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Over the past year I have joined my mother in her doctor visits because her memory is declining and she doesn't fully relate any issues or medical care but, does rely on me to help her with it at home. She fully and agreeably relies on my judgement to help. Her doctor is extremely dismissive of me in person. On the first visit, I handed her the FULL DPOA and she immediately told us that means nothing unless mom is incapacitated. I thought that was a regular "springing" POA that worked like that. The last two times she asked mom about her affairs being in order and she was told (by mom) that I am her primary home care and take care of everything for them...bill paying, house cleaning, shopping, cooking, appointments. The second time when mom told her that, she got closer to mom and looked pointedly at her and asked "and the rest of your children know this". I kept silent but was a bit put off. My family is tight and they all support me and are grateful I am able to be there as I am. I have one brother who comes to assist when my father is more incapacitated as his health is in much greater decline. There was a recent episode and mom had a bad morning with dad's care before her visit so she was visibly shaken. The doctor made comments like "How nice of your son to come and stay with you and your daughter is able to "bop in". WTH - I more than "BOP IN". They live next door and I am there 2-3 times each day. I never leave my property without taking them for a ride. I cook for them, clean, yard work, EVERYTHING. I wanted to set her straight but, mom has had her as her doctor for 20 years and she's almost 89. How do I inform this doctor she is overstepping her bounds and that as DPOA that I DO indeed have a say in what goes down. I wished she had just tended to moms' health. Instead she spent the whole visit talking about my fathers and his impending death and what was mom going to do. We have that covered and she has been told that 3 times now. I am a professional who owns my own business and has assigned staff to handle it while I spend my time caring. I do not rely on any income or inheritance from my parents and seek nothing but to help them in their elder years but, this doc is really rubbing me the wrong way.

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"She fully and agreeably relies on my judgement to help."

I found with my mother's doctors, SHE needed to be the one to convey this message, clearly and without room for discussion, to the medical personnel.

If mom still has cognitive function, tell her SHE needs to set this doctor straight. A simple " hey, Doc, I appreciate your concern, but (your name) is my primary caregiver, not to mention my POA, and needs to know everything related to my care; whether or not my other children are involved is really of no concern to you. Now please explain to both of us what's going on with my health today."

My mom had this terrible habit of clamming up as soon as we entered the doctors' offices. I had to remind her that, while I was ready, willing and able to advocate for her, SHE needed to let the medical people know her preferences. It also kept them from speaking to her like some wayward child.

If that still doesn't seem to work, might be time to "fire" this particular doctor and find another one.

Hope this helps!
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DT0ller Jul 8, 2021
Yep. Mom and I talked and she said she'd make it clearer to her. We weren't sure of the best words but you have helped with that too. Thank you.
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As DPOA you actually don't have a say in medical decisions unless your mother instructs you to take them for her or has become mentally incapacitated.

I agree with you, though, that the doctor seems to have a bit of an attitude on her and I'm not surprised it's rubbing you up the wrong way. Having said that - do you really mean that the first exchange you had with her was to hand her the DPOA document? What, before you got to "hello"?

Maybe it might be an idea to make a short appointment to see this doctor by yourself and have a Clear The Air chat, being respectful of the fact that the doctor *cannot* discuss your mother's confidential medical information without your mother's permission - instead, use it as an opportunity to fill her in on the family background and support structure. Don't forget, you are both on your mother's side, and a 20 year doctor-patient relationship is not something you want to spoil.
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disgustedtoo Jul 11, 2021
"...a 20 year doctor-patient relationship is not something you want to spoil."

Depends on how good that "relationship" was. From the sounds of it, there wasn't much of one. A good doc might have spent a little time in the course of 20 years to get a feel for the family dynamics, especially as mom started aging...

Spending 10-15 minutes with someone twice a year, doc hardly knows squat about her patients.
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Maybe it's time for another doctor for your Mom, if she agrees to it. Look for a doctor who specializes in geriatric medicine. You want a doctor who is sensitive to the issues of an elderly person, who doesn't over medicate, and who will treat you like a member of the team who are caring for your mother.
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rovana Jul 11, 2021
Sounds more like OP did not think the doctor was "sensitive" to HER issues. This whole business with the DPOA presented upfront does imply that there is a question of mom's competency. Which doctor does not agree with. Mom is the doctor's patient, not the OP. Probably not meant to be overbearing or interfering but OP was not very tactful.
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I would go to an attorney and have a HIPAA release drawn up that states it never expires and specifically states that it is intended to be honored in any jurisdiction presented.

This is the document that doctors understand.

Unless you have presented a DMPOA is doesn't mean anything as far as health care is concerned. It must be the medical POA to be valid. I think that the doctor is honoring your moms autonomy but, going about it in a terrible way.

I would encourage mom to tell her that she appreciates that she is looking out for her best interest but, that includes you being involved with her medical care.

