Communicating with Your Doctor, Part II

A Message to Physicians

In our last issue of Update, we made some suggestions on how caregivers could better communicate with their doctors. Now we'd like to look at how physicians can help with that process, for the well being of both patients and caregivers.

A recent survey by the Alzheimer's Association found that there is a large communication gap between doctors and Alzheimer's caregivers. (We suspect the findings would be consistent no matter what the diagnosis.) The survey found that caregivers are not receiving all the information they want from primary care physicians, although physicians believe they are meeting caregivers' needs. The survey also found a large gap between caregivers and physicians on whether physicians provided recommendations on how to cope with caregiving stress. Some key findings:

• 57 percent of caregivers said they wanted information about what to expect as the disease progressed; only 38 percent said they received such information. Yet 83 percent of physicians said they do provide that information.
• 52 percent of caregivers said they wanted information about the effect of Alzheimer's on a person's ability to do daily tasks and to cope; only 28 percent of caregivers said they received such information. 91 percent of physicians said the information was provided.
• 31 percent of caregivers said they got recommendations from their doctor on where to find help and services, yet 88 percent of physicians said they provided such recommendations.

While doctors believe they are communicating crucial information, in many cases it is either not being heard or is not comprehended. And helping the family caregivers find practical ways to cope and get assistance is critically important. Caregivers are under tremendous stress, which can contribute to their own health problems. Indeed, the AMA has recently issued physicians' guidelines and a health assessment for Alzheimer's caregivers. (See www.ama-assn.org/ama/pub/category/4642.html .)

Very often, if the caregiver is able to maintain good health and positive attitude, this sense of well-being can translate into more satisfying and better care for a loved one at home.

Good healthcare depends upon doctors, patients, and their family caregivers working together and exchanging information to solve health problems. A 1993 JAMA report offered some enlightened tips for doctors to consider. Consider sharing the summary of these tips with your physician as a resource for better communication:

• Consider the caregiver and patient as a single unit of care. Care decisions based on the interactions and interdependencies of this broader unit will contribute to more successful treatment outcomes.
   
• Plan on a regular assessment schedule. Regular caregiver and patient assessment and re-assessment of bio-psychosocial and environmental issues contribute to positive health outcomes.
   
• Link the caregiver with healthcare and community resources. A physician can have a powerful hand in helping a caregiver accept supportive services such as early and frequent use of respite. Have resource information on hand to give to caregivers.
   
• Provide training to caregivers either directly or by referral. Resources are available to help increase caregiver confidence in such areas as managing diagnostic monitoring techniques, behavior management and self-care behaviors.
   
• Offer specific help for upsetting patient behaviors. Effective medication and/or psychosocial strategies can drastically help to reduce caregiver burden.
   
• Validate the caregiving role. Social recognition provides a buffer against stress and burden.
   
• Respect the person with dementia. Acknowledge them at their appointment. As a courtesy, introduce yourself, and tell them you will be speaking with the relative/friend who is with them.

Adapted from "MD's & Family Caregivers: Communicating Effectively, A Resource for Physicians," reprinted with permission from the Oregon Senior & Disabled Services Division.

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