c h a p t e r 5
Talking About Sensitive Subjects
Caring for an older patient requires discusing sensitive topics.
You may be tempted to avoid these discusions, but there are helpful techniques to get you started and resources to help.
“Many people your age experience similar problems.”
At age 80, Mr. Abayo was proud of his independence and ability to get around. But, when he came to see Dr. Carli for a regular exam, he acknowledged that the trouble with his shoulder had started after he collided with another car at a four-way stop sign.
“Many of my patients are worried about being safe drivers,”
Dr. Carli said. After the exam, she spoke with Mr. Abayo and his son in her offi ce. She told them that a lot of her older patients had decided to rely on family and friends for transportation.
She gave Mr. Abayo a pamphlet on older drivers and the number of a local transportation resource that might be helpful.
Many older people have a “don’t ask, don’t tell” relationship with health care providers about some problems, especially those related to sensitive subjects, such as driving, urinary incontinence, or sexuality. Hidden health issues, such as memory loss or depression, are a challenge. Addressing problems related to safety and independence, such as giving up one’s driver’s license or moving to assisted living, also can be diffi cult.
You may feel awkward addressing some of these concerns because you don’t know how to help patients solve the problem. This chapter gives an overview talking about sensitive subjects 23
of techniques for broaching sensitive subjects, as well as resources for more information or support.
Try to take a universal, non-threatening approach. Start by saying, “Many people your age experience . . .” or “Some people taking this medication have trouble with . . .” Try: “I have to ask you a lot of questions, some that might seem silly.
Please don’t be offended . . .” Another approach is to tell anecdotes about patients in similar circumstances as a way to ease your patient into the discussion, of course always maintaining patient confidentiality to reassure the patient you are talking to that you won’t disclose personal information about him or her.
Some patients avoid issues that they think are inappropriate for their own clinicians. One way to overcome this is to keep informative brochures and materials readily available in the waiting room. Along with each topic listed alphabetically below is a sampling of resources. Although the lists are not exhaustive, they are a starting point for locating useful information and referrals.