What is the appropriate way to speak for someone in the doctor’s office?

Silverbird, I've experienced this as well, since my father had a severe hearing loss and despite many visits to the same doctors, most didn't seem to remember to address him in a louder voice.

I kept quiet until Dad would look at me, then I'd repeat what the doctor or NP asked or said, sometimes making it a bit clearer if they were speaking in terms I knew Dad wouldn't understand. Eventually, most of them learned to speak louder after several visits.

I don't think it's unusual or indicative of subservience when a parent anticipates that a son or daughter will assist them with answering questions. And I've also seen that some medical personnel will "dumb it down" in anticipation that the elder isn't going to comprehend their level of conversation.

I so disagree with the previous answer.

Doctors are mandated to report abuse. A parent who is hesitant to speak their mind in front of a caregiver may be deaf, demented, abused, confused or something else. The doctor got the question out in the open. S/Didn't make assumptions. S/he asked for your opinion/interpretation about what was going on. 

I always offered to step out of the room so that my mother could speak to the doctor in private if she wanted to. She never did, but I continued to make it a point. It is crucial that your loved one has an opportunity to express things she may not want to say in front of you, otherwise you could be isolating her without the least intention of doing so.

This is a difficult issue. I too have spent my fair share of time making incredulous and horrified faces while mother assured the triage nurse that she was in good health, for example, told the disabled driver's badge people that she could walk a mile uphill, and managed inadvertently to convince a heart failure nurse that she was not significantly affected by her ejection fraction of 18%.

I think both you and your mother have done the important thing, which is to acknowledge the issue, the *potential* for abuse if you control all of your mother's communication. But your mother does rely on you to be her memory, and her doctors need to rely on you for accuracy. All you can do about it, really, is demonstrate that you get the point.

I’ve had the opposite experience as well.
The doctor will ask a question and look at me to answer it. With my mom I would repeat the question so she could answer. It made the appointment go slower but I thought it was important for my mother to respond. She was hard of hearing and competent. Just didn’t appreciate doctors.

With my aunt who has dementia and sees a geriatric primary, and has better hearing and more comfortable in the situation than my mom was, there is no problem with answering.

She answers right away but the answer is often “I don’t remember” or “I feel Good” or “I don’t understand why I’m here. Nothing wrong with me “. Then they would start asking me the questions.

I would tell your mom to speak up that the doctors are concerned if she doesn’t answer. Perhaps your mom had grown accustomed to your answering in other settings and defers to you.
I would be impressed with a doctor who wants her to answer for herself.

You might also go over with your mom before hand why she wanted to go to this doctor and what her concerns are.

She might benefit from a note card with reminders on it.

Usually the nurse asks why you are there before you see the doctor. Good time for her to practice speaking up.

It’s a sign of dependence on you and good for her to be as independent as possible.

I should add that we seldom went/go to doctors and so had quite a bit to discuss. Since you go so often I’d think it would be pretty fresh on your mom’s mind if there is no problem with her memory.

I don't doubt you, Shaking. I was talking to my neighbours yesterday, the husband was in a chatty mood and told me all about his experiences in the cardiology department at our nearest specialist centre. He was lucky to get out of there alive. But I didn't know whether to be more aghast at some of the goings on, or incredulous that he could just sit there and blithely allow an inexperienced junior to plug him into a machine she manifestly didn't know how to use. I mean, would you?! This was the same hospital my mother attended once, but then she had me guarding her. I conclude that there are some hospitals you should never, ever visit on your own if you're ill, old or overly trusting.

Silverbird,
I used to take my Dad to doctor appointments. He had a horrible short term memory. The doctor would ask him a question, he'd shrug his shoulders and look at me.
Then I would answer. This was about 15 years ago in Northern California.

I also went along with my Mom to her appointments. She had stage 5 Alzheimer's. Her doctor knew that. I also answered questions that she answered improperly. This was about 3 years ago in Southern California.

In both cases, I never had any of their doctors accuse me of abuse or question why I was answering.

There were no signs of anything "amiss".

I would think that, if the doctor really was trying to find out if there was foul play, she would have you leave the room and then question your mom about abuse or check for signs of confusion/dementia on her own.

Given your Mom's response to the doctor, I would think the matter is all cleared up now.

I do the same thing with my husband. Since his stroke, he sometimes has difficulty understanding strangers and attending to what they are saying. In addition, and truthfully, he has no interest in understanding his myriad of medications and leaves it to me. He is always free to speak up at the doctor, and sometimes he has. But since I am the family pharmacist, nurse, record keeper and aide, he leaves it up to me. As for what the doctor said to you, next time count to five when he asks a question of Mom and give her a chance to formulate an answer.

