Thursday, 19 September 2019

Care Partner Wednesday--Do your Doctor's Manners Make You Angry?

Melanie shifted in the uncomfortable, straight-backed chair and glanced at her watch. It hadn't moved since the last time she looked, and compulsively staring at it wasn't doing a thing. Mom had mercifully fallen asleep in the chair beside her after almost an hour of meaningless chatter, pacing and protests loud enough that everyone in the doctor's waiting room heard them.

Studying the faces around her, Melanie tried to remember which ones had been there when they came in and which were new. Where were they in the queue? If Mom woke again before the receptionist called their names, Melanie knew there would be a scene. Correction. Another scene. Mom's restlessness spilled over at the half-hour mark and it had taken one of her pills and some chocolate to settle her down. If it happened again, she had no more tricks in her arsenal.

"Davidson." Melanie almost didn't believe it and sat for another second before scrambling to gather her things and her mother and follow the nurse into the office. Mom, befuddled and grumpy at being wakened, wasn't sure of her surroundings and protested at being moved. Melanie managed to herd her into the inner examining room, only to cringe at Mom's loud declaration, "I need to go to the bathroom." The nurse gave her a look and said, "Down the end of the hall. You can leave your things here."

Throughout the process of getting Mom down to the bathroom and helping her, Melanie's heart raced. What if, after all this wait, the doctor came to the room and they weren't there. Would they lose their chance?

She needn't have worried. Even with the bathroom trip, it was another 15 minutes before he showed up in the examining room.

A cardiac specialist, she'd never met this doctor before, but rather than introducing himself or even looking at her or Mom, his entire attention was on the chart. "Shortness of breath, some edema in the legs, irregular heartbeat. Has she ever had a Holter monitor?"

Melanie knew he was asking her a question and she should answer, but she didn't have a clue what he was talking about. She looked at him blankly. "I'm not sure what you mean."

His patronizing tone set her teeth on edge. "A Holter Monitor. A device which is worn for a day or two and it collects information about the heart which we analyze. Obviously not. I'll order it."

He approached Mom without talking to her and proceeded to listen to her heart and take her blood pressure, writing numbers on the chart. Miraculously, Mom didn't protest, probably because he was wearing a lab coat and she was of a generation who held the medical community in high regard. When the machine squeezed her arm she said, "It hurts." He ignored her.

"Definitely cardiac issues. I'll order the Holter. Make an appointment for a month from now so I can review the results."

Melanie opened her mouth to ask one of the many questions that lay stacked in her brain, but the opportunity had passed. She watched his back retreat from the office.

This fictional worst-case scenario illustrates many of the issues that drive us nuts when visiting the doctor, which is a frequent occurrence for anyone supporting an elder.

  • Long waits before seeing the doctor. I recognize emergencies happen and I would consider a wait under 20 minutes reasonable. But beyond that, barring an emergency, shows poor planning and lack of consideration for the patients.
  • A doctor whose manner is arrogant.
  • If the doctor focuses most or all of their conversations on the care partner without addressing their patient directly, that's unacceptable.
  • Basic manners apply. Introduce yourself, make eye contact, smile.
  • Don't speak in a patronizing tone. Ever.
  • Ask permission and explain before even the simplest procedure.
  • Don't talk as if the patient isn't there.
  • Welcome questions and build time into each appointment for them.
  • When the appointment is over, excuse yourself
Other points I would add:
Be available in a reasonable time when an appointment is needed.
Phone to schedule a follow-up appointment when results are in.
Be supportive and have information available related to the disease.
Watch your tone of voice and manner. Acknowledge how difficult this journey can be for both the care partner and the elder, and don't add to the pain.

When visiting a specialist, the bottom line is that often you have little choice who you see. You are referred, appointments may take long to schedule, and you take what you get. Many wonderful specialists are also people who see you for more than their specialty.  Others don't.

But if your elder's GP has some of the above characteristics, maybe it's time to consider changing. Caring is a long-term relationship and your medical support is an important factor, but not the only one.

If your doctor's manners make you angry, is he/she the right doctor for you?


Care Partner Wednesday--Do Your Doctor's Manners Make You Angry?

Wednesday, 11 September 2019

Care Partner Wednesday-After A Frightening Diagnosis Ask These 5 Powerful Questions

Bill and I and the doctor were crowded into a tiny examination room, peering at the computer screen. A week ago he'd had a serious event which brought him to the emergency room. His cardiologist was there that evening, and did multiple tests. We stared at the screen where the results were displayed.

"Idiopathic Cardiac Myopathy." Finally this series of symptoms, which we knew were heart related, had a name.

