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TwoWorlds Asked April 2018

Anyone else having problems with excessive doctor visits for elderly parents?

My 92 year old mother suffers from congestive heart failure. Her primary care physician refers her to so many specialists with follow up visits by each one that there are multiple visits per week. My mother is not ambulatory so I can not transport her by myself. Transport arrangements need to be made. They are demanding that I always be there, but I can’t be there that often. I am a business owner and this have hurt my business. My employees are complaining now because they are concerned as to their future because of lost business cost by my absence. The doctors and transport companies will not work with me as to schedules. Are all these follow up visits necessary? They are also very hard on my mother.

GardenArtist Apr 2018
I too wonder about the need for so many specialists. CHF is a cardiac function; I would think her cardiologist would be the lead doctor.

I'm wondering also if each of these specialtists is scripting for medicines; that could be another issue.

We went through being referred to PCPs, with many doctors asking us who we saw. I was somewhat blunt, after going through about 4 who perhaps gave a thorough exam the first time but did nothing significant thereafter. But usually they wanted to prescribe some med for something that could be handled by diet.

(One of the PCPs recommended a bunch of expensive nonscript stuff; for each one I countered with what we do naturally, and they worked and were safe so why should we buy more expensive stuff with a lot of chemicals? I bet he hated me and my strong ideas.)

I told them I failed to see the value of a PCP who merely attempted to coordinate visits; we could and did do that ourselves. I didn't need a medical orchestra leader.

I also made a policy eventually of no more than one doctor visit per week; it was too draining and taxing on both of us.

Would you mind listing the various types of specialty doctors? That could provide more insight into what seems to have gotten out of control.

And, even though it's not a medical visit, rest at home and some form of relaxation provides benefits just as important as being poked and prodded and measured and weighed.

CarlaCB Apr 2018
With all due respect to Countrymouse, the fact that the multiple visits are hard on the OP's mother is not the only point that matters. If the mother was a major hypochondriac and loved going to a different doctor every day, it would still be a problem for the daughter who has to work and runs a business. I don't think the caregiver's needs are irrelevant here. Her life matters too.

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Shane1124 Apr 2018
I agree with the posters above....have a good conversation with her PCP to discuss why all these specialists are necessary. Sometimes it’s just a CYA for the doctor at her, and your, inconvenience. It’s exhausting for both of you. Collaborate with the doctor with the goal to stop many of those visits & treat any health concern that arise & then take her to that specialist if she exhibits symptoms. Or let the PCP handle them.
Those visits - including getting dressed, transporting, etc probably wear you and her for the rest of the day! 
Good luck!

Countrymouse Apr 2018
I'm strangely fascinated that it takes you the entire paragraph, from your having to run a business via your employees' anxieties, to reach the one point that matters.

This merry-go-round of appointments is very hard on your mother.

Go back to your mother's PCP. It is the very essence of his role to act in his patient's best interests. Every single referral he makes must offer a demonstrable, significant benefit to your mother. Unless it does, he shouldn't be making it. You are free to question their value.

Now. Say that it's early days in this phase of your mother's disease, and in fact there are extremely good clinical reasons for everything that has been done so far. In that case, you need to delegate instead; and if you don't have a reliable deputy in your business then you'll have to delegate the appointments because there is only one of you.

You can ask a family member or close neighbour who knows your mother very well; or you can approach an agency and hire help - I'd suggest a nurse, if that's affordable, because you need someone who can take reliable, accurate notes.

Karsten Apr 2018
I live in Minnesota, so not far from the Mayo Clinic, but there must be similar places everywhere. When my dad was first diagnosed with ALZ by his local neurologist, the neurologist and his primary doctor ordered what seemed like hundreds of tests and specialist visits.

We took him down to the May Clinic, a couple hours away for a second opinion. The opinion ended up being pretty much the same, but in one two day period, the Mayo neurologist had my dad sent to all the various tests and other specialists needed (all in one facility , they all conferred, and by the end of the second day everything that needed to be done was finished. Saved us numerous separate visits to multiple doctors that would have been spread out over weeks, even months due to scheduling.

BarbBrooklyn Apr 2018
What does mom want?

Is her pcp a geriatrics doctor?

CarlaCB Apr 2018
I hear you, TwoWorlds. When people wax nostalgic about the golden days of the Waltons when elders were kept at home as part of an extended family, I always remind them that the Waltons only had one doctor, and he made house calls. There weren't these multiple specialists with repeated follow-ups for each when a person got older.

My situation is less onerous because my sister (who lives nearest my mother) and I are both retired and we always shared the burden of doctor visits, until very recently when my mother became wheelchair-bound. My sister can't push our 200-lb mother up the ramp into her house without straining her back and re-injuring her bad knee, so all excursions out of the house are now mine. My mother also sees multiple specialists (cardiologist, hematologist, nephrologist, pulmonologist, audiologist) and it's a major expenditure of time and effort. If I was trying to hold down a job I would not be able to do it.

I can only suggest to you to look for a substitute for yourself. Someone who can be paid to accompany your mother on all but the most critical doctor visits. Maybe a CNA or even just a responsible local lady. There's one in my mother's community they call "the Road Runner" and she's always looking for more clients. Try to get the doctors to fill you in separately, on the phone or email or through a website.

Okay one more suggestion. Drop the least critical specialists. We dropped the dermatologist, the proctologist, the gastroenterologist and the urologist. She sees the cardiologist only in the hospital on a consult. We never even went to the pulmonologist. My mother made most of the decisions on who to see based on how critical their services were and how actively they were treating her. Most of the reasons were financial for her - these specialist copays are $50 a pop in her plan and they're breaking the bank.

I don't know if it's money-grubbing or just CYA with all these specialists, but these elderly people can't be kept alive forever and no amount of medical expense will change that. So we have tried to minimize the expense and the time/effort for ourselves and our mother. Mom is 86.

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