Lend Us Your Ears: Note Takers Help the Elderly at
Their Doctor Visit
"There are four ears listening to what the doctor
By Susan Jaffe, Kaiser
Washington, DC -- Sharon Wolozin (left),
a medical note taker for Northwest Neighbors, recently
accompanied Barbara Dresner (right), to a medical
appointment in order to act as a second set of ears (Photo
by H. Darr Beiser/USA Today).
This story was produced in collaboration with
March 1, 2014 - It used to be difficult for
Edith Couturier, an 85-year-old resident of the District of
Columbia, to explain to her adult children on the West Coast all the
details of her medical appointments. But now she doesn't go alone —
she takes along a volunteer "medical note taker."
"There are four ears listening to what the
doctor says," said Couturier.
That second set of ears belongs to Sharon
Wolozin, who takes notes the old-fashioned way – with pen and paper
– and then reads some of the main points aloud to confirm them with
the doctor. If the patient forgets a question she told Wolozin she
planned to ask, Wolozin will remind her. But she is not an advocate
and has no medical training.
"We don't get between the doctor and the
patient," said Wolozin. Her role is only to create an accurate
record of what happened at the appointment that she gives to
Couturier, who can then share it with her children or others.
Wolozin is a volunteer for the
Northwest Neighbors Village in
Washington, D.C., one of the more than 200 "villages" across the
United States. These neighborhood membership organizations provide
volunteers and other resources to help with everything from
transportation and snow shoveling to hanging curtains and solving
But as many of the Northwest Neighbors' 210
dues-paying members "age in place" – the village movement's top goal
-- some need more than just a ride to the doctor, said executive
director Marianna Blagburn. So the group is expanding its services
this year with 16 newly trained "medical note takers" who will
accompany members into the doctor's office armed with questions
prepared in advance and take notes (although they will leave during
the physical exam, unless requested to stay). Then the notes are
sent to the patient and anyone else the patient designates.
The Northwest Neighbors' medical note-takers
are modeled after the "Medpal" volunteer service introduced in 2009
at Avenidas Village,
California's first village group, which now has 375 members in the
Palo Alto area.
"Members would come to us and say, 'I've got a
doctor's appointment, I am really worried, and I need another pair
of ears,'" says program director Vickie Epstein.
Ashby Village, in
Berkeley, Calif., began offering Medpals to its 275 members in 2011,
and Capitol Hill
Village in Washington, D.C., has been providing note takers
since 2007 to its members, which now total 370. Newton At Home, the
village in Newton, Mass., also offers its 180 members note takers.
The move comes as village organizations are
seeking new ways to help members with their health needs. The Newton
village also offers discharge planning services for members who have
been in the hospital and will even make sure the refrigerator is
well stocked when members return home.
No matter what their age, patients can have
difficulty making sense of complicated diagnoses and medical terms,
said Deb Rubenstein, care management director at
Iona Senior Services, a nonprofit
community service center in Washington, D.C. who helped
design the training program with a grant from the city.
patient may have arthritis that makes writing painful, have
difficulty hearing or hesitate to interrupt the doctor with a
question, she said. And as patients grower older, their medical
needs become more complex and demand greater understanding.
Although these note-taker programs are limited
to villages members, it’s important for all patients to be engaged
in their medical care, said Lynn Quincy, senior policy analyst at
“The evidence is overwhelming that when
patients are active participants – taking notes and asking questions
-- they interact with their doctors better and get better outcomes,”
“But on average patients don’t score very well on health
literacy and it can be hard for them to understand everything the
doctor said and the instructions they have to follow.”
Tips For A Successful Doctor’s Visit
The average doctor’s appointment is
about 20 minutes, according to the most recently available
statistics from the National Center for Health Statistics at
the Centers for Disease Control and Prevention. Here’s what
medical note takers at Northwest Neighbors Village recommend
to make the most of the time:
Go into the appointment with a
clear idea about the reasons you are there and your
goals for this appointment.
Bring a list of questions and your
List any symptoms or problems you
want to discuss.
Before leaving, confirm a summary
of what happened with the doctor, including
recommendations for next steps.
Make sure your understanding is
correct and write that down.
Do not rely on your memory.
The ability to be engaged is further undermined
when there is any kind of cognitive impairment, she said. It could
be temporary, due to illness, lack of sleep, or major stress. When
that happens, bringing another person with you to the appointment is
a great idea, she said.
Barbara Dresner, 88, also brought Wolozin to a
recent doctor's appointment, even though she has four adult
children, including a son who lives with her and two others who live
"I feel if I don't have to bother them, I'm
still being independent," said Dresner. And even though her doctor
provided a written summary of the appointment, she said Wolozin’s
notes were easier to understand.
But in the long run, note takers may not solve
communication problems between elderly patients and their doctors,
said Dr. Peter DeGolia, a geriatrician and professor of family
medicine at University Hospitals Case Medical Center in Cleveland.
The concept isn’t practical since most patients don’t have access to
a volunteer note taker. And even when a patient is assertive
and asks a question, the physician still has to provide
answers – written or oral – that the patient can understand.
Otherwise, "it's like two ships passing in the dark," he said.
The Couturier family has been grateful for the
service. Last year, one of Couturier's doctors canceled leg surgery
designed to improve her circulation and recommended a new medication
instead. But when her children reviewed Wolozin's notes, they
confirmed that she had taken the drug, and it didn't work. The
surgery was rescheduled, and she's doing better.
The medical note takers are "tremendously
important," said Couturier's son, Andy, of Santa Cruz, Calif. "If
the doctor comes in and says a lot of things really quickly, the
crucial link in the system is lost if the patient doesn't understand
the diagnosis or what medication to take."
Contact Susan Jaffe at
This article was produced by Kaiser Health
News with support from
The SCAN Foundation.