When Joslyn Jelinek had trouble persuading her elderly dad to make a doctor’s appointment, she arranged for a visiting nurse to see him at home. The move opened doors.
“He became a lot more receptive [to seeing a doctor] based on the relationship he made with the nurse,” said Jelinek, a clinical social worker in Chicago.
But her father, who had congestive heart failure, needed further reassurance, so Jelinek took him on a trial run to the doctor’s office to figure out where they would park and enter the hospital, and how long the process would take. They ended their rehearsal with a relaxing lunch. Afterward, Jelinek’s father, who has since died, was willing to go to the doctor.
Such hesitation is not unusual, particularly among older patients. An article in the Journal of Applied Gerontology in 2020 reported that one-fourth of people 65 and older had avoided medical care, based on a sample of 2,155 participants from the 2008 Health Information National Trends Survey.
But Jelinek’s efforts offer a useful case study in gentle persuasion - combining good listening skills and flexibility.
Be open, build trust
The 2020 study said seniors’ reluctance to see a doctor was largely tied to previous negative experiences, hassles maneuvering the health-care system, not believing they needed care, transportation issues, cost and provider communication. Many also avoided appointments because they were uncomfortable having their bodies examined or feared learning that they had a serious illness.
Jennifer Taber, an associate psychology professor at Kent State University and one of the 2020 study’s authors, said in an interview that she learned firsthand about the subject when she tried to persuade a friend with knee pain to see a doctor. Her friend didn’t want to go because she was afraid the focus would be on her weight. Taber decided to put her efforts on pause and to mull how to raise the issue again at a later date rather than risk shutting down the conversation.
When John Principe, an internist in Burr Ridge, Ill., needed to persuade his 50-year-0ld brother to have a colonoscopy, he took it slow, emphasizing the need for the test but also giving his brother time to come around. After his brother developed symptoms that couldn’t be arrested with suppositories, Principe made clear that it was crucial to get a colonoscopy, and his brother agreed.
Later, when Principe needed to talk to a patient about having the colonoscopy she had been avoiding, he was ready with a similar approach. He made time to talk with her, both to put her at ease and explain the importance of testing. After screening came back positive, he helped her choose a doctor for a colonoscopy, and when it showed a significant precancerous growth, he referred her to a surgeon. He kept in touch with her along the way.
“The key components to assisting this patient through this process were time, open lines of communication and education,” said Principe. “Trust is a key factor in this process.”
No power plays
Amy Goyer, who moderates AARP’s Family Caregivers Discussion Group on Facebook, suggested making clear that your goal is to support your loved one, not to take over their life.
“Don’t make this a power play,” said Goyer. “Talk about ways you can support their independence, even if it means making some changes.” She also suggested avoiding “you should” phrases - use “I” instead.
“Change is hard, and the ‘unknown’ is the biggest fear for all of us of any age. It’s normal to want to avoid change, so tell them you understand their reluctance, fears or even anger, and you want to help them make change easier for them,” said Goyer. “Sometimes, they just need acknowledgment that this is hard stuff to deal with.”
Or, as Jelinek put it, allow your loved one to have the “dignity of their own experience,” even if that means postponing a test or procedure. And, always make the extra effort to show loving support, she added.
“I always really couch any sort of request or criticism or difficult conversation in sort of a ‘love sandwich.’ Start with things about our relationship and what they mean to me, express why going to a doctor is something that should happen or would be helpful, and just end it with some love, too,” Jelinek said.
The 2020 study’s lead author, Bryan Leyva, an assistant professor of clinical medicine, internal medicine and pediatrics at the University of Miami’s Miller School of Medicine, says to ask your loved one why - specifically - they don’t want to see a doctor and look for ways to help.
“Sometimes it’s so simple as they don’t have a ride, or there’s a lot going on with their husband and his medical problems . . . by that conversation, you can begin to identify personal barriers to seeking health care,” said Leyva.
Focus on their goals
Ronan Factora, a geriatrician at Cleveland Clinic’s Center for Geriatric Medicine, suggested that loved ones use the same strategies he employs with reluctant patients. “Uniformly, our older persons say they want to improve their independence, functioning and want to avoid nursing homes,” he said. “If I can link the problems I am seeing them for and show that addressing these issues will help to achieve these goals, then I might have a buy-in from that person to come and see me.”
Whether the person is a family member or a friend can also help guide people in these conversations, according to Mark Kuczewski, a medical ethics professor and director of the Neiswanger Institute for Bioethics and Healthcare Leadership at Loyola University Chicago’s Stritch School of Medicine.
“With strangers, we can expect people to not push very hard,” said Kuczewski. “It’s a judgment call to what degree you’re familiar enough with each other that you want to push those boundaries.”
When his mother had advanced Parkinson’s disease and his father who cared for her developed terminal cancer, he and his sisters sat down with them several times to talk about the benefits of moving together to a nursing home where their dad could get medical care and their mom ongoing support.
Kuczewski suggested allowing the loved one to air their feelings before commenting.
“Usually we get a little too worked up because we go into the conversation trying to make sure it goes the way we want and the patient agrees with our plan,” said Kuczewski. “We need to try to go into these conversations with an open mind and make our main goal to try to understand what the patient is thinking and feeling.
“If we are good listeners, the patient is more likely to relax and feel supported and then they are more likely to listen to feedback as well,” he said.
And sometimes you have to make peace with not persuading someone.
“I think it just comes down to knowing that you can’t control someone else’s behavior or make them behave in a particular way,” Taber said, recalling her struggle to get her friend to see a doctor. “If it were my own spouse or parent, I might be more forceful, but I still think people make their own decisions and you just have to live with that.”
Things you can do
Experts recommend several tactics in approaching loved ones reluctant to see a doctor, including:
- Stay calm, take your time, and listen to a loved one’s reasons for not wanting to see a doctor.
- Acknowledge their concerns, but point out the benefits of seeing a doctor, including feeling better and getting back to doing things they enjoy.
- If transportation or mobility is an issue, ask the person if you should drive them or arrange a ride. Help them walk down steps and get in and out of a car, if they request it.
- If a loved one seems uncomfortable in a hospital or clinic setting or is overwhelmed by a doctor’s questions, consider asking whether it would be helpful for you or another person to go along to an appointment as their advocate.