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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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I think Ms Lynne forgot the motherhood and apple pie in her white paper summary. The big question is HOW to achieve that reliable system. That help she promises - who's going to do it? And who's paying?
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Well Hell!!!! DrK, was looking forward to your input and insights..... hope you at least continue to read different threads on this site... sending you hugs and hope your endeavors are successful...
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LadeeC & Veronica91: Am only now realizing that I missed a few of your comments earlier; sorry about that.

Well, what can I say. As I mentioned when I first posted some comments here, I’m visiting and here to learn. Also as I mentioned, I wish I could participate indefinitely in such a forum, but probably can’t, and didn’t want to give you the impression that I could.

I’m a bit sad to realize that I’ve accidentally made some people uncomfortable. I do greatly admire the work all caregivers do, and appreciate having had this opportunity to learn from this community. Take care and thank you!
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LadeeM .. what Veronica said, and .. if medPros (in general) come onto the forums hoping to strike up a profitable relationship, I guess that's just part of the game, but it strikes me wrong. It seems more like a distanced relationship, rather than becoming part of a community. Not sure my words are conveying my concern, but ..... there ya have it. It's sort of like this: I'm **really** good at what I do, it's my vocation and am paid for it .. if I came here, doled out advice and expected some kind of compensation, everyone on here would basically smack me over the head and tell me to get over my own dam*ed self, right?

Just because a medPro has more education and experience in the field (debatable considering my years, but, meh), doesn't exclude them from being a welcome part of the community .. but preferably on the same level as everyone else.
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No matter what we do, over the next 20 years most geriatric care will have to be provided by non-geriatricians: general internists, family practice docs, NPs, and of course lots of family caregivers. So, I am all for encouraging people to go into geriatrics but really think we must focus on making geriatric care more doable for all involved.

This is rather wonky, but this RAND white paper by Joanne Lynn describes some practical reforms for the nation to consider.
"A reliable care system that helps the chronically ill elderly live well at the end of life would make seven promises: correct medical treatment, reliable symptom relief, no gaps in care, no surprises in the course of care, customized care, consideration for family situation, and help as needed to make the best of every day. "
http://www.medicaring.org/whitepaper/

Good stuff but of course it's always hard to make change in healthcare :(
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LadeeM
We are freely sharing amongst ourselves information we have learned from training and experience. We are not picking each others brains so some day we can go off and write a book, text book or novel about the information gleaned here. As soon as some one mentions they can not visit very often because their time is not being paid for (funded) we wonder just why they are here. People come and go as we all will. Some just ask a question and move on others stay and become friends. Some have been through such a horrendous caregiving experience that once it is over they have PTSD and this site reminds them so much of what they went through it is healthier for them not to visit. Do you see what we were getting at.
That is why Agingcare has a policy of not allowing members to direct traffic to personal web sites where they may be conducting money making activities. There are ads on this site as there has to be income generated to pay the moderators and experts and maintain the site itself but I bet no one is getting rich.
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LadeeC and Veronica...... what are your concerns about DrK???? In what ways may we possibly be being 'used'.....
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I wish they wouldn't cancel apointments, especially if the elderly rely on their adult child to drive them to the appointments. The majority of these adult children have to schedule these appointments around their work schedule. Some take an unpaid day off. There is nothing more irritating than taking an unpaid time off in advance only to find out the appointment has been rescheduled.
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OK LadeeC Now I understand. Sometimes it simply impossible not to have strong feelings for and about the patient, it is still very important to maintain professional standards
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level of separation .. emotionally.
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LadeeC. Like you my antennae shot bolt upright at the mention of funding. I have rubbed shoulders with this subject for many years. Both my husband and son have been at least to a certain extent involved in this through their work and I have dealt with it as a volunteer for a local arts organization. I hope this is not the case and we are not being "used"
What do you mean by "there is supposed to be a level of separation" There needs to be confidentiality between the patient and those in whom he/she confides but they should be told up front that if it is something the entire team needs to know they should be prepared to share for the good of their overall treatment.. The whole team can not work as a unit if they don't have the whole picture but of course there are exceptions. The person that delivers meals to a patient on infectious precautions only needs to know how to use those precautions not the nature of the disease. However that is another soapbox because I do not think ancillary staff should come in contact with patients under those circumstances All members of a patient's care team should be bound by the same level of confidentiality and share all relevant information.
It is interesting that you object to the use of patient, I object to the use of client. I feel a client is someone who uses the services of a professional other than a medical professional but while they are being cared for in any circumstances by anyone medical and dependent on that person for care they are a patient. if the caregiver is family or not being paid they can be loved one' friend or Mom etc
But that's another soap box and not really relevant to your comments.
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Wow .. some great conversation going on. Yay!!

