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... did, knew, said, understood about caring for elders.

Personally, I'd love to see a roundtable discussion with MedPros on one side and family/full-time caregivers on the other. Short of that (since I don't see that happening any time soon), I'll start with a few items on my list ...

- Don't assume all elders act/respond the same
- Assume the caregivers probably know more than you do about THIS patient

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Good idea Ladee!

that they would understand how difficult it is to take them to the doctor each time we suspect there may be an urinary tract infection. Please just allow us to bring in a specimen for testing.
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- Know that something is wrong if the bedridden patient is publicly way too verbally abusive to his caregiver (but very nice to his other children). And quit telling the patient that he has a very sharp mind before talking individually the family.
- Don't feel insulted if the patient's family mentions another "health symptom" along with the current major one.
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Oh, don't get me started on our medical professionals. In this area we have assembly line medicine. It is like the patients are stamped with a number on their forehead and put on the belt. No one really seems to care. A good example is the prescription refill line at the University system here. You leave a voice mail, saying what is needed and other pertinent information. Maybe they'll call it in, maybe they won't. Usually it takes two tries to get the prescription or a call in from the pharmacy.

I miss the old days where doctors actually cared enough to make house calls. Now they don't even care enough to return a phone call.
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As a visiting "medPro" I'm glad to see these suggestions. Thanks for the tips, and thanks for all you do for aging people.
Leslie
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That when I tell them my mom (and formerly dad) is hard of hearing they need to increase their volume when talking, or they aren't being good care providers! I've had this with both my mom AND dad. You'd think docs who specialize in elder care would understand the need to S-L-O-W D-O-W-N when talking with folks in their 90s and would speak LOUDLY enough so they can hear what the doc is saying. I wind up repeating everything the doctors say because I can tell my folks can't hear them or understand them. And the docs STILL don't speak up! GRRRRRRR!!!!
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If you can't handle a condition, suggest someone who can. If you aren't up on how to treat dementia, admit it and refer the patient to someone who specializes in it.
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Treat all senior citizen as seriously as their younger counterparts. I am tired of looking out for my own care and doing my own research. Keep visiting doc you will get an earful but thanks for caring enough to come here
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Don't assume, if I seek help from you because I'm stressed, exhausted and getting the usual symptoms of those, that I will be relieved to hear from you that my mother probably won't be with us for much longer… (I'm sure he meant it consolingly. Idiot.)

Do, on the other hand, be an exact copy of my mother's own doctor who is BRILLIANT.
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this is just not a sexist post. i very much respect women but im unimpressed that many female medical professionals would look down on or even discount a male caregiver. no its not in my imagination. ive been treated horribly by female medical personnel based on my gender and appearance.
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Just curious ... did you get a better reception from male doctors, captain?
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Captain I very much respect all the male caregivers that I have met. The tattoos and long hair have nothing to do with the quality of the person. As a patient I was cared for by a male aide who had been medically discharged from the Marine core. The hospital made him cover his arms because of the tattoos. He was the nicest politest young man you could wish to meet. I asked him if he had been medical in the Marines and he said that he had been an explosives expert.
never judge a sausage by it's skin!!!!
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What I truly wish is that there was a sincere TEAM approach to the medical treatment(s). I can't tell you how many times we've had to play interference, as the advocate for the patient, between doctors and facilities.

I wish that it wasn't about quotas and making money.

And that there wasn't such a shield of protection around the idiot doctors (and YES they exist in abundance, along side the great ones). I wish that we could go to the primary doctor and explain our theory of what's going on with my client, without fearing that we're talking about lawsuits .. I just want you to LEARN from this. I am fully aware that it is the *practice* of medicine (which often interprets to trial and error .. just admit it).
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Captain .. there may, indeed, be a lack of esteem granted to you, as a male, from the doctors, and .. you're not alone. The looks we get from ALL the medPros from ambulance transport to ER docs, to attending physicians all imply, "what the HELL have you been doing? why didn't you get her here sooner, and how did you let her get like this?" Until they get the FULL picture of all her conditions and the music changes to "you've been doing great work." Yeah. I know. I just wish we could have the benefit of the doubt from the beginning, without having to defend ourselves.
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When you find out that a patient is a caregiver, note in on his or her chart, and then ASK about it at each visit. It has probably the single biggest impact on all other health issues. Ignoring it is like ignoring that someone has diabetes or COPD.
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Doctors may have studied in the mental health area of dementia or Alzheimer's but they can be so stupid at times it just kills me! We do know more about the patient than they do, they do not live this disease every single day, every single moment, we do, we could or should educate them.

