Discussing Sensitive Subjects With Your Doctor

By Sondra Forsyth

Much of the communication between doctor and patient is personal. To have a good partnership with your doctor, it is important to talk about sensitive subjects, like sex or memory problems, even if you are embarrassed or uncomfortable.

Most doctors are used to talking about personal matters and will try to ease your discomfort. Keep in mind that these topics concern many older people. It is important to understand that problems with memory, depression, sexual function, and incontinence are not necessarily normal parts of aging. A good doctor will take your concerns about these topics seriously and not brush them off as being “normal.” If you think your doctor isn’t taking your concerns seriously, talk to him or her about your feelings or consider looking for a new doctor.

Alcohol

Anyone at any age can have a drinking problem. Alcohol can have a greater effect as a person grows older because the aging process affects how the body handles alcohol. Someone whose drinking habits haven’t changed may find over
time that he or she has a problem. People can also develop a drinking problem later in life due to major life changes like the death of loved ones. In fact, depression in older adults often goes along with alcohol misuse. Talk to your doctor if you think you may be developing a drinking problem. You could say:
“Lately I’ve been wanting to have a drink earlier and earlier in the afternoon and I find it’s getting harder to stop after just one or
two. What kind of treatments could help with this?”

Falling and Fear of Falling

A fall can be a serious event, often leading to injury and loss of independence, at least for a while. For this reason, many older people develop a fear of falling.
Studies show that fear of falling can keep people from going about their normal activities, and as a result they may become frailer, which actually increases their risk of falling again.

If fear of falling is affecting your day-to-day life, let your doctor know. He or she may be able to recommend some things to do to reduce your chances of falling. Exercises can help you improve your balance and strengthen your muscles, at any age.

Feeling Unhappy With Your Doctor

Misunderstandings can come up in any relationship, including between a patient and doctor or the doctor’s staff. If you feel uncomfortable with something your doctor or his or her staff has said or done, be direct. For example, if the doctor does not return your telephone calls, you may want to say something like this:
“I realize that you care for a lot of patients and are very busy, but I feel frustrated when I have to wait for days for you to return my call. Is there a way we can work together to improve this?”

Being honest is much better for your health than avoiding the doctor. If you have a long-standing relationship with your doctor, working out the problem may be more useful than looking for a new doctor.

Grief, Mourning, and Depression

As people grow older, they may lose significant people in their lives, including spouses and cherished friends. Or they may have to move away from home or give up favorite activities. A doctor who knows about your losses is better able to understand how you are feeling. He or she can make suggestions that may be helpful to you.

Although it is normal to mourn when you have a loss, later life does not have to be a time of ongoing sadness. If you feel sad all the time or for more than a few weeks, let your doctor know. Also tell your doctor about symptoms such as lack of energy, poor appetite, trouble sleeping, or little interest in life. These could
be signs of depression, which is a medical condition. Depression may be common, especially when people experience losses, but it is also treatable. It should not be considered “normal” at any age. Let your doctor
know about your feelings and ask about treatment.

HIV/AIDS
The death of a spouse, divorce, or separation can lead some older people to find
themselves dating again and possibly having sex with a new partner. It’s a good idea to talk to your doctor about how safe sex can reduce your risk of sexually transmitted diseases such as HIV/AIDS. It’s important to practice safe sex, no matter what your age.

Incontinence

Older people sometimes have problems controlling their bladder. This is called urinary incontinence and it can often be treated. Depending on the type of incontinence you have, the doctor may recommend exercises, suggest helpful ways to change your habits, prescribe useful medications, or advise surgery. If you have trouble controlling your bladder or bowels, it is important to
let the doctor know. To bring up the topic, you could say something like:
“Since my last visit there have been several times that I couldn’t control my bladder.”

Memory problems

Many older people worry about their ability to think and remember. For most older adults, thinking and memory remain relatively intact in later years. However, if you or your family notice that you are having problems remembering recent events or thinking clearly, let your doctor know. Be specific about the changes you’ve noticed; for example, you could say: “I’ve always been able to balance my checkbook without any problems, but lately I’m very confused.”
Your doctor will probably want you to have a thorough checkup to see what might be causing your symptoms. In many cases, memory problems are caused by conditions such as depression or infection, or they may be a side effect of medication. Sometimes the problem is a type of dementia, such as Alzheimer’s disease.

With a careful history, physical exam, medical tests, and tests of memory and problem solving, specialists can diagnose Alzheimer’s with a high degree of accuracy. Determining the cause of memory problems is important to help the doctor, patient, and family choose the best plan of care. Although there is no cure for Alzheimer’s, medicines can help for a while, especially in the early stages of the disease. Medications also can ease serious behavioral symptoms such as agitation, anxiety, and depression. Support groups and education are important and can help patients and caregivers.

Problems with Family

Even strong and loving families can have problems, especially under the stress of illness. Although family problems can be painful to discuss, talking about them can help your doctor help you. Your doctor may be able to suggest steps to improve the situation for you and other family members. If you feel that a family member or caregiver is taking advantage of you or mistreating you, let your doctor know. Some older people are subjected to abuse by family members or others. Abuse can be physical, verbal, psychological, or even financial in nature.
Your doctor may be able to provide resources or referrals to other services that can help if you are being mistreated.

Sexuality

Most health professionals now understand that sexuality remains important in later life. If you are not satisfied with your sex life, don’t just assume it’s due to your age. In addition to talking about age-related changes, you can ask your doctor about the effects of an illness or a disability on sexual function. Also, ask
your doctor about the influence medications or surgery may have on your sex life. If you aren’t sure how to bring the topic up, try saying:
“I have a personal question I would like to ask you…” or “I understand that this condition or medication can affect my body in
many ways. Will it affect my sex life at all?”

Summary:

*Don’t hesitate to discuss sensitive subjects with your doctor.

*If you feel the doctor doesn’t take your concerns seriously, it might be time to think about changing doctors.

This article is an excerpt from the National Institutes of Aging’s publication A Guide for Older People: Talking With Your Doctor.