I take my mother to multiple doctors many times a month (Mayo Clinic), and one doctor just brought up that my mother always looks to me before she answers any question, and I usually speak for her. She responded to the doctor that I keep track of all her treatments and medical history, and she doesn’t know most of what has been done to her. I also regularly prompt my mother with how she’s described symptoms in the past, so she remembers what she needs to be describing, and I know that looks bad. The doctor said she was concerned about abuse or dementia because my mom wouldn’t speak without my permission.
Anyone ever experience this? How do I maintain my mother’s personal rights when she just trusts me to keep track of every medical thing? This is not the first doctor to show concern that I speak for her.
My Mom still thinks well (based on what she remembers at the time) but has MCI with significant short term memory problems. When we went to the orthopedic doctor this week following a fall, I gave them a copy of Mom's healthcare POA and informed them she was living with me. Since she hadn't been there for 14 years (last time for rotor cuff repair and rehab, I was with her then because she couldn't drive while the arm was in a sling), they wanted to update her medical history information and I provided most of that, then got out of the way for the actual exam. I did repeat one question in a louder voice when Mom looked my way but I didn't answer it. The x-ray tech didn't much like me accompanying Mom initially, but seem to understand by the time the x-rays were complete. The tech positioned Mom and she promptly moved as the tech walked to the control room. After the tech repositioned her, I reminded Mom she needed to hold position until the x-ray was taken as the tech walked to the control room the second time. When WE discussed treatment for the re-torn rotor cuff, I explained Mom had wanted to avoid surgery with the first tear and tried PT but ended up going with surgery because of the continuing pain level. Since she doesn't seem to have as much pain this time (and the increased arthritis deposits make her a much poorer surgical candidate), WE want to start with PT and see how much that helps. Although I didn't state this to the PA, I will admit reluctance to consider surgery now unless absolutely required because of the potential impacts of anesthesia on her MCI - her memory problems got so much worse immediately following her cataract surgeries.
Mom knows she has memory problems and counts on me to help her cope. I think I'm also a bit of a security blanket too, particularly when we are away from home. I try to facilitate Mom doing for herself as much as possible and to gently help when needed or when she asks. If someone else doesn't like that - too bad for them - my concern is my mother! Recently at a restaurant she asked me to repeat what the waitress said a couple of times, then she pushed the menu my way and told me to just order for her. I've never done that before so it was a bit uncomfortable for me, but I picked the grilled salmon dinner I knew she would like and we enjoyed our meal with other family members. I'm not sure whether Mom was really having problems hearing the waitress or coping with the menu at the end of long day; she asked for my help so I gave it.
My late mom told me, rather late in her life "there should always be two people present when someone is ill; the standing up person and the lying down person; The lying down person can't possibly understand or advocate for themselves".
Great wisdom there, mom; although in hindsight, I think she was already suffering some cognitive decline; her language skills were more sophisticated than "lying down person". But you get the thought!
What is problematic, and CM hit the nail on the head--the doctor is often trying to evaluate the patient by asking questions (I'm a psychologist, so I know whereof I speak; there is nothing so damaging as a parent answering "first" for a child, or trying to tell me "oh he knows that, you're asking it wrong". I'm asking it "that way" for a reason, dear.
What is wrong in the OP's original post is that the patient is looking to to the OP when a question is asked. This can mean "I don't know the answer, please help me" OR it can mean "If I answer questions incorrectly, she beats me". Or anything in between.
If you are dealing with a new doctor, much better to have a conversation about what is going on.
I still see docs (in NYC, no less) who seem to have time to actually talk to patients. Give it a shot.
Now we live near eldest DD and for the last month she has been taking me to appointments and I am very happy to have her in the room. She sits quietly but will occasionally promt me. When I was asked about surgeries she just said "Did you forget the two hip replacements. If I refuse to do or take something, she just listens and does not try to interfere. So far that is working well which does take up time from her from work. the new Dr will ask her if she is the daughter and if she is in scrubs asks her what she does. She is a Vet.
On our recent stay in observation where both of us were in the same room I heard DH tell the Dr that he was a retired MD and I was a nurse I whispered to the nurse when he said that that I try not to give that away. She whispered back that her Mom annoys her when she introduces her and say "This is my daughter ,she's a nurse you know.
As others have said gone are the days when Drs were treated like God's and the younger ones don't have the same depth of experience in a wider field than the old docs did. they will say things like "I am a cardiologist I don't know much about cardiology" All of this specialization is good in some ways but in others allows things to slip through the cracks.
I firmly believe everyone should have an advocate, preferably someone knowledgeable but at least someone to help remember what was said.
The suggestion about handing a note before the appointment is very good. I think the approach of letting the elderly loved one speak for themselves and if necessary prompting with things like" Mom this is Dr X we are here about your heart we see DrY next week for your feet.