I've been taking a bit of a respite .. long overdue, especially considering the stress of the last couple of months .. not to mention holidays. Now I have all kinds of stuff swirling around in my head in response to all the posts. So, if it comes off as a ramble .. eh .. it is. LOL Bear with me?

I have several pet peeves:

- Our scheduled appointment is at 1:15. We're expected to arrive 15 minutes early .. so that we can be seen 15 minutes AFTER the scheduled time. Really? Like our time isn't as valuable as the medPro? *grumbles*
- I'm not a fan of western medicine to begin with, but one of my greatest complaints is the seeming need to pigeon-hole the client (I will *not* call them a patient .. it implies we're just sitting there, patiently waiting for god's call .. pfft .. we are paying the medPro: they're working for US, dang it) into nice tidy categories. "Oh, it just comes with the aging process." or "That's what happens with dementia." (Well .. in this case, no, it was the meds, but I digress.) Why isn't there a more determined approach to *healing* the issues? It just seems like an 'easy out' to me.
- We seem to treat symptoms, rather than the patient, as a whole. When you have a client with multiple conditions, I really wish for a more holistic approach, rather than treating individual symptoms and NOT seeking a remedy - for the problem(s), as a whole. More often than not, one issue leads to the another.
- I'm tired of the assumption that just because Medicare won't cover a solution or treatment, alternatives are never considered or voiced.

Now .. for the hard topic swimming around in my head:

DrK .. you are, of course, welcome to this site, as is anyone involved with treating loved ones or the elderly. I met your arrival with some trepidation wondering if your reasons for being here were self-aggrandizing. Most of us are here to help ourselves, for sure, so I kind of stuffed that negative reaction and allowed a mental twist in my head to make room for whatever might come. Most of us come here to find help, one way or the other in dealing with the issues we face, daily. Most of us stay to offer each other support. Your mention of funding raises a flag for me, as if the only reason you'd remain and contribute would be in the role as the "professional" for which you'd be compensated. I truly hope I'm wrong about that.

We NEED the medPros to be on the team. The team. We need the entire medical field to hear and understand the daily, hourly, struggles we endure for the sake of our elderly. I wish every doctor and aide and nurse would spend a few hours a week reading the forums. I know there's supposed to be a measure of separation. I get that, to a degree, I really do. But we NEED some of you to care enough about the plight of the elderly and their caregivers, that financial compensation doesn't enter the picture.

I hope you find it in your heart to stay and learn and contribute, we need you, as much as we need everyone else, here.

LadeeC
(not to be confused with LadeeM)
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Brandywine, I Agree. I lie on the table. I lay my bag on the chair. Now I lay me down to sleep means I am placing myself on the bed. Lie is intransitive. Lay is transitive, which means it needs a direct object.
That was fun.
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One of my main concern with the medical profession is the use of hospitalists especially for those with dementia. What ever happened to a person's own doctor visiting patients in the hospital? It seem that particularly with older patients that it is important for the doctor to thoroughly know the medical history. The hospitalists do not know the patient or the family.
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Just to set one point straight. An overseas physician can not just get off the boat - well the plane these days and hang up his shingle. It is necessary for him/her to meet very stringent standards and pass advanced examinations before he/she can obtain a US medical license not to mention becoming a permanent resident in order to remain here. Now that is not to say some practice in areas where they have no experience and some are unpleasant lazy individuals, but others come from very honorable halls of learning and have advanced credentials. I met one of the lazy type in the ER one day. I had gone with a dangerously high blood pressure which I caught by chance and had been monitoring every half hour. He prescribed a medication without even seeing me and discharged me (still with B/P too high) with the instructions to stop taking my blood pressure so often. I was glad to leave as I would not have trusted him to treat me anyway.
Brandywine I have noticed that I am always called out of the waiting room by my first name but this is because of the privacy laws. Since HIPPA patient's names are no longer on the doors of their hospital rooms. When I have been admitted to the hospital I have been asked how I wish to be addressed .
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Wish the doctors and nurses would not call me honey, hun, sweetheart, or, sweetie pie, or sweety. I have a name. Its Brandy or Mrs. X. Even ma'am or miss would be better. I wish they would say lie down on the table not lay down on the table. But mostly not honey.
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Dr K has a point about talking to the patient with out being interrupted. I will sit next to mom, we both face the MD and I let him talk to her. If she lies, my eyebrows go up. At the end, he will turn to me to see if I have questions. I always ask them with her present, taking him aside upsets their patient-doctor relationship. If I think she is losing it and he says she is fine, I send her in next time with a sibling who will tell him the same thing.
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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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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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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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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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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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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,
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, 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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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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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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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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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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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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