Aging Parents: Is It Better To Have A Friend Be Your Doctor?

January 20th’s NY Times, Science Section’s “Hard Cases” column, Too Close to a Patient for Comfortmakes the case, based on AMA guidelines and other sources, that objectivity in medical care may be compromised by doctor-friends. “Medical care supplied by a relative — or an old friend, or a trusted employee — just seems so logical. After all, who could care for you more? But that is just the problem…”

The article triggered 2 thoughts and a dilemma:

1. When I was too young to know about medicine, I remember hearing that a doctor could not do surgery on a family member. Might have been true—or not. A playmate was having surgery. She was 9.

2. In graduate school, the professor in “Techniques of Counseling” gave us a practical list of counseling do’s and don’ts followed by his saying something like: “Be forewarned: if you’re trying to counsel a family member, your emotions will dictate and you may forget this.”

If the emotional ties of friendship can interfere with doctors’ objectivity, how do we reconcile this when it comes to helping aging parents, the elders we care about, and ourselves?

Boomers and those older, remember doctors who knew your family, possibly made house calls, and definitely made hospital visits. It was more “warm and fuzzy” then. Today’s efficiencies, however, dictate something entirely different.

I hear people say “It’s not the doctor’s “bedside manner” that matters. Agree. Knowledge and expertise are most important. But it helps if we feel s/he cares about us, doesn’t it?

Three people immediately come to mind. They don’t have friends as their doctors; yet they’re confident in their doctor’s ability to is do what’s best for them and they feel a certain bond–perhaps a professional-type friendship. Another commonality: they make every effort to take care of themselves to the best of their ability. It appears doctors appreciate this.

1. Several weeks ago I reconnected with a friend, living in a large city in the west with excellent healthcare available. I was unaware that she has a serious, unusual vision problem. Asking about her doctor, she related she did the research and now has the best doctor–adding she was concerned that, because she’s now on Medicare, it would be a challenge finding a doctor who would take her. Then she said, laughingly, something like “When we met he told me he isn’t taking new patients, but I’m ‘vibrant’ so he’s making an exception.”

2. Sr. Advisor R, at 101, has obviously had many doctors over the years. This last year a new best ophthalmologist  (taking few new patients) has been doing his best to maintain her sight, which was rapidly worsening.

She was initially concerned that he thought “She’s old, I can’t do much.” R made him realize she takes very good care of herself (corroborated by the lab tests her primary care doctor sent), lives in her home by herself, and will do everything possible to maintain her independence. He, like her other doctors, respects that–and her. For several months there was no improvement. 12 weeks ago there was slight improvement in one eye. I drove her to her last appointment and there was even more improvement in that eye. The doctor was cautiously optimistic; said to be sure to call immediately if she noted any change–not to wait for her next appointment. He wasn’t a friend but he cared. R’s spirits lifted.

3. Next I check with my friend of decades, who had polio as a child. In her mid-70’s, she has seen countless doctors who were not friends. “Confidence in them,” she says, is a must or she finds a new doctor. She has made changes over the years, as allowed in her health plan.

And we learn a tip–

She writes thank you notes after each appointment. The notes aren’t a hidden agenda to make them like her, she says, but actually to let them know that she’s very appreciative of their help. In addition, reading her note must make them think about her again after her visit. “It puts you on a level that most patients aren’t on,” she says.

A tip for us personally? And for those we care for and about. .

 

Related: New England Journal of Medicine‘s May 2014: Ethical Challenges in Treating Friends and Family..

Aging Parents: “In Patient” vs “Under Observation” — How Being in a Hospital Bed can Fool You

Does being in a hospital bed qualify Medicare-eligible seniors as In-Patient?

For some time now, we’ve been hearing about Medicare-eligible seniors who’ve been given “Under Observation” status when admitted to hospitals–for what any intelligent person would assume should be “In-Patient” status. “Under Observation” status is not “In-Patient.” 

If parents need to enter a skilled nursing facility or a nursing home after the required three days of hospitalization, Medicare will not pay and the family will be required to pay all of the bills, including the hospital costs, if hospital status was “Under Observation.”