Not only do I agree with Barb, CountryMouse, 97YearOldMom, Sue1957 and Ahmijoy, I fully respect their opinions, their experience, and their rights to state their own opinions.

From what I've observed, they're each experienced in elder care in a wide variety of areas and applications. They're intelligent, knowledgeable, compassionate, insightful, and their primary purpose here is to help.

And, their answers are not reactionary.

I let my mother answer the doctor's questions, then jump in to supplement (and sometimes contradict) what my mother is saying. Often I direct my comments to my mother instead of the doctor, as in "don't forget to tell her about the fall in the bathroom last week."

I think some parents are naturally more dependent or deferential than others. My mother speaks for herself, although she's not always completely truthful, and she is somewhat forgetful.

Maybe try prompting your parent when she looks to you for answers, maybe just repeating the doctor's question or rephrasing it. Even though I add to or correct my mother's statements sometimes, I really can't speak for her. She's the one living in her body, so I do sometimes learn new things by listening to what she tells the doctor.

I had a neurologist ask me to let Mom answer his questions. He would ask her a question, she would answer and then he would look at me and I would tell him what I had seen or just shake my head no. After her first visit I started keeping a diary of sorts. Then I would type up the info and give it to the nurse when we went for next appt. The neurologist would ask Mom questioned based on my observations I also typed up a sheet with all her hospital stays and surgeries. Allergies, likes and dislikes. Every doctor got one and every hospital stay. I was told by a hospital staff member a neurogist was being called in. I asked who, Dr. So and So she said. I told her the paper I gave them lists Moms neurologist and he has privileges there! Why would you call in someone who doesn't know her!

I see where the doctor may be coming from. Can't evaluate a patient if they don't answer the questions. Let Mom answer good or bad and then give your opinion. Or ask to speak to the doctor privately at the end of the appt.

You really have to be careful nowadays because doctors are just looking for something to report. Encourage mom to talk a little more!

We have been going in together for a couple of years now and our PA has been very good at asking wife the questions and letting me clarify anything that needed it. We would all go over her medications together and any special instructions.
When wife started showing signs of dementia it took two visits for him to see it and he immediately started the testing and when the results were in he completed the referral to the neurologist and has kept on top of it.
When I was assigned as her guardian I immediately took the order in and ask them to include it in her record. Once the supervising DR read the order and accepted it the only thing that changed was the PA would ask me the questions directly. He did acknowledge the order and said that we now that straightened out.
A few other DRs. staff did insist on wife answering the questions and provide the signature until they realized wife did in fact have a problem and defaulted to me. Most will still ask her a few questions which I feel is their way of tracking her degeneration.

No one has ever suggested any form of abuse and has allowed me to clarify questions or answers.

Just a couple of thoughts on this subject of doctors expectations in the exam room.

Silver is taking her LO to the Mayo Clinic, not a county hospital that has a monopoly on all the medical care in a rural area.

I respect her question and perhaps it’s a good standard to ask doctors what the protocol is for office visits in their practice. I suppose if a senior has a companion with them in the exam room it is a courtesy to explain oneself to the doctor or nurse as to why you are there and help them understand  that you have a right to be there.

We may look like a puppeteer that is interfering with the doctors evaluation of the patient but in actuality we are the one that is making our loved ones life work often to the detriment of our own life.

I think it’s quiet clear that Silver wants what’s best for her mom and is concerned as to why more than one doctor has seemed to find fault with her response to their questions.

Perhaps Mayo has an awareness training program going on? Regardless, it’s a valid concern on their part and we get many questions on what to do when our parents go in alone or even with their companion and the elders don’t give honest or straight forward answers on what is going on.
We are only trying to help the doctor understand the reality of the seniors life. 

But to speak to CM and Shakes concern, what came to mind for me is a book I read called “How Not To Die”. I read it a few years ago and have watched with interest as it’s grown in popularity and now has an accompanying cookbook.

It’s basically a vegan approach to health but as it relates to this post, it contends that the 3rd leading cause of death in America is medical treatment.

The author, Michael Greger, describes it as How Not to die of Iatrogenic Causes. Many, many do. There are also many appropriate and impressive footnotes to back up his claims.

