After her father had a transient ischemic attack, also known as a mini-stroke, Lisa McCarty snapped into action. She had taken a prominent role in his life and was knowledgeable about his health, so she offered to make a follow-up appointment with the cardiologist. Her dad, on the other hand, responded with sarcasm, McCarty says, and told his daughter he was capable of making a phone call himself. “I took that sarcasm, which he was known for, as that he wanted to handle it and was declaring his independence and ability to do it on his own,” says McCarty, a writer and health advocate. “He was also setting a boundary in this situation, which I had to respect to some degree, but also keep him safe.”
McCarty respected her father’s wishes but still remained involved in his care: She checked in to ensure he’d made the appointment, took him to future doctors’ appointments, researched other specialists, compiled a list of questions to address with medical professionals before every appointment, and discussed his health on a daily basis over the phone.
McCarty’s father died from his heart condition and other complications with cancer a few years later. She considers their conversations about his health a success, though, offering support when it was needed and stepping away when it was not. “I respected his independence while also voicing my opinion and speaking up when I was concerned about something,” she says.
When it comes to the people we love, it’s normal to take an interest in their health and well-being. As parents or other relatives age, their physical and mental health may become a topic of concern. If it’s been a few months since you’ve seen a loved one, the difference in their demeanor may be apparent. For those with whom you’re regularly in touch, they may frequently remark about the same aches and pains, prompting you to speak up.
However, many people approach these conversations by making demands of their loved ones. While well-intentioned, a heavy-handed approach “puts people on the defensive,” says Chris Segrin, head of the University of Arizona’s department of communication and a behavioral scientist whose specialty is interpersonal relationships. Some people consider putting pressure on a loved one the most effective strategy because “they’re convinced this is the thing to be done,” he says.
People avoid medical care for a variety of reasons. A record high 38 percent of Americans say they or a loved one postponed medical treatment due to the cost in 2022, according to a Gallup poll. The logistics of getting to a doctor — having too little time, a lack of transportation, and inconvenient hours at the doctor’s office — often deter people from seeking care, especially in rural areas where access to a doctor can be difficult.
They may also believe they are generally healthy enough and don’t need preventive care. When people have had a traumatic past medical experience, they may avoid care in the future. “People have bad experiences with doctors and those bad experiences can be both in the form of not getting good health guidance, and also in the form of maybe getting good health guidance, but maybe not being treated well,” says Matt Lundquist, the founder and clinical director of Tribeca Therapy, “or not being treated with dignity or experiencing body shaming or someone not being accommodating of a disability or racism or sexual assault.”
To tactfully broach conversations about a loved one’s physical and mental health, experts recommend affirming their autonomy, validating their hesitancy with the health care system, and avoiding shame and blame. While we can’t change others’ behavior, we can encourage — and support — friends and family to take steps toward improving their care.
Rather than launching into a spur-of-the-moment diatribe, carefully plan the points you’d like to outline, says therapist Israa Nasir. Make an internal list of topics you’d like to address instead of focusing on their health more broadly. Are they always mentioning how they’re having trouble walking up stairs? Have you noticed that they haven’t been to the dentist in a few years? Keep a mental note. If you’re feeling nervous, you can practice the conversation with a partner, friend, or roommate ahead of time or write down exactly what you want to say, Nasir explains.
Should you have a strained relationship with the relative you’re looking to speak with, you can outsource the conversation to a third party, Segrin says. This person should be someone your loved one trusts and listens to. Explain to the other person your concerns and why you consider them the best person to have this discussion. You could approach the third party by saying, “We both want Mom to be part of our future, but it seems like she’s not taking her health seriously. Unfortunately, I’m not the one to be able to have this conversation, but maybe you could.”
Give your loved one a heads-up that you want to discuss something important with them in private, Nasir says. This way they can prepare themselves for a serious conversation and avoid feeling ambushed.
Regardless of who initiates the conversation, these talks should always be one-on-one and in a private place. Do not broach the discussion at the dinner table or encourage other family members to get involved. “I would highly advise against that type of tactic,” Segrin says, “where you line the person up in front of five loved ones who all take turns trying to convince them.”