We might also assume that those in a bed in a hospital are automatically considered “In-Patients.” Not true. Hospitalization for those designated “Under Observation”–even if they’ve been lying in a hospital bed for the three days before going to a skilled nursing facility or nursing home–does not qualify them for Medicare reimbursement. 

If this is news to you, you’ll want to click on this February 6, 2014 FoxNews. com article with video. It explains the factors contributing to the admissions status problem, as well as the many difficulties with the appeals process experienced by “Under-Observation”-Medicare-enrolled patients, who were denied reimbursement.

There is a key word in the first two paragraphs: assume.  Sr. Advisor R, as readers know, is amazingly wise about handling life and will be 101 in September. Her wise words were the subject of an earlier post.  “Don’t Assume” is an example of R’s wise words. Perhaps that’s one reason she has navigated the challenges of life so well.

May the FoxNews link help all Medicare-eligible seniors and their caregiver children to better navigate the hospital-admissions-status challenge and all that follows.

Personal note: My Tuesday, Saturday posting schedule is still ify, so my goal of one post a week remains for the time being. My out-patient procedure in the hospital this past week (no bed involved) prompted this post when I learned that some of my “learned friends,” who are on Medicare, were clueless about the important bed nuance.

Changing often: “Of Current Interest” (right sidebar near bottom). Links to timely information and research from top universities, plus some fun stuff–to help parents age well. (Note 5/17/14 addition from Harvard Medical School for Caregivers)

  

Hospitalization Tips That Make a Difference: For Aging Parents, Grandparents, Our Children, and Us

     I recently learned that a friend who worked in the health professions needed surgery.  He recently turned 65, is medicare eligible, but elected to remain with his managed care plan. The hospital he selected was one he knew and liked, was near his home, and was approved by his plan.
     Surgery was successful, but was followed by an infection, then other complications. His family insisted he be moved to a larger, more comprehensive hospital for additional treatment. This took a lot of doing–was not easily accomplished.
     After well over a month and several weeks in the larger hospital, he is in rehab for physical therapy, but health issues remain and he’s very weak. There’s conversation about his returning to the comprehensive hospital.

This sobering chain of events calls attention to:

1. a slogan
2. advice, gained from Dr.Susan Love’s (surgeon and prominent breast cancer prevention advocate) hospital experience about the importance of family.
3. information from Jon La Pook, MD (NewYork-Presbyterian/Columbia U. Medical Center and Chief Medical Correspondent for CBS News) about how to get optimal hospital care.

1. WHERE YOU’RE TREATED FIRST MAKES ALL THE DIFFERENCE. Memorial Sloan-Kettering Cancer Center’s slogan (goes back to the 1990s if not earlier).

2. The IMPORTANCE OF FAMILY MEMBERS WHILE HOSPITALIZED.  NY Times 2/19/13 Science Section interview, Susan Love’s Illness Gives New Focus to Her Cause. Dr. Love discusses the 4-week ordeal following her bone marrow transplant and the fact that family members “offered round the clock support,” advocated for her during that time “when she wasn’t very articulate,” and the fact that one family member “slept in the hospital every night.”

While the article initially focuses on Dr. Love’s reasons for devoting her efforts to the cause of disease rather than the medicines to treat it, we learn about the importance of family, which translates into good advice for all of us.

Likewise, Marti Weston shares a personal experience as she blogs about the importance of family in her 2/9/13 post  Elder in Hospital. Does a Family Member Need to be There, Too? The bottom line is “yes.”  Marti gives specifics about why and about certain things/actions family members can do/take (which includes sleeping at the hospital) to avert problems.

3. OPTIMAL HOSPITAL CARE. Dr. Jon La Pook’s TV interview on CBS (following  NY-Presbyterian/Columbia U Medical Center’s earning #7 Best Hospital honors in the latest US News Best Hospital’s edition) gives the excellent advice about how to get optimal hospital care these days.

For example, Dr. La Pook stresses the importance of communication between the patient’s regular doctor and the hospital’s doctor or the hospitalist, emphasizing it needs to be “a good hand-off” and likening it to the passing of the baton in a relay. You don’t want the baton dropped.