So the pendalum swings from when our elders were of the era where whatever the doctors said was taken as the gospel to not necessarily so today. We are all on a learning curve with the diseases we deal with. We should be respectful of the knowledge of doctors, IMHO, but they are not infallible. They should also recognize that a person knows his or her body and that if they are lucky enough to have a loved one caring for them, there is no one who knows more about the patient than that spouse or child who accompanies them into the exam room. An exam, I might add that is often rushed to a point of rudeness by the staff or the doctor. Sometimes the doctor doesn’t take his/her hand off the door knob or even bring their stethoscope into the exam room. That’s not the case with the doctors my mom saw or the geriatric primary my aunt sees. It was the case with the doctor aunt was seeing when I started attending appointments with her.
It’s a partnership we are looking for from the doctors. We can’t just blindly trust them. We have to be respondible enough to eat a healthy diet. Exercise. Not smoke. Watch the alcohol. We have to recognize that they “have a license to practice” and that’s what they are doing. They can make mistakes and of course, we aren’t stupid. The Golden generation wanted to just hand it over to the doctors and blame them if something went wrong. 
Something always goes wrong. We all die. We are responsible for our own health. 

 We are hiring the medical staff to guide us through to the best of their ability and while they have a responsibility to make sure we are doing our job, we have a responsibility to make sure they are too. 
After all, they are the ones getting paid. Not many of us are. 

There’s a new medical system that’s been put in place. Be very very careful. I was a part of the old one, remember? Caveat emptor.

I'm a doctor (pediatrician) and also the daughter who has done all the parent medical visits so I can speak a bit from both perspectives. As an MD, I can say that if someone (regardless of age!) other than the patient is present at a medical appointment, it's a clear signal to me that the patient might not be able to advocate for him/herself. It's not always obvious why that is, so I think the best thing to do is clarify it at the beginning on the visit- like 'Mom would like to speak for herself and I'm here to offer supporting history/details' or 'Dad doesn't hear well and since I'm his primary caregiver we'd like to make sure we both understand the plan for him.' As a daughter, I've had to ask for the same sense of clarity from Mom - 'What role do you want me to take in today's visit?' and 'Are you ok if I add details that I think might be important?'

For the most part I go to Mom's appts with her ,she will look to me for answers when asked questions by health care providers before I answer I will usually say something like, I think the Dr. would like your feelings answers etc so why don't you try and if you need a hand I will jump in and help you, she is still in control, but you are there if needed,most Dr's appreciated this ,maybe talk to your parent before the appt and tell them to give the Dr their best answer ,if it's right that's great if not discreetly shake your head no ,it will be clear that you are not controlling or abusing
We had one Dr that was barely civil to my Aunt myself when we tried to talk about mom,he said that she "presented well" 2 other Dr's. had sent him letters saying mom's driving license should be revoked, no way would he do it, 2 days after she was pulled over for unsafe driving and speeding ,exactly a week later she was in a serious accident, we now by pass him and see the specialists ,social workers etc

My mother seemed to slip a bit after her Breast Cancer surgery, she was 85 at the time. After that I started taking time off and going to her appointments with her. Cancer, Surgeon & Primary Care seemed fine with it but I always got the feeling that the Cardiologist thought I was interfering with her decisions on her care. He kept pushing for her to see a specialist for a valve replacement which I knew she would not want. Just to appease him we went, I waited outside while she was examined and was called in for the discussion after. Once he told Mom what the procedure entailed and expected outcome/survival rate she told him she wanted nothing to do with it. She was angry at the Cardiologist and when we went to see him later that day she told him so. “Why did you waste my time with that and make my daughter miss a day of work for something she told you that I wouldn’t want that.” After that his attitude toward me changed.
When I had my own heart issues a few years ago my son was the one who went to the ER with me and my husband met us there a short time later. When the physician came in to explain anything or ask questions I asked that they both be in the room to hear what was said and so that they could also ask questions. When I was transferred to another hospital for treatment I again made it known that I wanted them both in the room for any explanations of procedures and treatment. That way they could relate to me later or inform other family what was going on.

Good points in these answers! Not that this applies to Silver, but I'll just add that I've seen my in-laws do this:
Dr: How you doing today, Mr X?
Mrs X: Oh, he's worse.
Dr: How many kids do you have, Mr X?
Mrs X: Two
Son X: Me and my brother.

If a Dr is trying to assess the abilities and needs of a patient, sometimes it's the patient who needs to answer. I've pointed this out to my in-laws and they understand, but it seems that it's an ingrained behavior that's very hard for them to stop.

