It's getting to be an increasing problem to the point mom's doctor just doesn't want to deal with me. It's almost like I feel he is trying to make me go his way or it's no way as I still need his approval for any renewal of meds, etc. It's far too late in the game to change doctors, so I have to make this work. I plan on getting an appt. with the doctor just to have a heart to heart talk. Lately, I call him just for a diagnosis of what is going on with mom and what to do (mom is bedbound since falling and there are new things to deal with) and instead of giving me some direction, just bluntly tells me "well, you know she's going to die"........ I'm sorry, but I feel this is inappropriate and insensitive.....to say the least. He keeps wanting me to just go with hospice and while that may be appropriate in some situations, it is NOT for mom at this time for various reasons. (FYI---mom just fell out of bed and recovering....is happy to be alive at this time, NOT wanting to die. She does NOT have a terminal illness.) Any feedback on how you all have dealt with this would be appreciated. cadams
I wouldn't tolerate his attitude toward giving up. I assume he's not a geriatric doctor?
We had two PCPs who were lousy; only a few visits and they were history. There were also 2 internists who were more thorough but clearly didn't know how to deal with older folk and they're history now too. I've got recommendations for a geriatric doctor, so that'll be the next one, and hopefully he'll work out.
I tried to work with the doctors who are now history, but some of them weren't worth the effort. One of them insisted that my father should be taking Fosamax, and insisted that he "has to take something!" Never once did he raise the issue that walking is the best exercise for osteoporosis. Nor was he concerned about the side effects of dangerous drugs like Fosmax. After a few discussions and he just couldn't grasp the fact that we don't see medicine as the solution for everything, and after his office failed to cooperate in getting home care, we moved on.
You can try one last time but if the doctor doesn't change his attitude, I'd find another one. It isn't worth the agony of trying to make some of the old style doctors get on board. Some of the younger doctors are so much more progressive. I love to work with them.
Good of you to advocate for your mom. GardenArtist is right, its never too late to find another doctor. Or report this doctor the Medical Association if necessary. I know its hard to find a good doctor but its worth it. Take the time to call around and see if you can get a second and third opinion.
As to hospice, it sounds as though it might be a good idea, even though she is not actively dying. If the doctor will recommend it, it gets you a new set of medical professionals who will evaluate and support you in your keeping mom at home, and keeping her comfortable.
Many patients "graduate" from hospice because they do well.
It sounds as though there is not really a definitive dx for your mom at this point and what she needs is comfort care. That is really the definition of hospice.
A geriatrician who shares or at least fully appreciates your perspective on mom's life could be a better pick if your heart-to-heart talk does not work out. I would also have loved to have had more time to make memories with both my parents (especially with their grandkids) despite the onset of dementia and needs for care; we still respected their advance directives and all but didn't want to hasten death even with benign neglect, which is sometimes not so benign. I felt I had to tell my dad's doc that his quality of life was not so bad, and he did listen to me, but we did limit hospital stays for both my parents at the end when the status of major life-threatening impairments was non-reversible.
As for changing docs. That is t going to happen. There are near no physicians accepting new Medicare patients. With the reimbursement cut and cut again...docs don't want more of this patient/payer. My Mom tried to fire this doc years ago...and found she couldn't get a new one.
I became eligible for Medicare...but..I do not have a primary. Because I cannot find one accepting new Medicare patients. So..I just stick with the urgent care "doc-n-a-box" services. Just make sure it is not Emergency care... Medicare won't pay for that.
And if hospice does not offer anything you need or any financial/coverage advantages for you or mom at this time, there is no reason they have to be involved. If you do find a good reason to start that though make sure their philosophy is compatible with what you and mom want too, in terms of medication use, etc., and not just a cookie cutter approach like everyone gets morphine and Ativan around the clock, and stop all the other meds that may help them function or feel better. Had to fight tht a little for my mom... difficult memories there!
www.agingcare.com/articles/palliative-care-how-it-can-help-your-aging-parent-achieve-quality-of-life-136281.htm
www.agingcare.com/articles/palliative-care-what-is-it-and-how-is-it-different-from-hospice-197744.htm
cadams
There are two kinds of Medicare. With Traditional Medicare, it's pretty easy to find doctors. If you have Medicare Advantage, it can be much more difficult because you are restricted to a network. And about the doc saying LO is at the end of life, my Dad's doc said this to me 11 years ago and he's still going strong.
Blessings,
Jamie
One battle I could not win was medication. The Nursing Home and physicians "double teamed" me here. My back was against the wall (so to speak). As far as Hospice, for us, it was a prayer answered. Mom had so much more attention and care and had Hospice for close to a year. Advocating for our loved ones can be bone-sucking, but I am so thankful I was able to do this for my mom.
Several times I have written a note with my concerns and "secretly" given it to the receptionist before the appointment. Twice the doctor has talked to my mom about concerns I wanted addressed, but at the last appointment, nothing.
She doesn't think she needs new hearing aids, or to even get the ones she has checked and adjusted, but she is constantly saying "What?". Then she gets upset when I need to talk louder. I told the doctor, hoping he would recommend a hearing check (since she won't do it at my suggestion) and he didn't mention it. He ignored another issue as well.