He opens our eyes to to basic, but critical, things like hand-washing “it could save your life;” tells you what to be on the lookout for; and introduces new terms ie. “electronic healthcare buddy.” Link to this enlightening interview: http://www.cbsnews.com/8301-204_162-57594022/u.s-news-and-world-report-releases-2013-best-hospitals-list/.

This information can benefit all generations, as we try to help parents age well.

Note-New: Check out “Of Current Interest”(right sidebar). Links to timely information and research from top universities about cancer, dementia, Parkinson’s, plus some fun stuff–to help parents age well.

Medical Emergencies, Emergency Rooms, Hospitals: Getting Optimal Care

Follow-up to yesterday’s post: U.S. News & World Report 2013-14 Best Hospitals. 

Had I been able to be proactive (instead of at the North Rim of the Grand Canyon without Wi Fi or cell capability) this “Best Hospitals” information would have been posted, as close as possible to the day the magazine came out in July. Because of the time lapse, I was able to watch this CBS News broadcast video (http://www.cbsnews.com/8301-204_162-57594022/u.s-news-and-world-report-releases-2013-best-hospitals-list/.

The video’s specific information, imparted by Dr. Jon Pook in the interview, was the best–spontaneous, personalized, current and instructive. Dr. Pook is a doctor at at NY-Presbyterian/Columbia U. Medical Center and chief medical correspondent for CBS news.

I learned from his discussion, how to get optimal hospital care. For example, he elaborates on the importance of communication needing to be “a good hand-off” between the patient’s regular doctor and the hospital’s doctor or the hospitalist, comparing it to the passing of the baton in a relay. He calls attention to basic, but critical, things like hand-washing that “could save your life” and tells you what to be on the lookout for. Dr. Pook uses the term “electronic healthcare buddy.” It was new to me, but made so much sense that I, for one, am glad to know about this option.

Take a five minutes and watch the video. You too will be glad.

Aging: Life Can Change in an Instant. Are We Prepared? cont. 7 “To-Do’s”

RHW’s wife, in essence, had neither control nor a Plan B.  She stepped back, relying on her husband’s good judgment, accepting the fact that he was going to consult one other specialist, then proceed as he thought best. All worked out well, but not without stress and worry. A pre-thought-out/pre-discussed plan for such emergencies would have–no doubt– made decisions easier.

Perhaps businesses do better in this regard when they require employees’ emergency information and keep it on file. A friend’s sister, (a widow on Medicare) had a seizure while at work. Her first ever seizure. 911 was called immediately and she was taken to the nearest hospital for stabilization and evaluation.

What about her emergency information? She listed just one person to call in an emergency. A MISTAKE– list at least 3 people if possible. 1st person was her adult son, a teacher. He couldn’t be reached–his class was on a field trip, scheduled to return after school hours. Her granddaughter (from another country) was in the US for the summer, working nearby; she was young; clueless about making health care decisions. The initial major decision: which (of 3) hospitals’ neurological centers should her grandmother be taken to. Evidently 911 responders made the decision. Several hours later the adult son made the decision to have his mother  transferred to a different hospital for further treatment. It was a good decision, made under tough circumstances.

7 “To-Do’s” can help us prepare as well as possible 

1.  Make time to sit down with aging parents, discuss and prioritize whom to put on an emergency contact list, their relationship or reason for being on the list. Include a person knowledgeable about healthcare management in the event others on the list aren’t available. Know what hospital(s) they prefer–or their doctors are affiliated with–should there be an emergency.

2. Make the contact list (3 people). Keep it in an easy-to-find place. 

3. Two additional lists–medications (dosage and frequency) as well as list of allergies and medical issues–keep with the contact list.

4. If parents have a Do Not Resuscitate (DNR) directive, it’s essential that 911 responders (if called) have–or can easily find– the DNR (otherwise they must do all they can to save a life).

5.  When elders have a good mind and want to participate in–or dictate– actions taken for their care, we need to ask ourselves “what’s the goal” (as did RHW’s wife); then decide how involved we need to be.