For the last twelve years, I have been the driver and helper for several elderly friends. I often discreetly leave a note with the receptionist when I check in the patient. That way, I feel that important issues can be addressed and it doesn't appear to the patient that I am speaking for them or being a "tattle-tale". I will mention things such as non-compliance on taking meds, falls, bowel or urinary issues. One time the doctor helped out by "prescribing" that my friend move up from pads to briefs to help with urinary incontinence. It helps to maintain the dignity of the patient and the friendship we share. By using a note, the doctor is able to better determine what the real picture is and make suggestions that come from him/her and the patient is confident that
the doctor is aware and has their best interests in mind.

Yes! And oh GOODNESS how frustrating that is too!

Wanting to gauge if she'd got better after a nasty infection, I asked my friend J if she could tell me the time - there was a large wall clock in the ward and I wanted to know if she could remember it was there, see it, and tell the time from it. Her daughter instantly chipped in "it's half past three." Great. That shot the fox.

But it is difficult to zip it. To *make* myself -

"Are you having any trouble walking, Mrs H?"
"Oh no, I hold onto things."
"Mmmmmmggggnnnnffffff...!!!!!"

- I cultivated a glazed stare at the ceiling, and crossed my eyes when something mother said was dangerously misleading. This worked pretty well but only because her GP knew the cues. If you never see the same doctor twice it can be more difficult to make it understood that your loved one's answers may need revision...🙄

today time is of the essence at dr apts...……… so yes I dominate the conv all of the time to get as much info to the dr as possible. my adult stepson usually stays quiet and I think tuned out. if he chimes up its always talking about something that is totally unrelated to his situation or the current subject so yes I cut him off quickly.dr seems to understand

Great answer, Countrymouse. I experienced a similar concern from medical providers. I handled it by asking my mother, in the providers' presence, if it was alright for me to respond. Then I'd try to keep my answers short and to the point, ending by asking my mother if I'd answered accurately. The respect was mutual.

I’m very fortunate that my friend (92) that has dementia has a wonderful MD. He will always see me privately Just prior to going into the med room to see my friend. Then once in the room he will speak directly to him. It doesn’t matter how he answers because the doc has already received all the details from me.

I take mom to her appointments but never have had any doctor question my presence - FYI ... I usually write it up in an email to my sister with dr's name & contact info as she is back-up P.O.A. but the bonus is that I copy myself so have a file on her medical issues easily accessible 

I used to drive seniors to appointments many years ago - over 75% of time they asked me to come in with them - on our way home quite often they asked questions as they were unsure of what the doctor exactly said - they spoke for themselves but often only remembered 1/2 what was said as they digested something said earlier by that dr - I felt my job was note-taker & rememberer of details -

I feel most times you need an advocate because when you focus on some 1 item & miss an important side item like what & when to take meds but miss that you can't eat certain foods with that med - on important appointments I take someone with me to make sure I get all the details right

Up till about a month ago hubby has been my advocate and saved my life several times during a very serious illness. However it got to the point where hubby was just discussing me with the Dr. My PCP finally asked to see me alone which I was about to do anyway.
Now we live near eldest DD and for the last month she has been taking me to appointments and I am very happy to have her in the room. She sits quietly but will occasionally promt me. When I was asked about surgeries she just said "Did you forget the two hip replacements. If I refuse to do or take something, she just listens and does not try to interfere. So far that is working well which does take up time from her from work. the new Dr will ask her if she is the daughter and if she is in scrubs asks her what she does. She is a Vet.
On our recent stay in observation where both of us were in the same room I heard DH tell the Dr that he was a retired MD and I was a nurse I whispered to the nurse when he said that that I try not to give that away. She whispered back that her Mom annoys her when she introduces her and say "This is my daughter ,she's a nurse you know.

As others have said gone are the days when Drs were treated like God's and the younger ones don't have the same depth of experience in a wider field than the old docs did. they will say things like "I am a cardiologist I don't know much about cardiology" All of this specialization is good in some ways but in others allows things to slip through the cracks.
I firmly believe everyone should have an advocate, preferably someone knowledgeable but at least someone to help remember what was said.
The suggestion about handing a note before the appointment is very good. I think the approach of letting the elderly loved one speak for themselves and if necessary prompting with things like" Mom this is Dr X we are here about your heart we see DrY next week for your feet.
I feel most healthcare professionals will not see a caregivers presence as controlling. This of it in the way your nurse will report her findings to the Dr when he/she shows up in your room.
It is very important for the Dr to know if the patient is not following instructions about medications.