1. When you meet my parent and I tell you they have dementia or Alzheimer's you amaze me that you sit there and ask them a list of questions and accept their answers rather than look at me to see if it is correct or totally wrong, which 99% of the time it is...wrong!

2. There are times that I would personally like to speak to you alone without my parent in the room. They have lucid moments and it hurts their feelings to hear you tell someone about their behavior or actions, they do not always believe that they have a problem, even though we know they do.

3. If I am telling you that my parent is out of control or using abusive language towards me, please do not just sit there and say, "It's not them it's the disease." If I am telling you this, I am most likely at my wits end and need some help. In my case my parent needed medication.

4. If there are multiple things that will be changing, please take a few minutes to write them down on a sheet for us to take home. We can become so frazzled by having to shlep them back and forth to the doctor that we may forget something we were suppose to do. Having it written down helps us greatly.

5. Do not be condescending you are a doctor, you are not infallible. Working with doctors myself I have seen many who have what we referred to as a "God complex" you are not and we do not appreciate it!

6. Listen to us when we talk to you, you can worry about typing everything in to your computer when we are done. I kept telling a doctor about a side effect of feeling like you had the flu for 3 years! Turns out it was a serious side effect and the medication had to be stopped immediately but it was only done after 3 years of complaints and me bringing in paperwork from the internet to prove he needed to do something! Listen to us and take appropriate steps!
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HolyCow... very good.... but maybe you could print that out and take it with you next time... I am so tired of elders having a Dr. that is not helping them, and will stick with that Dr come hell or high water... In C's case, it's because he has given her an open ended Hydrocodone script..... HE doesn't have to deal with her everyday.... I DO.....

And God forbid that a paid caregiver stand there and ask questions or make suggestions.... or family members ,as was said, that are with them 24/7.... The days are gone that people don't speak up to a Dr..... it needs to be done more often.... loudly if necessary......

My two idiot sisters would only complain about the Dr not stopping to answer questions... I stood in the doorway..... he stopped... he wasn't happy, but then neither was I......we ended up changing Dr.s much against my dads wishes... again... hydrocodone addiction......

I don't care anymore how crazy they think I am... I will not go quietly...... and that goes for telling the family something is WRONG and not being heard.....
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High-5's #5, HC!!

It's more than personally insulting to have medPros be condescending to the caregiver, it's hurtful to the client. We should be counted as part of that healthcare team I mentioned. When the client can no longer do 'it' (whatever "it" is), we're doing it on their behalf.
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Captain, those female doctors were too disturbed by their attraction to you.

I will say that a person can control their "presentation." Once after a fall I went to see the doctor without styling my hair or dressing up. He asked me if I had an alcohol problem! It was a good question, but he wouldn't have asked it if I had shown up in "business casual." So the alcoholics with nice clothes and hairdos go undetected.

Captain, you might have gotten respect in a white shirt and tie. They are dumb to need those visual clues, but you are stubborn if you refuse to play that game when it is necessary.
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LadeeM,
I was a companion to a diabetic for a while. No one thought it would be a good idea to give me a half-hour tutorial on the subject before they left me in charge of their mother!
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Jinx, they probably should have done… I'm not sure I'd have known that irritability was a problem if I hadn't been told.

