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Caregivers may pick and choose elder care battles

by Isabel Fawcett, SPHR

The common saying that one needs to pick and choose one's battles in life is sage advice.

Caregivers may be familiar with the painful choices involved when picking and choosing our eldercare battles.

Caregiver Battles in Eldercare

As it might apply to eldercare, regrettably, there always will be the possibility of brewing battles. Some caregiving battles may, or may not, arise from caregiver or medical practitioner oversight and/or negligence. Other situations are simply the fact that nothing in life is ever perfect. Occasionally, misunderstandings and inadvertent human oversights happen.

The decision regarding which eldercare battles to choose, or not, resides with each caregiver and/or elder. The caregiving battles of which I speak are not in the realm of caregivers who choose litigation as the patient care battleground of choice. Litigant battles are in a singular class and occasionally abused.

Non-litigious battles in caregiving arise when elders or caregivers take a layperson's exception to doctors' advice, in-patient and/or outpatient care or perceived circumstances, medical treatment, or healthcare protocols, up to and including health insurance industry practices. The disputed matter reasonably, or erroneously, may be perceived to have adversely affected the elderly patient, including health, safety outcomes, or possible symptoms.

Even absent choosing to do battle over a matter of healthcare dispute, elders are vulnerable, whether due to declining health or advancing age. Throw perceived caregiving disputes into the mix with medical practitioners who may not understand that the caregiver's intervention is not personal, and the elder is caught between the devil and the deep blue healthcare and caregiving sea.

I would never want anyone I love to be caught in the cross-hairs of annoyed or unyielding medical practitioners. Such an outcome would be my worst caregiving nightmare and potentially abusive to the elder. All the more reason why caregivers may want to carefully consider picking and choosing if, when, whether, and/or how, it may be appropriate to intervene. No reasonable person wants to throw an elder under the medical provider and healthcare bus.

While I've seldom felt a need to challenge medical providers, I comfortably took exception in the following caregiving situation.

Reasonable Caregiver Doubt

Eldercare Red-Flag: Elder's observable and recurring adverse reactions to new (or changed) prescription medicines or dosage.

After careful observation for 3 days, I called the doctor's office to inform the doctor that a new prescription seemed to be causing continuing dizziness to my loved one. I received a call back from the nurse, who told me that the doctor had reportedly said that my elder should continue the newly prescribed regimen - in spite of dizzy spells, "because in looking back" at my loved one's medical record, my elder had (in the distant past) "reported occasional dizziness."

Clarification

I clarified that I'd understood the nurse's reply. When the nurse verified that I had understood him correctly, I said:

"With all due respect to the doctor whom I appreciate and continue to admire, the answer you just gave is not acceptable. I told you that the elder is experiencing almost all-day dizzy or severe light-headedness starting within a short time of taking the newly prescribed medicine. In turn, your answer suggests that the doctor's reply disregards the present reported symptom in favor of a years-ago patient record disclosure of "occasional" dizziness. (I recalled when and how the original patient disclosure had been obtained during a routine medical history interrogatory briefly reviewed with the patient upon first visit.)

Executive Caregiving Decision

Upon hearing the nurse's repetition and increasing attempts at hollow medical practitioner disclaimers, I told the nurse to inform the doctor that, for my elder's mobility safety, especially while climbing stairs, I had personally made the executive layperson decision to stop administering the newly prescribed medicine to my elder. Three consecutive days of any severe recurring and even mildly incapacitating symptom right after ingesting a prescribed medicine is a carer's red-flag.

I concluded my conversation with the nurse by stating that I would await further word from the doctor regarding my independent decision. I reiterated that I respected the doctor who had skillfully cared for my elder for years. I was not hallucinating and neither was my elder, I told the nurse.

I was pleasantly surprised and deeply appreciative when the nurse called me back with the doctor's final breaking news verdict. The doctor had cancelled the newer prescription regimen and reverted to the former prescribed medicine regimen. Interestingly, the former prescription medicine continued working just as it had behind the scenes previously, without any instances of prolonged or severe dizziness reported or visibly manifested by my elder. The elderly patient remained on the older prescription for the duration, without as much as a single recurrence of dizziness. Imagine - such a coincidence.

Caregiver's Victory and Defeat

I wish I could say I felt a sense of victory, but when I ended the call, I felt my body shaking, tears brimming and stinging, ready to flow. Other than relief about my loved one reverting to normal and safe life functioning, I otherwise felt like a heel. There are battle royals I'd rather never take on in life. Challenging a medical decision of competent doctors, whom I personally know have consistently gone above and beyond what is expected of them, is not something I ever will relish. Ethical doctors always will have my highest regard and utmost respect.

After the prescription battle, I dreaded the upcoming medical visits. I didn't know how the doctor would react to my perceived challenge months earlier. I also had no desire or intention to make the doctor uncomfortable by my presence in any way, up to and including possibly perceiving my elder or me as a litigious patient profile. I also felt badly for my elder who was worried about how the doctor would treat us both. I am not litigious. I prefer to not waste precious life energy in litigation of any sort. I am, however, not afraid to challenge situations where I may perceive that something may be remiss.

Most importantly, I worried about my elder's long-standing trusting business relationship with a top-notch physician and possible fallout in their relationship. My elder would not have chosen that battle, or any other, for that matter, with his physician. Sometimes there is just no winning feeling for the caregiver in such situations.

I am thankful that the strained smiles, rigid hello and goodbye medical appointment handshakes, palpable periods of noticeable silence during medical visits, and seemingly bruised feelings appeared to have faded within a year. The great news is that the doctor-caregiver, doctor-patient, and doctor-caregiver-patient relationships bounced back, seemingly stronger than ever, for which I will always give the doctor all the credit.

The doctor stands taller than ever in my estimation, having nothing to do with "winning" anything. Ethical conduct is everything in medical practice as far as I am concerned, as is patient trust.

I heard a caregiver's hallelujah chorus on this one after about 4 or 5 doctor's office visits. Can I get an "Amen?" Please don't ignore your best carer's intuition, painful though it may be to work through it all. No one said it would be easy, caregivers.