Why Your Ill Loved One Fools the Doctor and What to Do About It

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A frequent problem expressed among caregivers is that their aging loved ones aren’t truthful with their doctors. At home, they may gripe about intense pain or exhibit memory problems and accuse family members of theft when they can’t locate one of their belongings, but the moment they sit down with their doctor, a change occurs. Like an actor on stage, the patient becomes animated and charming and has no complaints to report.

My mom was a supreme example. She fell in her apartment—often more than once a week—and had memory problems. She was taken advantage of by unscrupulous telemarketers and suffered from digestive issues. However, when I took her to her doctor, all her hardships disappeared. What I called her “hostess personality” took over as soon as we would arrive at the office. While she may have complained of arthritis pain in the car on the drive there, the minute she had a chance to tell her doctor how terrible she felt, she became perkiness personified.

I’m not alone, either. A while back, a friend of mine took her mother to the doctor because she suspected her mom was in the early stages of Alzheimer’s disease. My friend sat dumbfounded as her mom charmed the socks off the doctor and seemed as sharp as she had been 10 years ago. Her mother denied having any health issues, especially those associated with memory. The doctor was too busy to run additional tests on someone who appeared to be “so sharp for her age,” so he signed off on some prescriptions and sent them on their way. My friend felt like banging her head against the wall.

Why Do Seniors Put on an Act for Their Physicians?

One reason our elders put on such a show for medical professionals is fear. They don’t want to face the reality of a serious diagnosis for many reasons. Hearing that one has COPD, cancer, Parkinson’s disease or some form of dementia is devastating enough. But one of the most frightening consequences of such a diagnosis is the possible loss of independence. So, they put on their company manners and tell the doctor whatever sounds best in order to get out of there with the cleanest bill of health possible.

Denial is a natural and powerful tool for humans. It often helps us get through difficult situations until we can emotionally wrap our heads around an issue and tackle it. In the case of our aging loved ones, when they come home from a doctor’s visit without any major developments, they’ve dodged a bullet. Whether or not it is a conscious effort, many seniors gather and direct all their energy into that one appointment, and it’s often enough to convince a doctor or other professional, who isn’t privy to their daily behaviors and routines, that all is well. It also doesn’t help that healthcare providers are pressed for time and cut appointments increasingly short these days.

Fortunately, there are some tips and tricks that family caregivers can use to ensure their doctors are well informed and their loved ones’ dignity remains intact.

Tips for Promoting Honest Communication with Doctors

  1. Talk with your loved one ahead of time, explaining how doctors these days respect and appreciate an educated patient. Our elders grew up in an age when doctors were put on pedestals and there was little meaningful patient-physician interaction. Reminding them that they have some power during these appointments may encourage them to be more forthcoming.
  2. Remind your loved one that you are on their side and that their safety and health are your number one priority. If your relationship isn’t the best, try to improve it. This isn’t always possible, though, as some elders are suspicious of everyone’s motives. All you can do is try.
  3. Try to talk to the doctor ahead of time. Alert them to your loved one’s impressive acting abilities, and discuss any symptoms and problematic behaviors you observe at home. Keep in mind that few doctors will talk to you without an appointment, and you’ll need the proper HIPAA authorization or a valid medical power of attorney document to have a comprehensive discussion about a loved one’s condition.
  4. Another option for communicating with the doctor is to write and send them a letter ahead of the appointment noting your concerns. This way, the doctor is prepared with the facts as you see them. They can then bring up these issues in a tactful way, pursue additional testing or suggest a referral to a specialist without revealing you as the inside source of information.
  5. Consider attaching a diary that you’ve kept over a week or two to your letter that indicates the dates and times of new or worsening behaviors or health issues that concern you. Again, this will enable you to share detailed information with the doctor without embarrassing your loved one during the appointment.
  6. Bring a complete list of every prescription, over-the-counter medication, herbal supplement and vitamin your loved one takes, including dosages. Instead of composing a list, some caregivers simply put all their loved one’s pill bottles in a bag and bring them to the appointment. This can help the doctor spot drug interactions and prevent overmedication.
  7. Medical professionals are notoriously busy, but during the visit, make sure the doctor interacts with your loved one. Some will look over their notes and then speak directly to you, the caregiver, since it’s faster and easier to get straight answers. However, you are there to support your loved one, take notes and contribute to the improvement of their care plan. Taking over the appointment will only build resentment and cause your loved one to shut down further. In some cases where an elder is no longer capable of communicating with the physician, their caregiver must take a more active role in appointments. Nevertheless, your they still deserve the dignity of being treated as an adult patient and participating in their own care as much as possible, no matter how childish their behavior may sometimes be.

