PARTNERS IN CARE
Working well with a doctor makes the caregiver's job easier
BY:BARRY J. JACOBS, PSYD
The doctor seems very busy. While sitting in the waiting room, you catch a glimpse of him racing down the hallway. You note he's already a half-hour late for your loved one's appointment, so you figure he'll give you short shrift. You wonder how you can slow him down enough to listen to your worries about your loved one's health.For concerned family caregivers, this is a too-common situation. You want to stand shoulder-to-shoulder with the doctor in order to provide well-coordinated care. Instead, the overburdened physician seems to always be beyond your grasp, a stride ahead, racing to his next patient. You're left trailing behind, your questions unanswered. Worse, if you try slowing him down, the doctor can make you feel like you're one more obstacle he has to dodge. It can make caregivers feel all the more neglected and alone.
So, how do you get your loved one's doctor to be more available, attentive and responsive? Step into our office for a helpful little heart-to-heart...
The Big Picture
The wise and kindly Marcus Welbys of yesteryear may be a rare commodity, but the vast majority of those who want to be a physician go into the profession genuinely to help others. But our flawed healthcare system places a premium on a doctor's productivity. To keep their practice in the financial black, family physicians, internists and pediatricians must churn through patients rapidly—with the average medical visit being a mere eight to 10 minutes. To survive at this pace, many doctors adopt a "just the facts" philosophy. They don't want to stop caring about their patients—only to do it in an abbreviated, efficient way.
Enter the family caregiver. Most of the time, you aren't asking for a lot—just the courtesy of having your loved one's condition and treatments adequately explained. Plus, you'd like acknowledgment of the crucial role you play in the patient's life by being allowed to ask questions regarding your concerns. Most doctors don't begrudge you these things, but they may believe they're hard to fit into an already jam-packed medical session.
So, it's not surprising that many caregivers become frustrated. They adopt a "squeaky wheel" approach—calling the doctor frequently, badgering the office staff, throwing small fits. This, unfortunately, can make a doctor more elusive as he tries to sidestep a demanding family member. What should be a coalition of allies striving to help the patient can then turn into a cat-and-mouse game, with a desperate caregiver chasing the despairing physician.
5 Ways to Make It Work
STEP ONE: Simplify the physician's job. Too many caregiver-physician relationships are weak alliances at best, adversarial at worst. You can change this by deciding to actively support the doctor's efforts. Tell her you want to do all you can to assist. Volunteer to be her eyes and ears, closely observing the effects of various treatments on the patient. For example, you can keep a detailed log of your loved one's blood sugars, blood pressure, temperature, oxygen level, sleep patterns or toileting. This will be invaluable information for the doctor to better understand how the patient is functioning physiologically. Just as important, you also can report on your loved one's behaviors—social interactions, feeding and grooming—to provide essential data on how the patient is managing with the activities of daily living.
If you do this, the doctor will be less likely to avoid you. He instead will see you as a source of vital data that abets the medical treatment and makes his job easier. He will come to regard you as his partner in care.
A typical frustration of physicians is their not knowing what medication, radiological tests or lab studies have been prescribed or conducted by other doctors treating the patient. Even in an era in which electronic health records are more commonplace, communication among doctors can still be disjointed. You can make yourself indispensable to the medical team by playing the essential role of messenger, conveying written and verbal reports from one doctor to another in a timely fashion. The doctors will come to rely on you as a virtual case manager who helps coordinate treatments.
STEP TWO: Ask how best to communicate. Some doctors happily make time to speak with you when you are in their office; others will bolt the other way. Some prefer to talk on the phone; others resent it. While more physicians now use e-mail to communicate with patients and family members, others aren't comfortable doing so. Ask about the physician's preference and then communicate through that channel.
This approach sends two good messages: First, you're conveying both respect for and willingness to conform to his style. This will reinforce the fact that you are his advocate, too. Second, you are communicating your expectation to the doctor that he will be consistently available to you through his preferred mode to address your questions or concerns.
STEP THREE: Understand scheduling. Medical offices run on time templates, with particular scheduling periods at different day parts. For instance, the morning session may run from 8:30 to noon, during which patients will be seen every 10 minutes; the afternoon session may run from 1:30 to 5, also with 10-minute slots. It's worth asking the receptionist what template the physician uses in order to find out when the sessions start and end, and the visit's expected duration.
If you and your loved one don't like waiting to see the doctor, ask the receptionist to schedule appointments for the first slot of a morning or afternoon session. Conversely, if you don't mind waiting, schedule your appointment for the last slot. If you believe you'll need more than one slot's time to fully cover your issues, ask the receptionist to schedule a "double slot." Then, for example, you will have 20 minutes (rather than 10) of the physician's time to discuss crucial matters. This will not increase your co-pay, and doctors generally don't mind double-slotted appointments. In fact, they greatly prefer them to too-packed, one-slot appointments that run over, putting the doctor behind schedule.
STEP FOUR: Be organized. Because the doctor is anxious to complete the visit within the allotted time, she's eager to establish its agenda from the outset. You can assist—and ingratiate yourself to her—by conveying your concerns in a pithy, organized way at the beginning of the visit.
There are two recommended ways to do this: If your physician accepts e-mails, at least two business days prior to the visit send a detailed note identifying both your information and questions. This provides the doctor the opportunity to review your message and prepare responses. Another option is to present the physician with a typed list of concerns and questions at the start of the appointment. He can then peruse the information upon entering the room. The list will help him structure your time together in a way that meets your needs for guidance and his needs for efficiency.
STEP FIVE: Offer praise. Most of us respond better to praise than to punishment. This includes doctors. Encourage her to work more closely and productively with you in the future by acknowledging how she's met your expectations. For example, if you believe she is ably taking care of your ill loved one or has excelled at answering your questions, tell her so.
Better yet, write a thank-you note. Praise the doctor for being supportive and a comfort. He won't forget that note's generous words and will do all he can to win your trust and approval again as you proceed forward together in an effort to help your loved one live as well as possible.