Some doctors have god complexes and they are a pita to deal with. If mom standing up and addressing the issues doesn't solve them, I would be finding a different doctor. You can be assured that the current one will call APS if you do this, so be prepared to deal with that. Which is a good thing, it clears up any doubts about what you do for your folks.
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notgoodenough Jul 8, 2021
I wonder, a doctor were to call APS in the situation you describe, if there would be any recourse for the person being "accused" of abuse? Like maybe a complaint with the AMA? There should be some redress for people who have had these sort of abuse complaints made against them out of spite...
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It sounds like you and the doctor have gotten off to a not-so-great start. Your mother has appointed you her POA when she can no longer decide for herself. As long as she's able to make decisions for herself, it sounds like the doctor would rather deal with your mother. That's fine, right? Your mother is still of sound mind, correct? You can be at doctor's appointments and listen in so you are also kept abreast of issues with your mother. That's fine, right?

Ultimately, it's sounds like the bigger issue is you don't think the doctor gives you enough credit for the time you spend with your mother and the work you do for her. Why do you care? Can you perhaps change your perspective a bit? The doctor has known your mother for many years and perhaps she is trying to provide words of comfort rather than words against you. Your mother's care and her relationship with her doctor has nothing to do with you personally. Life is waaay too short to find issues and problems everywhere you turn. In the end, what's important is the relationship you have with your mother that should be affirming, not the perceived snippiness of the doctor. Please reassess what's important here.
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DT0ller Jul 11, 2021
Why I care is because "life is too short". What happens when the doc NEEDS to work with me when mom does become incapacitated. Should I trust her attitude will change? Do I continue with someone who is standoffish and rude just because she doesn't accept me in my mother's care? How can that have nothing to do with me as you say? If going forward mom wants me to be more involved, how does that not involve me?

I won't push for a change but, just so everyone knows if I asked my mom would change. She wouldn't forsake me for anyone. Neither would I for her so, I give both my parents as much autonomy as they want and as much help as they want (which is more than being left alone). My parents asked me to help, ask me everyday for something new and I do it willingly. I do it all willingly and lovingly so, some of the assumptions of this forum are crazy out of line.
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I believe "Notgoodenough" nailed it when suggesting that your mother needs to clarify your role with the doctor rather than you. I understand a few possibilities of where the doctor is coming from. It could be that she believes a durable POA is not sufficient for health care decisions. She may or may not be correct depending on the wording in the DPOA document and what state you live in.

I suspect the primary hurdle for the doctor is that she does not consider your mother incapacitated. It does not sound like your mother is incapacitated. Memory loss and incapacity are a long way apart on the scale of how impaired someone's thinking is. Your mother may not be able to remember what the doctor said, but she is certainly capable of expressing her wishes in regard to her care. It's a common mistake to believe that someone who can't manage on their own automatically activates a POA.

The language in most POA documents is clear that the individual has to be unable to make decisions before the POA can step in. It's a gray area to say if someone is unable to understand their decisions and their consequences versus not agreeing with the opinions of others.

I once had a client with vascular dementia who "fell in love" with a caregiver and began to give the aide large amounts of money (thousands). The family knew he was being suckered, his doctor knew it, Adult Protective Services knew it, and law enforcement knew it. The fact that the person had documented dementia did not mean anyone could step in and put an end to the scam. The reason was that while he was making bad choices, no doctor considered him incapacitated.

That's an extreme example, but it shows why a doctor might disregard a POA document when the patient is still able to converse and make decisions. As for your mother's doctor, she may be off the hook for wanting to deal directly with your mother rather than going through you, she is NOT practicing in a way that a compassionate physician would.

One thing I know with all my heart after 20 years of caring for dementia patients is that the caregiver MUST have a trusted ally in the physician directing their loved one's care. Dementia caregiving is a long, often solitary road. Having a good doctor backing you up versus someone who makes life more difficult is the difference between peace of mind versus one more source of stress.

My loved one would have to be dead set on staying with a doctor even knowing how miserable I was before I would stick with someone who wasn't an ally. Doctors are a dime a dozen depending on where you live. There are areas of the country where it's a take-it-or-leave-it shortage of doctors. If that's not the case where you are, I'd be doctor shopping pronto. Good luck.
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DT0ller Jul 11, 2021
Yes, thank you. After I told my mother how the comments upset me and some in the Caregivers forum thought she might suspect elder-abuse which upset me even more, she said we'd talk with the doctor again so she'd understand our family dynamics. I'm not making decisions for mom. She is not incapacitated but, it brings to light a new question. If the doctor doesn't consider her incapacitated, why isn't she listening to her tell her about her home health care? Why wouldn't she work more freely with me after we signed her office's consent form? Why does she feel unwelcoming of my presence? I know she's not there for ME but, she needs to understand I am there for my MOM.
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DT0ller, after reading your responses, I think that you should get your mom established with your dads doctor.

Only seeing your mom 2x a year, this "doctor' probably doesn't even recognized your mom when she comes in.

She isn't addressing the situation that brings your mom in and she is not respecting your mom's caregiving daughter, HUGE WAVING RED FLAGS! If she isn't helping your mom with her medical conditions, she could very well be harming her. Perfect timing for a second opinion and a smooth transition.

