December 28, 2010

The physician / patient relationship is among the most sacred in the world, but when the patient has dementia, that relationship becomes more complicated for everyone. The most important thing is to have a physician who partners with you, understands the disease process of your loved one’s particular form of dementia, and understands the responsibilities of caregiving. That physician may be a neurologist, a geriatrician, an internist or a family practice doctor.  However, as the caregiver, you need to know there are nuances to managing dementia patients that doctors who don’t care for them regularly would not know.  Medicine is an art, not a cookbook, and that is nowhere more true than in managing a dementia patient.  As caregiver, you must understand there are responsibilities on both sides of the doctor ~ patient / caregiver relationship and I will attempt to describe both sides of the equation.

  1. Expect that some things the physician tries will not work for your loved one.  Be willing to work with the physician.
  2. Note that pharmaceutical company ads are designed to sell drugs and not to prescribe them.  Trust your physician’s recommendations, not the ads you see on TV.
  3. If your loved one’s behavior or condition changes for the worse after changing medications, notify the physician immediately.  Don’t wait for the next visit.
  4. The physician should be a good resource for coordinated care — home health, daycare, hospice, assisted living, nursing home, etc.
  5. The physician should be a neutral third party who views things more objectively than either the caregiver or the dementia patient.  Follow his or her medical recommendations to the letter and consider seriously (and objectively, if possible) recommendations regarding care, such a placing your loved one in an in-patient facility, placing him on hospice care, sending your loved one to dementia daycare, etc.  Most caregivers have not been through this process before, but an experienced physician has.  Trust his/her recommendations.
  6. Many caregivers do not feel comfortable telling the physician about behavioral and other issues the patient has in the examination room in front of the patient.  If this is the case, a few days before the patient’s visit, send the physician a letter or e-mail detailing your concerns in as few words as possible (while still covering the subject).
  7. NEVER send a dementia patient to the doctor alone!  There is no substitute for a responsible caregiver as an advocate for his/her loved one.  Elderly dementia patients are often sent from an in-patient facility by ambulance to their physician with no caregiver in attendance.  The patient does not have the ability to answer for himself or to remember the physician’s recommendations, so the visit is a waste of time.  As the caregiver, it is your responsibility to be able to answer for your loved one, to watch after your loved one’s interests and to implement the doctor’s orders.
  8. If certain behaviors are a particular problem, keep a time / date log of them and present it to the physician.
  9. Write down questions in advance of the patient visit, so you will not need to call the doctor afterward.
  10. If your loved one’s condition changes markedly, have him evaluated by his physician.  This can indicate infection, stroke or other serious problems.
  11. Make certain to bring a list of all the patient’s medications and the exact dosage to each patient visit.
  12. Your pharmacist is a valuable partner in patient care, also.  Use the same pharmacy for all your loved one’s medications, so that the pharmacist has a complete list and can watch for drug interactions.

Do you have other recommendations?  Please comment!


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5 Responses to “THE PHYSICIAN, the PATIENT and the CAREGIVER”

  1. ellen says:

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  2. Thanks for that high-quality content. I like your blog and I hope you will keep posting so often in future.

  3. news says:

    An insightful post right there mate . Thank you for that !

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