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The Communication Triad

Physician/Provider, Patient, and Caregiver

iStock 000016042817SmallIt may surprise you to learn that clear and thorough communication is an essential element in diagnosing and treating medical conditions. The questions we ask and the way we listen are the most important part of any health encounter. The physician or other medical provider must gain a comprehensive picture of the patient’s history and current physical status while the patient must understand the physician’s instructions and treatment plan.

Hopefully, there is also an open and caring dialog about treatment options, quality of life, and other related issues. Oftentimes, senior patients will bring their spouses, children, or other family members or caregivers into the conversation as active participants in their medical care—either by choice or by necessity. When this happens, it becomes even more important for everyone involved to communicate well.


Tell the Truth. When I see a patient for the first time, my challenge is to establish trust and begin to build the foundation for an ongoing relationship. As the patient, your responsibility is to share details about your medical history and, more importantly, your current physical situation openly, honestly, and directly. This is the key to understanding what’s going on and will help us develop the best possible treatment plan. Sometimes, however, I find a patient who is reluctant to reveal the whole truth for a variety of reasons. Perhaps she’s in denial and doesn’t want to face troubling conditions or declining health. Or maybe she doesn’t want to be perceived as a “whiner” and thinks she can just tough it out. Please understand that you don’t have to (and shouldn’t!) hide anything from your health care provider. We can’t help you get better if we don’t know what’s really going on.

You Are Accountable for Your Own Well-Being.
Remember that you are the one in charge of your own health and medical care. You must be brave enough to speak up for yourself--don’t be intimidated by your medical provider or bullied by your adult child! You have the right to ask questions until you understand your condition and the options available to you. Your physician/provider and your caregiver(s) can be supportive, helpful partners with you in this process but, ultimately, the choice is your own.


Ask to Be Involved. Your loved one’s physician/provider should welcome your participation in their health and well-being. Ask how you can best help and support the treatment plan. Inquire until you have a comfortable understanding of the situation.

Problems Can Morph into Win/Win Solutions. But first, the issues have to get out on the table. One woman’s arthritis was making it nearly impossible for her to vacuum. When she finally admitted to her family that she needed some help with housekeeping, her teenaged granddaughter, who needed a summer job, happily showed up to help. Conversations about moving to a different living environment are another good example—with all parties willing to talk openly, the chances of a favorable outcome are good.

HIPAA Limits What We Can Share.
Sometimes, patients and family members have very different perspectives from one another and bring lifelong family issues and dynamics into the situation. It can be tricky for the physician/provider who finds himself in the middle of an ongoing family drama. And HIPAA regulations dictate that a patient’s right to privacy must be respected. So, if a patient doesn’t want his wife or son to know about his medical condition, we health care providers are not at liberty to share that information.

Long Distance Caregiving. It’s easy for family members who don’t live near their senior loved ones to lose touch with what’s happening with their health. I try to meet with my patients’ long-distance caregivers while they’re in town visiting so we can establish a personal relationship and talk face-to-face.


iStock 000019181061SmallListen, Listen, Listen. Yes, it can be challenging to slow down and really listen to your patients and their families when you have many priorities, agendas, and schedules to juggle with limited time. But it’s absolutely necessary. People are so appreciative of attentive care, and it truly contributes to the overall quality of the healing experience. Just face it: sometimes you’re going to run late.

Welcome, encourage, and invite caregivers into the conversation (with the patient’s permission). They can be your champions by helping with appointments and logistics as well as ensuring compliance with your treatment plan. Often, the amount of information we have to share can be overwhelming for the patient, so a second person to hear, ask questions, and remember is invaluable.

Balance and Boundaries. Fostering effective communication requires practice, skill, and a delicate balance: good boundaries to focus and direct the conversation on what’s important to get the answers you need, with careful, compassionate listening to really hear the patient’s concerns and questions.

Explain Your Thinking. Senior patients often experience more than one physical challenge at a time and, of course, we must deal with the most acute issues first. And when some patients come in to be seen about a particular ailment, we may discover a different condition that requires more immediate attention.

When this happens, it’s vital to assure the patient that, over the next several visits, you will get to the other problems. They need to know that you’ve heard their concerns and understand why they’re not being immediately addressed.

Our Loyalty is Always to the Patient. At times, it may feel that communicating with the family is “easier” or preferable in some way to communicating with the patient. We mustn’t lose site of the fact that our primary responsibility is to the patient. Although it may be difficult, we have to be honest with the patient about what we’re going to tell their family. We must hold confidences when requested. The conversation should be directed, first and foremost, to the patient herself—not to the caregiver.

Never underestimate the power of a good conversation! A cooperative communication triad--Physician/Provider, Patient, and Caregiver—can be the strongest medicine for what ails many senior patients.

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