6. For elders still working, it’s important that their emergency contact information at work stays updated.

7. US News’ Best Hospitals yearly publication in July is an invaluable resource and good conversation-starter. This link from CBS News about the 2013-2014 publication contains a video with excellent additional advice–including having an “electronic healthcare buddy.” Don’t miss it. 

Yet, with our busy lives, will we set aside time for the 7 to-do’s? We know, intellectually, that being prepared saves time. In our situations it can help parents age well–or at least better–and save us some additional stress

Help Aging Parents: Confident People Can Become Intimidated When It Comes To Speaking With Doctors

Not Wanting to Upset The Doctor
…when he/she is their–or our–lifeline 

Last Tuesday’s NY Times, Science Times Health page devoted 2 articles–almost an entire page to–“The Trouble With ‘Doctor Knows Best.'” The second article, written by Dr. Pauline Chen calls attention to the fact that a friend, “a brilliant and accomplished academic in her 70’s” didn’t feel comfortable speaking with her doctor who was “generally warm and caring.” She, however, perceived him as too busy, uninterested in what she was feeling or wanted to say and she didn’t want him to think she was questioning his judgment and didn’t want to upset him or have him angry at her.

Efforts are–and evidently have been–made for over a generation, according to this piece, to get patients and doctors to work together to make decisions about treatment and care. And while the medical establishment and politicians evidently have been enthusiastic about the results, a recent study shows it hasn’t been satisfactory from patients’ perspectives.

The concern about one’s physician feeling certain conversations and questions may be taken as judgmental and may incur anger is no doubt on target. When our physician is our lifeline–and especially our parents’ lifeline–I think most of us tend to err on the side of diplomacy–thinking twice about what we say and how we say it.

This shouldn’t come as a surprise. Think about interactions with someone who has power, authority, dominance, control over our destiny–be it in the doctor’s office, the workplace, school or wherever.

Throughout my years of counseling high school students, we rehearsed little speeches–student to teacher–usually involving something “unfair” (often a grade, sometimes a reprimand, sometimes a misunderstanding).

I think the analogy is appropriate. Normally confident, successful students would feel powerless with the most warm and caring of teachers who, after all, held the key to their grade. In my highly competitive high school it translated to their college acceptance, their future–their life as they saw it.

Interestingly I think it was easier for me to successfully counsel and coach the kids and wait to get feedback that they did it right–which hopefully would empower them to successfully handle future sticky situations. (“Nothing succeeds like success,” they say).

Yet often when the parents jumped in first, fronting for their child,  it was triggered by their child’s emotions, compounded by their emotions. I recall in many cases the teachers were upset and let me know it.

And so I wonder:  Do we do better advocating for our parents in uncomfortable situations (possibly 2 layers of emotions) than they do advocating for themselves? Are we able to stand back emotionally and tactfully ask uncomfortable questions–or should someone we respect rehearse with us and empower us? Should we rehearse with and empower older parents?

To help parents (and ourselves) age well, there’s no question that sometimes uncomfortable conversations with physicians are necessary. The key is getting to the point where we feel justified and empowered to have those conversations.

Click https://helpparentsagewell.com/2011/03/22/help-aging-parents-the-doctor-patient-relationship) for reasons it makes sense to accompany aging parents to doctors’ appointments.

Challenging Doctors to Help Parents–Who Are Patients–Age Well

Are We Brave Enough to Question a Doctor?

Reaching old age in relatively healthy condition involves many things. Along the way, there are the inevitable health issues that may require hospitalization.

I also think it’s safe to say that most of us just naturally want to please our parents’ doctors or at least not get on their bad side. We want to collaborate, not seem critical or questioning.  But sometimes………

While it’s not uncommon to feel stressed just thinking about having a difficult conversation, especially one that involves someone in authority, it can be more daunting when we feel we must have this kind of conversation with our parents’ doctor or other health workers who care for our parents.

*                         *                     *                        *                       *

Maureen Dowd tackled this issue in her  April 13, 2011 NY Times column, informing us that–among other things– “A report in the April issue of Health Affairs indicated that one out of every three people suffer a mistake during a hospital stay.”

For those of us trying to help parents, older people or anyone age well, I think this column really is a “must-read,” especially if a hospital stay is imminent or might be in their future.