Carol Bradley Bursack

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Over the span of two decades, author, columnist, consultant and speaker Carol Bradley Bursack cared for a neighbor and six elderly family members. Her experiences inspired her to pen, "Minding Our Elders: Caregivers Share Their Personal Stories," a portable support group book for caregivers.

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39 Comments

oldcodger2 .... you have said the other things that are on my mind. We are definitely put between a rock and a hard place, damaging our own health, well-being and relationships in the process. And why is it we are good enough to deal with all the unpleasantness, but not good enough to be trusted in our efforts to make things better and safer??? And when things hit rock bottom ... it's quite true we could be seen as being neglectful, even though we've had no legal authority or obligation to oversee our parents and their issues. I agree with others that we do have to respect our elders' right to make their own decisions and live their lives as they choose. However, if they are a sinking ship, and we have done all we can to avert the situation, they should not expect us to go down with them .... and neither should anyone else. I only pray that if I am lucky enough to grow old, that I will have faith in the two beautiful children my spouse and I have raised, with our values, to do right by me .... and that I will never, ever put them through the pain and agony that that my father is causing me.
My MIL is the same way. Forgets what day it is, forgets her meds, complains of aches and pains constantly - NEVER has a good day. The sun NEVER shines - EVER - for her.

Yet, if someone stops by to see her or calls her - she is chipper as a little birdie in Spring! No complaints! All is well in her world. Same with Doctor visits. She complains of this or that until NOT taking her to the doctor would basically be neglect on our part and then when she gets to the doctor - she tells him she is 'doing pretty good for an old lady' as she puts it.

The Doctor jokes with her and she jokes with him. They laugh and have a pretty good time. I have to remind her about why she is there.

Even though we know why they do it (for attention or be prove their independence) - it does not lessen the frustration. We get to hear them harangue about how awful they feel all the time. (I then feel guilty because I get so exasperated. I know she doesn't feel great or even close to good - ever).

But, everyone else gets to see the 'sweet little old lady.' Her other kids think we are making it all up - they can't see anything wrong with mom. We does her hair for them, puts on make up, dresser nicer, walks straighter. If they call or visit (rare occasions) she looks and sounds like a completely different person. She tells them, I'M FINE - YOU DON'T NEED TO WORRY ABOUT ME.

No, THEY don't have to worry about mom - WE do it for them :0(

As for that lovely question "Do you feel safe at home" - that is legally required if an older person or child is taken to the ER. (she had to go last year due to sciatica). I wonder what would happen if an elderly parent happened to be 'mad' at you at the time and decided to say 'YES' just for the heck of it? In this day and age, a person is guilty until proven innocent.
Yes this is a problem for me too. I am caregiver firmly 90 year old husband. He is still handsome and charming and dresses to the nines when he goes to see the doctor. He makes polite chitchat and really goes the extra mike. At home he wallows in self pitt, wearing an old bathrobe and moaning and groaning and asking questions that indicate he is mentally somewhere else. I was beginning to think he was "exaggerating" his problems at home. I see that he is to some degree acting both at home and in the doctors office. I guess that is normal andI have to make allowances. It was helpful to read everybody's comments on this.