The doctor is in but I’m outta here


What do healthcare providers, caregivers and their loved ones living with dementia have in common? Looming frustration at medical appointments!

Last week, while sitting in a Raleigh, NC medical waiting room for at least 30 minutes with my 80 year old client for his 6 month follow-up eye exam (monitoring Age-Related Macular Degeneration) I brainstormed ways that his next appointment might be a more pleasant experience for him. Could the waiting room experience be improved? My dear client has moderate stage Alzheimer’s, arthritis, hearing loss in one ear, and a slow, unsteady gait even with a walker. Daily life for him is no walk in the park. Add a trip to the doctor? Expect confusion, a slow pace, a change in disposition and possibly an abrupt change of plan. No one wants to hear “we’ll have to reschedule!”

The “old is new” model of doctors making house calls is one approach to caring and treating people for whom travel and wait times are difficult. Similarly, concierge medicine (also known as retainer medicine) offers enhanced care, including lower patient loads and more time and availability, for an annual fee. However, add-on trip charges and annual retainers are not covered by Medicare and are not an option for many seniors. At this time, in the rising tide of dementia diagnoses combined with other chronic and acute health issues, visits to a doctor’s office are still the norm.

This list of 6 suggested ways to improve the medical waiting room and exam experience for people living with dementia and their caregivers is only a start. Let’s disrupt the traditional medical office visit and improve the experience for providers, caregivers and care recipients.

  1. Caregivers: Plan ahead. Explain to the appointment scheduler that the patient has dementia. Ask for an appointment time that fits well with the daily routine, e.g., mornings are challenging, afternoons are calmer, after lunch and not too close to dinnertime. Caregivers: Prepare well for the appointment with appropriate clothing, incontinence supplies, a snack, entertainment (IPad, puzzles, fidget blanket, photo album…), and a trip to the bathroom before you leave home (you and your care recipient). Bring a list of written questions and medications list.
  2. Caregivers: Notify the front desk staff (quietly, respectfully) that the patient has dementia. You can purchase or make your own cards to hand to people that explain the person with you has dementia. Recommend that the most important tests are done first in case patience runs out and the visit unravels.
  3. Medical staff: Perhaps the doctor could see the patient first and then do tests? For vision testing, consider dilating eyes as soon as the patient arrives. Is it possible to re-evaluate the testing protocol for a patient that may become uncooperative and end the visit prematurely? Which tests are most crucial to inform a diagnosis?
  4. Medical staff: Listen and act on a caregiver’s suggestions to facilitate patient interaction, e.g., patient is hard of hearing, patient has balance problems, patient is incontinent, a long wait in a cold exam room will sink the ship, etc.
  5. Physician/Physician Assistant/Nurse Practitioner: Use a person-centered approach, please. Be inclusive of patient and caregiver when asking questions, making diagnoses, describing treatments. Speak clearly. Make eye contact. Smile (or at least try not to look scary).
  6. All participants (you too, doctors): bring along your sense of humor. Share a smile or a laugh. Music, natural lighting, or fun distractions may ease anxiety.  Position the patient so that he can look out a window. One practice that I visit is known for its beautiful saltwater aquarium in the reception area.  Flexibility and good humor will lead to a greater chance of a successful visit.