The general practitioner is usually the key person involved in organizing the care for anybody living at home with a chronic degenerative condition. It is essential that both patient and carers have confidence in and get on with their family doctor. Unfortunately there are always going to be some people who feel that the relationship with their general practitioner is unsatisfactory. This is, however, often as much the fault of the patient and the patient’s family as it is the doctor’s.
Many patients visit their doctor and for a host of reasons fail to get across why they have really made the appointment. It is easy to describe a simple physical problem that can be demonstrated such as a rash or a swollen joint, but often much more difficult to describe adequately less tangible conditions, particularly those associated with stress. Before visiting your doctor therefore it is important to get quite clear in your own mind what the problem really is and how it has affected your day to day life. This means, whether the problem is affecting you or someone else, deciding in your own mind what is really wrong. You also need to have an idea beforehand of what sort of action you hope the doctor will take. If you are worried about forgetting things, jot down a few points on a piece of paper, more in the form of notes to jog your own memory rather than as a lengthy account for the doctor to read.
If you wish to tell the doctor that you are worried about an elderly relative’s mental condition, rather than just saying that the person in question is becoming more forgetful, be prepared to describe what is happening and how seriously you regard the problem. Have examples ready of how the forgetfulness or muddled thinking is having an important impact on the life of the person concerned and those around them. If you want a careful analysis made of the forgetfulness or confusion, make sure that the doctor is aware that you want a proper assessment of whether the condition is the result simply of old age or of an early form of dementia. You must also be ready to tell him that if it is dementia, you want the underlying cause diagnosed, just in case it is one of the treatable conditions. Try not to make it appear as if you are demanding action, but rather let the doctor know that you are concerned and are seeking his support and advice.
If, despite this, the matter doesn’t appear to be taken seriously, particularly if the doctor hasn’t examined the patient and has not requested a second opinion, tell him that you realize that blood and other tests are probably necessary to rule out conditions such as glandular disorders and nutritional deficiencies, and that you would be prepared to go to hospital for a second opinion if he would prefer that. Above all, don’t be put off; but at the same time try to handle the situation tactfully if you think your problems are being treated with disinterest.
It is very important that you listen carefully to what the doctor says. Most people, including myself, feel anxious when seeking medical advice for themselves or their family. This results in a tendency to want to make sure that the doctor has heard all that you wish to say, often in the way in which you want to say it, which may result in your not answering his questions accurately; more importantly you may not take in what he says to you. If at the end of the consultation you are not quite clear about what has been decided, ask your doctor to summarize the action that he is going to take.
There are all sorts of doctors just as there are all sorts of people. If you don’t get on with your doctor you must change to somebody else. This often seems an incredibly difficult obstacle to overcome, but it really is very important. If you are looking after somebody with dementia, you are going to need help, increasingly so, over many years. Doctors realize that they won’t always relate well to every patient or relative. If you feel you have this type of problem, summon up the courage to discuss it with your doctor and explain the reasons in a friendly and tactful manner. He will probably understand and a discussion of this nature can often lead to a better understanding, making a change unnecessary. An alternative approach is to arrange to see a different member of the practice on a subsequent occasion. One of the benefits of large group practices is that there is a greater likelihood of most people’s needs being met by at least one of the partners.
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