The other thing I've noticed is that, if you really want doctors to address you as if you are a half-wit, then take your knitting with you. Works every time. Anyone know why this might be?
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I must say that mums doc is useless and very embarrassed when I told him the results of the brain scan as ive been telling him for years shes not depressed? BUT her geriatrician was excellent AND im delighted to say refused to speak to my sister when she rang last week(just my sister being a bitch wanting a REPORT?) anyhow he told my mum that he didnt care where her family were they will help out financially,emotionally and any other way they can and told her quite harshly that she was a very lucky woman to have a daughter like me! Mum didnt register but I sure as hell felt great! He is very caring and said it was the hardest diagnosis any doc could give to a patient or family. He respects me and that i seemed to know what I was talking about he agreed with everything I had to say and was disgusted at my siblings but not shocked.
So just to say they are not all bad and anyone that has seen him has a very high opinion of him and his utter respect for the elderly as for her own Doc i wonder if he even likes old people? I would recommend a geriatrician to any old person as regular docs just dont specialise enough in the elderly.
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This has been indeed a terrific earful, your MedPro visitor appreciates it!
I'm going to make a small comment in response to HolyCow, because I do ask patients with dementia to answer some questions, and I've noticed that caregivers are sometimes quite flummoxed by this.
Why I do it: because it's helpful for me to see what kind of responses the person with dementia has. I'm not looking for accurate answers, I'm just trying to get a sense of what the person is like. After all, people with dementia are very variable!
Anyway, I used to write about geriatrics for another caregiving website but that site doesn't now have a very active caregiving forum for me to learn from.
Appreciate your letting me listen in. Having only had brief personal experiences as a family caregiver, I can't say I know what you are going through, but I do appreciate the work you do!
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drkernisan, then please take a few seconds to share with the caregiver why you are asking these questions... we spend our days trying to be mind readers.... and when I am with a Dr... who has spent years and years in school.... I think I go in with some 'relief' that for that little space in time I don't have to be the 'responsible' one....that you guys will be the 'leader' of the conversation....as a rule we are armed to the teeth with information that will help you to help our charge and help us too....
That 'team' mentality that LadeeC was talking about can be as simple as the Dr., the patient, and the caregiver....
And how awesome that you care and have your own way of gathering information..... just let us know what is going on... we'll set quietly and let you do your job.... but include us..... we know more than Dr's think we do....

Thank you for sharing with us.... this opens another door and adds a little to the bridge we hope to build.... sending you hugs for putting up with tired caregivers.....
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hi LadeeM,
That's a good suggestion, to share what I'm doing with the caregivers. I usually tell them afterwards why I was asking questions that the patient probably couldn't answer properly. (In case I wasn't clear before: I do it because I want to understand the reality of the person w dementia)
In a perfect world, I'd be able to let the family caregiver know beforehand what to expect, but often in a clinic that's usually hard to arrange.
Also in a perfect world, all older people and their families would get healthcare from clinicians with the right training and focus...but as you know, the world isn't perfect. So in the meantime, agree with you that we need to keep working on these bridges! best, leslie
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drkernisan... is there a possibility you could make a pamphlet to hand out to caregivers to share your approach?? I completely agree that the patient should be questioned, as there are things you are looking for in their replies..... and please, there are some great doctors out there.... and I personally appreciate you interacting with us here..... it helps to understand the stress and pressure you are under also...... you are a rare one for sure......but I doubt many caregivers have any illusions left about a perfect world....lol
So your simple straightforward approach is appreciated by me for sure.... as I am brain dead from being asked when someone is coming to pick up my charge who is already home.....

Would you mind sharing what brought you to this site? Wish more Dr's had the time to do this... it would open so many doors.... thank you for your input.... we all have such a hard job to do.... and you have to put up with grumpy tired caregivers too.... ??? You are a blessing for us... hope we hear from you again.... and I'm not afraid to hug anyone.... so sending you hugs across the miles.....
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Hi LadeeM,
I came to the site because right now I'm researching what kinds of questions are being posted online by caregivers like you: people caring for aging parents or other older relatives/friends.

I'm a geriatrician but most of my work has always been in improving healthcare for older adults.I started off studying quality measures (things we grade doctors on) but then in 2008 I discovered another website, for people worried about aging parents, and I switched my focus to educating and supporting family caregivers.

