Ask for a referral to a nutritionist for diet advice, and ask for additional screening to determine if you have metabolic syndrome, a constellation of symptoms that includes high cholesterol and oversized waist girth. If so, ask what services are available through your insurance to monitor and control this condition.

Situation 4: Appetite and Swallowing Problems. An older family member is having difficulty chewing and swallowing as a result of Parkinson's, Alzheimer's, surgery, a stroke, cancer treatment , or an unknown cause. The doctor tells you it's important to make sure the person you're caring for gets adequate nutrition. But how?

A: Ask for a referral to a swallow therapist. Also called speech and swallow therapists, these experts can train you in a variety of strategies to make sure the person you're caring for is eating safely. Swallow therapists can also develop a program of muscle exercises and other strategies to make it easier for your family member to eat and maintain appetite.

Situation 5: Lack of Exercise. The doctor notes that you or someone you're caring for isn't getting much exercise, and remarks on how important it is to keep moving in order to stay strong, mobile, and independent. But in the car going home, you think about all the things that get in the way of exercise, such as lack of access to a gym or other facility, weakness or frailty, or simply not knowing what to do. What information do you really need from the doctor?

"¢ If frailty, balance issues, or fear of falling is preventing you or someone you care for from getting exercise, ask for help obtaining a cane, walker, or any other equipment that could help. Ask also if a social worker or home nurse is available to help with walks.

"¢ If bad weather and lack of access to a gym is the problem, ask the doctor whether your health facility offers any facilities or classes that might fill the gap. Many medical centers now offer yoga, stretching, Tai Chi, Qui Gong, and other movement classes and workshops.

"¢ If balance problems or weakness are the issues, ask for a referral to a physical therapist, who can develop an exercise program. Some exercises can be done at home with minimal equipment, and often medical centers also have physical therapy groups that function as a strengthening class.