Just so you all understand--I completely support the idea of a patient, elderly or otherwise, having an advocate--someone else to take notes and listen.

My late mom told me, rather late in her life "there should always be two people present when someone is ill; the standing up person and the lying down person; The lying down person can't possibly understand or advocate for themselves".

Great wisdom there, mom; although in hindsight, I think she was already suffering some cognitive decline; her language skills were more sophisticated than "lying down person". But you get the thought!

What is problematic, and CM hit the nail on the head--the doctor is often trying to evaluate the patient by asking questions (I'm a psychologist, so I know whereof I speak; there is nothing so damaging as a parent answering "first" for a child, or trying to tell me "oh he knows that, you're asking it wrong". I'm asking it "that way" for a reason, dear.

What is wrong in the OP's original post is that the patient is looking to to the OP when a question is asked. This can mean "I don't know the answer, please help me" OR it can mean "If I answer questions incorrectly, she beats me". Or anything in between.

If you are dealing with a new doctor, much better to have a conversation about what is going on.

I still see docs (in NYC, no less) who seem to have time to actually talk to patients. Give it a shot.

this is exactly what hub's aunt says she's going through, that she's not allowed, when she goes to the doctor, to answer anything or talk to her doctor himself, that the one that takes her now goes in with her and handles everything

I started going to the doctor with my elderly parents when they started having memory or cognitive problems or needed a driver. In the early days, I mostly listened and occasionally prompted them when they gave an incomplete or misleading answer. Dad would tell the doctor he was taking all his medicine as prescribed and I would ask Dad "Didn't you tell me last week that you were taking your blood pressure in the morning and then deciding how much medicine you were going to take that day?"

My Mom still thinks well (based on what she remembers at the time) but has MCI with significant short term memory problems. When we went to the orthopedic doctor this week following a fall, I gave them a copy of Mom's healthcare POA and informed them she was living with me. Since she hadn't been there for 14 years (last time for rotor cuff repair and rehab, I was with her then because she couldn't drive while the arm was in a sling), they wanted to update her medical history information and I provided most of that, then got out of the way for the actual exam. I did repeat one question in a louder voice when Mom looked my way but I didn't answer it. The x-ray tech didn't much like me accompanying Mom initially, but seem to understand by the time the x-rays were complete. The tech positioned Mom and she promptly moved as the tech walked to the control room. After the tech repositioned her, I reminded Mom she needed to hold position until the x-ray was taken as the tech walked to the control room the second time. When WE discussed treatment for the re-torn rotor cuff, I explained Mom had wanted to avoid surgery with the first tear and tried PT but ended up going with surgery because of the continuing pain level. Since she doesn't seem to have as much pain this time (and the increased arthritis deposits make her a much poorer surgical candidate), WE want to start with PT and see how much that helps. Although I didn't state this to the PA, I will admit reluctance to consider surgery now unless absolutely required because of the potential impacts of anesthesia on her MCI - her memory problems got so much worse immediately following her cataract surgeries.

Mom knows she has memory problems and counts on me to help her cope. I think I'm also a bit of a security blanket too, particularly when we are away from home. I try to facilitate Mom doing for herself as much as possible and to gently help when needed or when she asks. If someone else doesn't like that - too bad for them - my concern is my mother! Recently at a restaurant she asked me to repeat what the waitress said a couple of times, then she pushed the menu my way and told me to just order for her. I've never done that before so it was a bit uncomfortable for me, but I picked the grilled salmon dinner I knew she would like and we enjoyed our meal with other family members. I'm not sure whether Mom was really having problems hearing the waitress or coping with the menu at the end of long day; she asked for my help so I gave it.

Although my mother's PC physician attempted to speak to her at visits, the physician would ask "So, N, when is your daughter (me) due to arrive (from out of state). This gave me the impression that the physician knew she had to "on her game" when I was there because I would ask a lot of questions. My mother would not. In fact, she didn't even speak up about what her ailment was at the doctor visit!

I allow my mother to try and answer the questions. If she is confused as is often the case I try to repeat the question to her sometimes more simply. If they ask her a question I know she cant possibly answer I tell the doctor that. Some of them start asking me the questions. I certainly allowed her to answer the question of how long she wanted to continue to live regarding valve replacement surgery. My mother has never been detailed oriented. Some doctors may seem annoyed but I explain her history of Christian Science and then they seem to understand.