I wrote geriatrics content for that other website for five years. I've been interested in a long time in creating some kind of curriculum about geriatrics, for caregivers. Didn't work out with the other site, so I'm now looking into other ways to do this.

As I'm sure you know, there are not enough geriatricians available. So, given the shortage, I think it's key that we give caregivers the information, education, and tools to get better geriatric care from non-geriatricians.

I suppose I could create a pamphlet to help caregivers understand what the geriatrician is doing, but overall I think it's better to teach caregivers to anticipate where non-geriatricians often overlook important problems.

I wish I could post advice to these forums every day, indefinitely. But right now I have no funding to keep doing this...but I'm here for now and hope I can be of at least a little bit of help!
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Dr Kernison, We appreciate your time and interest in this site and I certainly hope lack of "funding" does not prevent you from continuing to visit. Everyone on this site gives freely of their time whether their experience is of the book learning kind or obtained practically in the school of hard knocks. The only reward is the friendship of others and the knowledge we all gain.
I realize that reading all the posts and replying takes a great deal of time which as a busy professional you don't have.
However if you could just post occasionally with maybe a case history or how you were able to solve a particular problem it would be very educational and much appreciated. May be you could start with "Why I choose geriatrics as my specialty" not a very attractive field for most medical students.Thank you again for your interest and compassion
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I wish that doctors involved in the care of a clearly fragile elderly patient would take the initiative to do some of the hard things that family is having trouble with. Like evaluating whether the patient is safe to drive or ordering inspections of the home of a patient who claims to be fine living independently when the evidence says otherwise (like multiple falls). In my situation where I am long-distance and the only local relative is not willing to risk serious arguments, there are limitations on what can be accomplished because of my mother's denial and refusal to accept others judgments of what is safe. She lives independently but it is quite questionable that she should. Her doctors' stronger intervention at this point would be gratefully received by our family (but not my mom of course!). As it is we still have to wait for something unfortunate to happen and it is hard for all involved. I do communicate with her doctors and get them to help some, but I have to push really hard and make a pest of myself to them. I realize the way our modern medical system is they probably just don't have time to take the extra proactive steps of their own initiative and they don't get paid for that extra time. But that leaves family struggling ineffectively with an elder who as long as they are barely deemed legally competent can live in a state of perpetual risk if they refuse all actions which would reduce that risk.
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Veronica91, you make good points, I'll do the best I can.

Since you mention cases and how I solve problems: a few years ago, for my master's in public health thesis project, I wrote a blog for caregivers. I used stories to illustrate common problems that come up in geriatrics, and every story ended with actionable tips. It was called Older Patients Wiser Care and it's still online; if you ever come across it I hope it can be of some use.

For Bermuda, all I can say is that I know and I"m sorry! Doctors and health care system currently badly set up to help families. There is a geriatrician named Joanne Lynn who does policy and has proposed organizing Medicare services differently for people who are older and developing lots of needs...in a way that would address these practical problems. I think things are slowly improving, but the situation remains very difficult for most families right now. You should not have to be so persistent to get good care, but that's usually what it takes unless you are lucky enough to find a great senior clinic.
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Great topic, I think it needs to be raised to a level that will get the attention of a large number of people, AARP, AMA, Medicare, etc. Many physicians who have a Nursing Home practice are Internist and many while MD's are not trained in the US and have only the minimal credentials. Understandable to some extend from a
"money making" perspective but not an excuse for sub standard care. Legislation to restrict the profit level of for profit nursing homes similar to that recently associated with the 80% rule for Insurance companies is one approach. A portion of the profits enjoyed by the fat cat owners of for profit nursing home chains should provide as incentives to doctor's who are board certified in the area of Geriatric Medicine. The elderly deserve the level of care children receive, children are usually treated by pediatricians, the elderly should be treated by those skilled in Geriatric Medicine.
I can't let the comment from captain go without a response, guess what I am a female and I also have been treated improperly by female and male physicians. My response to them was YOU ARE FIRED! Come on captain, be a captain and keel haul the doc's they are not the almighty.
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