He pats her hand, says, "I just think you're doing real well", and sends us on our way.
To add a complication to this, I (and a professional therapist I consulted) have decided she probably has schizoid personality disorder, and has had it for a long, long, time. So of course she knows what's best and sees no need to find another doctor.
It's extremely frustrating on many levels, and I just keep trying to take care of myself.
As others have questioned, why is it too late to change doctors? I see by default (doctor up and quit) you are now going that route and hope you have more luck with the "new" one - if not, do not hesitate to seek out someone who will work appropriately with you.
Although our mom's doctor did not behave like this, we had to change because he or his office just was not working with us. In order to work with federal pension, we needed a specific Dx for mom. They required we come in for exam, which we did. I had to leave the exam room when she started getting belligerent with the tech doing tests. The doc talked to me before going in, and assured me he would provide that letter. Despite pinging them at least once/month via the portal (or by phone if I could ever get through) AND her regular physical several months later (brother took her), I got the run around. No response or we need to know what you need - I SENT that to you via mail, copies of the documents explaining it all, BEFORE the first visit... but hey, here is a way to update via the portal, here you go AGAIN. Oh we need the DPOA, here you go! End result, 6 months later, lots of frustration and no letter. I still tried, but meanwhile took her to my PC who not only provided a letter, but SEVERAL because the just right magic words were not in place. NEVER heard from the other doctor.
No doctor should be saying there's nothing to be done, she's going to die. We're ALL going to die, sometimes too soon, but that is totally unacceptable and ridiculous.
Yes, others have said it can be difficult to find a new doctor - they might not take your insurance, etc. I had to choose my MA plan carefully (even the previous one too) to make sure the doctors in my area that I have been to accept that insurance.
Hopefully by now you have a new, better doc in place and mom's care is proceeding. As for sister, again that question about DPOA and medical directives are important. If YOU have that in place and YOU are the primary, sister cannot do anything but moan and complain. If SHE has that power, you could have a battle brewing. If none of you has this power, in order to ensure mom gets the care YOU want, not what sister wants, you might have to go the court route to get guardianship and stewardship. This can be costly and time-consuming. If sister's primary concern is $$$, remind her that if this battle is taken there will be little or no $$ left! If she does not have to care for mom then just what is her complaint?
The folks who are recommending hospice are likely not aware that you already have great in-home care assistance.
I suggest you ask the care manager and/or the nurse and therapists to recommend a new PCP.
Medicine/Insurance/Home Health and Hospice agencies may sometimes seem like you are hitting a brick wall and you are because your hands are tied...it is always a problem in getting the doctor to approve their care...I do not know what the problem is..because you contact the insurance agency and they say it's covered but if you can get through to the doctors office you may not get your answers, you may never get the returned phone call and then you only get half of what you asked for.
The sad part is you need a doctor to approve all the orders with Home Health. Hospice they have a medical director that can handle all of the issues..so it's a 50/50 split...because Hospice is only for palletive care...they do not care if the patient, eats, drinks, poops, takes their medicine or if they slowly decline and die.
The best thing for you is to put your emotions aside and deal with them on a logical standpoint...this is hard to do..but it is the only way to handle all the aspects of taking care of her. A word of wisdom...plan ahead...know what you want to ask....before you talk to the doctor, nurse or agency and document everything that happens...this may be of benefit to you one day.
Does your mother have a hospital bed..can you get one for her with the side rails so she will not fall out of bed...if your insurance does not cover it..you can rent one...or buy one...look on line someone might have an inexpensive one to sell..if she goes under Hospice ...she should be able to get one if the doctors approves it.
Do some research and if you have care for her at home...and it meets your expectations..then keep her at home..because a nursing home is the last place you would want to see her..In order for her to get the care be... firm..and direct. Good luck you will be in my thoughts and prayers..
Mother loves him, for some weird reason. She has attached herself to every dr she's ever liked. And I mean, over the years she was a weekly visitor to the clinic for one thing or another.
My sis researched geriatric physicians for mother, as hers was sick a year ago and didn't look like he'd come back. She got her in to a young, female and mother refused to go. Wouldn't even consider it.
My "beef" with mother's PCP is his age and lack of up to date medicine!! Two of my kids are drs and they are appalled at the 20+ drugs mother is on--most are for s/e of something else she's on.
Also, the dr kids have both stated that the best care you will ever get is from a younger female doctor. Just saying.
BTW, Mother routinely waits 6 months to get in for a visit for, say, a cold. Seriously?? The wait list for her dr is obscene--you could die while waiting to be seen. She has routinely got a UTI and she can't WAIT months to get in.
Grrrrrrrrr......the "heart to heart" with her about changing drs just resulted in my being sent to timeout (again).
I DID end up changing doctors simply because mom's primary Dr.
quit the field. I have to say the new Dr., while not nearly as mature, was pretty upbeat and more positive, so you all were absolutely right on about changing drs......
Sad to report now though that mom DID pass away peacefully in her sleep the day before Hurricane Irma hit Florida. So......now I am dealing with the shock of all that and in a whole different phase.
Thanks again. cadams
My deepest sympathies and condolences on the passing of your mother. I am very sorry for your loss. Thinking of you and your family during this difficult time. Take care of yourself.