Getting doctors to ask the right elder care questions
by Carol Bradley Bursack, Editor-in-Chief
Many of us are familiar with escorting our elders to a doctor's visit with high hopes that a particular health issue will be handled. Two of the most sensitive health issues are dementia and dealing with driving problems. In cases of dementia and memory problems, a third party can help adult children make decisions with, and in some cases for, their parents.
Enter the doctor.
Working Towards a Dementia Diagnosis: Make an Appointment
Mom, who last night, couldn't remember that she'd had supper. Mom, who likes some wine, but forgets she just had some so has more. Mom, who just bought a new iPod with her credit card over the phone, is not willing to see the doctor about her memory and decision making abilities, but will see him to renew her heart medication.
So, you set up the appointment with high hopes.
Dealing with the Cover-Up
The doctor does the physical. Yep, things seem pretty good. Afterward, you want to chat. The doctor doesn't have much time, but he does ask the usual questions. This doctor even asks about alcohol consumption. Your cute little Mom sort of giggles and says she has one glass each evening with dinner. She'd never have more. He believes her. He asks her about any memory problems, and she just laughs. She is at her most charming. She seems bright and quick for her age. You and Mom are dismissed and Mom is satisfied. You are upset.
Is this the doctor's fault? Not really, although some fault rests with the medical system which generally insists doctors only spend a small amount of time with each patient. However, some of the problem is most doctors take what they see at face value, and from what this doctor sees, Mom seems fine.
It happens all the time.
Geriatricians: One Option for Getting Help
One solution is the geriatrician. Geriatricians are trained to watch for signs elders are covering up memory problems, decision making troubles, or hiding substance abuse issues.
One problem is that geriatricians are rather scarce. They are typically not as well paid as other specialists because they generally don't perform "procedures," therefore getting young people to specialize in geriatrics is difficult.
So, what can you do if you can't see a geriatrician?
Communication is Key: Write a Letter
I'm not going to be so naïve as to say call the doctor ahead of time. Go ahead if you can. You may get lucky. But, if you write the doctor well ahead of Mom's appointment, and spell out as briefly as possible what your concerns are, you may have a better chance of success.
A dementia diagnosis generally requires seeing more than one doctor. Providing your parent's primary care physician with a written letter can get the diagnosis process started. In your letter be sure to explain the general memory problems, but be sure to include specifics. Doing so could prepare the doctor when your parent comes magically "alive" for an appointment, as well as help your parent get a more in-depth diagnosis.
From Memory Tests to Referrals: Working Towards a Diagnosis
Helping inform your parent's doctor about the lingering memory problems could lead to the doctor performing additional tests during a visit. For example, there are numerous tests, such as the Mini Mental State Exam (MMSE), that are used to assess the mental status of patients. The MMSE checks for memory, concentration, and a host of other cognitive skills.
While a written letter may lead to walking out of the office with an angry parent who still denies having problems. Yet, if you receive a referral to a geriatric neurologist, take comfort.
You're on your way towards a real diagnosis.