Catholic Charities In the News
How to encourage dad to follow doctor’s orders
September 12, 2009 - The Clarion Herald
By Dr. Elmore Rigamer
Medical Director for Catholic Charities Archdiocese of New Orleans
Q: My father is 80 years old and in poor health. He complains that his doctor orders too many tests and that he does not want to follow a low-fat diet. He says he is not going to get better, so what does it matter. How much should we encourage him to follow the doctor’s orders?
These are difficult but important conversations. You might start by asking him what he means when he says he is not going to get better. Does he mean that he will not be as active as he was 20 years ago? Does he mean that he will have pain no matter what medicine the doctor gives? Or is he saying that if he has to live the way he is living now and nothing can be done to change that, why should he make himself uncomfortable with unnecessary medical procedures and pills with unpleasant side effects? This might be an ongoing conversation.
Too often people like your father do not have the opportunity to spend time with one doctor to talk about all his problems, what he can expect, and most important, what care he would like to have.
There are still too many times when an elderly person has a doctor for each disease. The patient has many prescriptions from different doctors. No one explains the bigger picture of his health, the course the illnesses will take and how he would like to handle it. Doctors are beginning to realize the importance of a “medical home.” The medical home is the doctor whom you see frequently, knows your medical history and knows what your specialists are doing.
I would start by asking your father if he would like to talk to his primary care doctor – or the doctor he sees most frequently – about all his health concerns. The purpose of the visit is to review all his health problems, their likely course, the available treatments and what he would like to do. This is not a visit for a specific ailment. This is a visit planned for this purpose and it should take about an hour.
Ideally, one result of the visit is that there will be one physician who coordinates the care, knows what other physicians are prescribing and makes sure that the patient’s wishes are followed.
The physician is the conductor following the script he and the patient write. If your father says he does not want to do this, accept his decision and ask him again later. But in my experience, most elderly people want to understand their medical conditions, and once they know they have the opportunity, they want to speak with their doctor. They do not want to be rushed, they want to have all their questions answered, and they want to know that as patients they will make the decisions about their care. Some like to have this conversation with their doctor alone, others want a family member to be present. Discuss with him how much he wants to know about his medical condition.
How much is he capable of understanding? Some want to know everything. Others would like a younger family member to ask difficult questions and then explain it to them. Your father brings up an important point when he says that he does not want to take medicines that will not help him. Some chronic diseases cease responding to medicine.
We often see family members struggling to pay for expensive medications that will have no bearing on the medical outcome or the patient’s comfort. The medications were prescribed months or even years ago and refilling them has been automatic. Anyone on multiple medications prescribed by several different doctors should have one person – a doctor or experienced nurse – look at the whole picture and coordinate treatments.
Jane Brody, writing in The New York Times, referred readers to a good booklet available free through The National Institute on Aging. “End-of-Life: Helping With Comfort and Care.” It can be obtained through the institute’s Web site, www.nia.nih.gov, or by calling (800) 222-2225.
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