Kindly, he explained that idiopathic meant they had no idea why Bill developed this. "It means the medical profession are idiots," the doctor quipped. Cardiac meant it involved his heart, which we  knew. But the doctor pointed to the computer screen and explained how Bill's heart was big and floppy and not functioning as a heart should. That was why his elbows and knees were turning black, his ankles were double their normal size, and Bill was short of breath.

Obviously, it wasn't good news. But we felt an incredible relief. This thing had a name.

As a care partner, you will quickly learn that many hours are spent in doctor's offices. Especially with your GP, what are the questions you need to ask?

1. Diagnosis--what is the name? With a proper diagnosis, you can do your own research into all aspects of the disease. Ask which are the most reliable sources for finding information. Are there support groups or societies for that disease which you could access? He might have pamphlets to get you started. You know, I'm sure, that not every internet site is a reliable source of information. Organizations formed around a disease, such as the Alzheimer Society, are a great place to start to look for both information and support. Ask your doctor where to start.

2. Prognosis--No doctor has a crystal ball, and most families would love to look into one. But he can tell you what to expect in the next days or years. Most diseases have an early, middle and late stage. Ask him what each of these looks like, how long they generally last and what kind of treatments are given. Take notes, but know that you can also find more information online.

3. Treatment--Focus on the stage of the disease where you loved one is living. What kinds of medications are given at this stage, what are the side effects and what benefits should you expect to see. Is there anything you should know about administering the medication? Timing is vital in the case of some medications, and others need to be taken whole and can't be crushed.

What other non-medical interventions are important? Exercise is often key, but how much and what kind? What other kind of therapies would benefit? My niece attends a Parkinson's boxing class and loves it, and it helps her with balance and strength and coordination. She attends a choir with the same group, and loves it less, but it strengthens her voice, which is always an issue in her disease. Your doctor may not know all the resources available, but it's a place to start.

4. Specialists--Your GP is probably your primary care physician. However, your loved one may need several specialists, depending on other conditions and the severity of their condition. Ask about this, and at what point will they enter the picture.

Something to consider: Your doctor and specialists should be in a close geographic proximity and have privileges at the same hospital. We learned this the hard way. Bill had a GP in downtown Toronto because it was handy for him to visit her immediately after work. For many years this worked well, but when he got sicker and needed a cardiologist and other specialized treatments, they were in Mississauga where we lived. Because of the distance, the doctors didn't talk to each other, and his care suffered. When we tried to get a GP at our local hospital no one was accepting patients. Thankfully, a friend asked a favour of her doctor and he took him on, but we had an anxious several weeks trying to work out the details.

5. Heredity--Should other members of the family be tested for this disease? Does it run in families? As scary as the answer might be, this is vital information.

Have your questions listed, and prioritize them as there may not be time for all of them. Remember, this won't be your only visit, so some questions could be deferred while others will occur to you later. Keep a running list.

Your doctor is part of the team caring for your loved one. Make sure your relationship gives you the freedom to ask all the questions you need answers to.

Care Partner Wednesday--After A Frightening Diagnosis, Ask These 5 Powerful Questions

Wednesday, 4 September 2019

Care Partner Wednesday--Do You Have The Right Doctor?

Older people's bodies aren't the same as younger people's.

Duh. Am I a master of stating the obvious? But there's more to it than you might realize. And the implications for you and your elder might be something you haven't considered.

What are the Differences?

By no means a comprehensive list, here are a few of the implications of aging:

  1. Older people are more sensitive to temperature changes.
  2. They are less able to cope with the side effects of drugs because their kidney and liver function (the ability of their body to remove the drugs from their systems) are less efficient.
  3. Their bones become less dense. 
  4. Their night vision is poorer and their reactions slower, and they cope with dry eyes.
  5. They tend to not hear high pitched sounds as well.
  6. Some people have issues with constipation, diarrhea, and incontinence.
  7. Their immune system is less efficient, making them more prone to infections.
  8. Many serious medical issues, such as heart attacks, depression, and thyroid issues present differently than in younger people and are easily misdiagnosed by a medical professional not familiar with the elderly population.
Should you consider a different doctor?

Changing doctors can be a difficult decision, and not one considered lightly. In some communities, finding any doctor to take on a new patient is a challenge. Why would you contemplate such a move?
Here are a few questions to evaluate:

1. Does your present doctor serve a significant aging population and understand the differences?

2. When you take your elder to their GP, do they see one doctor or are their several physicians and you may get any one of them?

3. Are you in an area where a geriatrician is available, and would you be able to get a referral to them?

4. Are you comfortable with wait times in the office and the level of respect given your elder when they visit the doctor? (We'll be dealing with this in another blog post.)

5. How would your elder respond to the suggestion of changing doctors? If the reasons were explained, would they be open to it?

When you weigh all the options, changing doctors might not be the best option. Or it might be the wisest move you could make. 

Only you and your elder know the answer.

Care Partner Wednesday--Do You Have The Right Doctor?