I feel most healthcare professionals will not see a caregivers presence as controlling. This of it in the way your nurse will report her findings to the Dr when he/she shows up in your room.
It is very important for the Dr to know if the patient is not following instructions about medications.
I used to drive seniors to appointments many years ago - over 75% of time they asked me to come in with them - on our way home quite often they asked questions as they were unsure of what the doctor exactly said - they spoke for themselves but often only remembered 1/2 what was said as they digested something said earlier by that dr - I felt my job was note-taker & rememberer of details -
I feel most times you need an advocate because when you focus on some 1 item & miss an important side item like what & when to take meds but miss that you can't eat certain foods with that med - on important appointments I take someone with me to make sure I get all the details right
Wanting to gauge if she'd got better after a nasty infection, I asked my friend J if she could tell me the time - there was a large wall clock in the ward and I wanted to know if she could remember it was there, see it, and tell the time from it. Her daughter instantly chipped in "it's half past three." Great. That shot the fox.
But it is difficult to zip it. To *make* myself -
"Are you having any trouble walking, Mrs H?"
"Oh no, I hold onto things."
"Mmmmmmggggnnnnffffff...!!!!!"
- I cultivated a glazed stare at the ceiling, and crossed my eyes when something mother said was dangerously misleading. This worked pretty well but only because her GP knew the cues. If you never see the same doctor twice it can be more difficult to make it understood that your loved one's answers may need revision...🙄
the doctor is aware and has their best interests in mind.
Dr: How you doing today, Mr X?
Mrs X: Oh, he's worse.
Dr: How many kids do you have, Mr X?
Mrs X: Two
Son X: Me and my brother.
If a Dr is trying to assess the abilities and needs of a patient, sometimes it's the patient who needs to answer. I've pointed this out to my in-laws and they understand, but it seems that it's an ingrained behavior that's very hard for them to stop.
When I had my own heart issues a few years ago my son was the one who went to the ER with me and my husband met us there a short time later. When the physician came in to explain anything or ask questions I asked that they both be in the room to hear what was said and so that they could also ask questions. When I was transferred to another hospital for treatment I again made it known that I wanted them both in the room for any explanations of procedures and treatment. That way they could relate to me later or inform other family what was going on.
We had one Dr that was barely civil to my Aunt myself when we tried to talk about mom,he said that she "presented well" 2 other Dr's. had sent him letters saying mom's driving license should be revoked, no way would he do it, 2 days after she was pulled over for unsafe driving and speeding ,exactly a week later she was in a serious accident, we now by pass him and see the specialists ,social workers etc
Silver is taking her LO to the Mayo Clinic, not a county hospital that has a monopoly on all the medical care in a rural area.
I respect her question and perhaps it’s a good standard to ask doctors what the protocol is for office visits in their practice. I suppose if a senior has a companion with them in the exam room it is a courtesy to explain oneself to the doctor or nurse as to why you are there and help them understand that you have a right to be there.
We may look like a puppeteer that is interfering with the doctors evaluation of the patient but in actuality we are the one that is making our loved ones life work often to the detriment of our own life.
I think it’s quiet clear that Silver wants what’s best for her mom and is concerned as to why more than one doctor has seemed to find fault with her response to their questions.
Perhaps Mayo has an awareness training program going on? Regardless, it’s a valid concern on their part and we get many questions on what to do when our parents go in alone or even with their companion and the elders don’t give honest or straight forward answers on what is going on.
We are only trying to help the doctor understand the reality of the seniors life.
But to speak to CM and Shakes concern, what came to mind for me is a book I read called “How Not To Die”. I read it a few years ago and have watched with interest as it’s grown in popularity and now has an accompanying cookbook.
It’s basically a vegan approach to health but as it relates to this post, it contends that the 3rd leading cause of death in America is medical treatment.
The author, Michael Greger, describes it as How Not to die of Iatrogenic Causes. Many, many do. There are also many appropriate and impressive footnotes to back up his claims.
So the pendalum swings from when our elders were of the era where whatever the doctors said was taken as the gospel to not necessarily so today. We are all on a learning curve with the diseases we deal with. We should be respectful of the knowledge of doctors, IMHO, but they are not infallible. They should also recognize that a person knows his or her body and that if they are lucky enough to have a loved one caring for them, there is no one who knows more about the patient than that spouse or child who accompanies them into the exam room. An exam, I might add that is often rushed to a point of rudeness by the staff or the doctor. Sometimes the doctor doesn’t take his/her hand off the door knob or even bring their stethoscope into the exam room. That’s not the case with the doctors my mom saw or the geriatric primary my aunt sees. It was the case with the doctor aunt was seeing when I started attending appointments with her.