I understand not wanting to push for change but, this "doctor" has ignored her 3 times already (I believe in the 3 strikes and you are out rule.) and God forbid that something happens to your mom, this is the Yahoo that you would need to have confidence in to provide records and/or medical care. Not something that I would want to deal with in a time of crisis. Your alarm bells are telling you how wrong this person is for a reason, trust yourself.

She is blessed to have you looking after her and advocating for her well being.
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notgoodenough Jul 11, 2021
Totally agree. Especially as mom is aging, you want her doctor(s) to be partners with you and mom in her care; an adversarial relationship will be detrimental to mom at the end of the day, regardless of the reason behind it.

Since you already have a relationship with dad's doctor, either switch mom's care to him/her OR ask that doctor for a reference, if he/she can't take on mom as a patient.
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There are HIPPA forms that need to filled out at all Drs offices,, have your mom sign one that says they may talk to you . We did these at all of my moms doctors and I never had a problem. Plus my POA was indeed one that came into effect upon signing ( as is the one we just did for ourselves and DD) It also helped that her Dr was our Dr, and a elder care specialist. I agree this Dr is a bit heavy handed, and may mean well.. or they could just be a controlling butthead...
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I don't understand the issue. You and your mother are in agreement, right? You are not suggesting decisions that are contrary to her decisions. So where does the issue of the medical power of attorney come in? If you said, "My mother should have this vaccination," and your mother said, "I do want that vaccination," then the issue of her competency and your authority would be critical. But if she is stating her decisions (perhaps based on your advice) and the doctor is acting on them, why do you need the doctor to recognize your authority? I would think this would only arise if your mother was insisting on a decision you thought was not in her best interest.

It sounds like you would like better recognition of your caring role from her doctor. I don't blame you, but it really doesn't seem to me to matter to the care Mom gets from that doctor. That doctor and your mom have known each other for a couple of decades and their relationship is well established. Unless your mother wants to change doctors, try to respect that relationship and don't be bothered by the relationship between you and the doctor.

If it ever arises that you want the doctor to do something or refrain from doing something that is different than what your mother tells the doctor then you may need to get a lawyer involved. But as long as you are just giving your mother advice and she states her decisions to the doctor, where is the problem?

BTW it sounds to me like you are an extremely valuable and loving care partner to your mother. You deserve a lot of credit for what you do. I wish the doctor would express that, too.
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DT0ller Jul 11, 2021
My only issue or question is, if she needs my mom to tell her 3 times my role, and she undermines my role in her caregiving - will she work with me as my mother becomes more reliant. Everyone seems to think I am inserting myself when I was just trying to establish the connection now that mom is beginning to need more and ASKED me to be a part of her visits. The problem is, the doctor doesn't seem to recognize it. My DPOA includes medical and financial. IT is NOT a springing POA. I've signed her office's required Consent form. That was all before this last episode of asking whether or not my siblings knew I was taking care of things for her.

It's okay though as mom and I have decided together on a course of action to speak with her about my role. Coming once more from mom...then we'll see about the next step.
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"...this doc is really rubbing me the wrong way."

This doc is rubbing ME the wrong way, and she's not even my doctor!

I've dealt with a few like that in the past - mainly pediatricians. If YOU the pediatrician are not listening to me and talking to me, then I don't want your "service." One was actually head of some children's hospital, but sorry, I have a baby who cannot speak for herself and if you don't work with me and talk to me, you won't have my children as a patient. I had to change pediatricians twice. The next one was referred by other mothers at the day care and she was the BEST! Sadly she decided to go "save the world" after 5 years, but hand-picked her replacement. I gave him a chance and he was second best!

I feel the same way about vets with my cats. Talk TO me, not AT me, and for sure DON'T IGNORE ME! I can fend for myself, but my children, when still young, and my cats can't. Same applied with my mother. I had to change docs when she moved to MC (too far away and could never get in touch with them, including the 9 months I tried to get the competency letter sent, which was NEVER sent/received!) The new doc seemed okay at first, but when dealing with dementia, it's the same as for my young kids or my cats - work with ME, talk to ME, LISTEN to ME! So, we had to find yet another.

If mom wishes to stay with this doctor, I would have her fill out and sign the medical release or HIPPA form or whatever they use in that office. It isn't just doctors who might reject a DPOA, banks are notorious for this as well. If you sign the bank forms or the doctor office form, they have to allow you access to her information and include you in discussions.

I really don't care what her reasons were for doing/saying what she did. None of that was called for. I wouldn't even waste my time having a "discussion" with her, as you are not likely going to change her attitude. She has shown her colors already. Once, maybe a bad day. Several times? Nope. I would do my best to find someone else and convince mom to change doctors. No one needs that BS from a doctor.
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rovana Jul 8, 2021
But if mom, the patient, is not incompetent, I can see why the doctor would basically want to deal with mom. The HIPAA release would be the relevant document, not a DPOA. Frankly I think shoving a legal document right off the bat at a doctor would be offensive, unless it were really a matter of incompetency. Would sound like there is some adversarial stuff going on here.
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