However, if your loved one’s well-being is at risk — they’re experiencing shortness of breath, chest pains, suicidality, or are having adverse effects of alcohol and/or drugs — don’t hesitate in getting them to a hospital immediately or calling 911. You may need to enlist the help of other loved ones in emergency situations, Segrin says.
Once you’ve set the stage for the conversation, begin by asking your loved one about their experience. Rather than exclaiming “You always complain about your back hurting — you need to go to a physical therapist,” start by asking “What’s going on with you? How do you feel about this?” suggests Lundquist. Don’t make assumptions that they’re being purposefully neglectful or unmotivated.
Use “I statements” when framing your discussion. First, tell your loved one how much you value them and their health. Then share your concerns. You could say, “It’s hard for me to see you in pain. I would love to figure out a plan we can do together that would make this easier for you.”
Always be sure to validate their concerns. If they avoid medical care because of the cost or believe health professionals are only out to make money off of patients, acknowledge your loved one’s hesitations, says therapist and podcast co-host Shade Adekunle.
You can also use your own experience as an example, Segrin says. If you’re trying to encourage a sibling to see a dentist, tell them about a recent positive visit you had at the dentist. You could say, “I had a really terrible toothache a few weeks ago. The scheduler at the dentist’s office was amazing and got me in right away. I got the cavity filled and the whole procedure was a breeze.”
“Leading by example is a really good way to get a conversation going,” Segrin says, “because it helps the other person lower their guard and lower their defenses so they’re not feeling attacked.”
If you and your loved ones are in a position to plan for the future, in the instance of, say, an older relative who values their independence, ask them when they would consider some assistance, Adekunle says. Try asking, “How will we know when it’s time for you to get a bit more support? What do you think that we should be looking for?” They can make decisions about their well-being without being stripped of autonomy.
Other questions and statements to help begin or continue the conversation with curiosity and empathy include:
Statements to avoid include:
Be prepared for your loved one to potentially get defensive or shut down the conversation. Remind your loved one that you’re coming from a place of concern but don’t press them to talk any more than they’re comfortable. Your goal is to preserve the relationship and, ideally, empower your relative to make decisions for themself. In worst-case scenarios, your relative might keep you in the dark when something serious occurs, like a car accident or a fall, because they’re worried about being blamed or losing their independence, Adekunle says. Keeping the conversation focused on validation and empathy instead of blame and demands can help avoid this.
If emotions — anger, frustration, fear, sadness — are preventing either of you from having a constructive conversation, step away for a few minutes, get some air and a glass of water, Nasir says. You may need to drop the discussion entirely for the day. However, don’t forget to pick it up again in the future.
Change doesn’t happen overnight, but if your loved one is receptive to receiving help, make an offer that will slowly move them in the right direction. Maybe that means curating a list of local doctors who take their insurance; maybe that’s offering to drive them to a doctor’s appointment. You might consider a compromise: If your knee pain hasn’t subsided in a week, would you think about reaching out to a doctor? “When do you think that you would be ready to go see someone about this?” Adekunle suggests asking. “Because then that probably means it’s serious.”
You can also offer to call the office on their behalf, but be sure to get your loved one’s permission before you take any action. “When they realize someone’s making decisions and choices for me, without consulting me,” Segrin says, “that’s very likely to result in what we call a boomerang effect where you get the exact opposite of what you want.”
You can also offer easy suggestions that encourage a more healthy or balanced lifestyle. If your best friend told you their therapist recommended they get more fresh air to minimize stress, offer to go on a post-work stroll a few times a week if you can. “Let them know you support them in their journey,” Nasir says. “If you’re just there to nag at them and you’re not ready to show up for them, then it’s not your place to have this conversation.”
Ultimately, your loved one is a person with the right and agency to make choices for themselves. All you can do is tell them how much they mean to you and show up for them when it matters.
Update, November 20, 5:05 pm ET: This story was published on November 19 and has been updated to clarify Lisa McCarty’s current occupation.2023-11-19T12:25:06Z dg43tfdfdgfd