It’s a partnership we are looking for from the doctors. We can’t just blindly trust them. We have to be respondible enough to eat a healthy diet. Exercise. Not smoke. Watch the alcohol. We have to recognize that they “have a license to practice” and that’s what they are doing. They can make mistakes and of course, we aren’t stupid. The Golden generation wanted to just hand it over to the doctors and blame them if something went wrong.
Something always goes wrong. We all die. We are responsible for our own health.
We are hiring the medical staff to guide us through to the best of their ability and while they have a responsibility to make sure we are doing our job, we have a responsibility to make sure they are too.
After all, they are the ones getting paid. Not many of us are.
When wife started showing signs of dementia it took two visits for him to see it and he immediately started the testing and when the results were in he completed the referral to the neurologist and has kept on top of it.
When I was assigned as her guardian I immediately took the order in and ask them to include it in her record. Once the supervising DR read the order and accepted it the only thing that changed was the PA would ask me the questions directly. He did acknowledge the order and said that we now that straightened out.
A few other DRs. staff did insist on wife answering the questions and provide the signature until they realized wife did in fact have a problem and defaulted to me. Most will still ask her a few questions which I feel is their way of tracking her degeneration.
No one has ever suggested any form of abuse and has allowed me to clarify questions or answers.
I see where the doctor may be coming from. Can't evaluate a patient if they don't answer the questions. Let Mom answer good or bad and then give your opinion. Or ask to speak to the doctor privately at the end of the appt.
I think some parents are naturally more dependent or deferential than others. My mother speaks for herself, although she's not always completely truthful, and she is somewhat forgetful.
Maybe try prompting your parent when she looks to you for answers, maybe just repeating the doctor's question or rephrasing it. Even though I add to or correct my mother's statements sometimes, I really can't speak for her. She's the one living in her body, so I do sometimes learn new things by listening to what she tells the doctor.
From what I've observed, they're each experienced in elder care in a wide variety of areas and applications. They're intelligent, knowledgeable, compassionate, insightful, and their primary purpose here is to help.
And, their answers are not reactionary.
I used to take my Dad to doctor appointments. He had a horrible short term memory. The doctor would ask him a question, he'd shrug his shoulders and look at me.
Then I would answer. This was about 15 years ago in Northern California.
I also went along with my Mom to her appointments. She had stage 5 Alzheimer's. Her doctor knew that. I also answered questions that she answered improperly. This was about 3 years ago in Southern California.
In both cases, I never had any of their doctors accuse me of abuse or question why I was answering.
There were no signs of anything "amiss".
I would think that, if the doctor really was trying to find out if there was foul play, she would have you leave the room and then question your mom about abuse or check for signs of confusion/dementia on her own.
Given your Mom's response to the doctor, I would think the matter is all cleared up now.
The doctor will ask a question and look at me to answer it. With my mom I would repeat the question so she could answer. It made the appointment go slower but I thought it was important for my mother to respond. She was hard of hearing and competent. Just didn’t appreciate doctors.
With my aunt who has dementia and sees a geriatric primary, and has better hearing and more comfortable in the situation than my mom was, there is no problem with answering.
She answers right away but the answer is often “I don’t remember” or “I feel Good” or “I don’t understand why I’m here. Nothing wrong with me “. Then they would start asking me the questions.
I would tell your mom to speak up that the doctors are concerned if she doesn’t answer. Perhaps your mom had grown accustomed to your answering in other settings and defers to you.
I would be impressed with a doctor who wants her to answer for herself.
You might also go over with your mom before hand why she wanted to go to this doctor and what her concerns are.
She might benefit from a note card with reminders on it.
Usually the nurse asks why you are there before you see the doctor. Good time for her to practice speaking up.
It’s a sign of dependence on you and good for her to be as independent as possible.
I should add that we seldom went/go to doctors and so had quite a bit to discuss. Since you go so often I’d think it would be pretty fresh on your mom’s mind if there is no problem with her memory.
This is a difficult issue. I too have spent my fair share of time making incredulous and horrified faces while mother assured the triage nurse that she was in good health, for example, told the disabled driver's badge people that she could walk a mile uphill, and managed inadvertently to convince a heart failure nurse that she was not significantly affected by her ejection fraction of 18%.
I think both you and your mother have done the important thing, which is to acknowledge the issue, the *potential* for abuse if you control all of your mother's communication. But your mother does rely on you to be her memory, and her doctors need to rely on you for accuracy. All you can do about it, really, is demonstrate that you get the point.
Doctors are mandated to report abuse. A parent who is hesitant to speak their mind in front of a caregiver may be deaf, demented, abused, confused or something else. The doctor got the question out in the open. S/Didn't make assumptions. S/he asked for your opinion/interpretation about what was going on.