The Patients Who Really Test Patience
Most of my career has been spent working with older adults. I've worked in acute-care hospitals and briefly in a skilled nursing facility, but the majority of the time I've worked in the community. I think one of the reasons working in the community has appealed to me is the level of preventative care that can be provided. Often we're treating someone for a sub-acute condition, but we can spot the things that could be troublesome down the road. The nearly empty refrigerator, the torn carpets and loose floorboards, the spouse who actually requires more care than the patient, the well-meaning family who brings high-carb-content foods to a diabetic, the stacks of unpaid bills on the kitchen table.
Yep, there is a little bit of dietician, nurse, social worker, GP, and physical therapist in any professional who makes house calls. Most patients and their families really appreciate this holistic approach and I believe it results in better long-term outcomes. Often, older adults are resistant to change. Frequently I'll hear, "I've gotten to X years old without your help before. I certainly don't need it now." I respect the truth in that statement, but I also recognize the educational opportunity to make someone aware that if they make some changes, often small, they'll make it to X + 10 and probably not need more of my help. Many times I hear older adults say, "I don't want to be a burden." That is understandable and one of the toughest battles to fight. How to get people to accept a small level of help to prevent becoming a major burden?
Last week the essay "A Very Ungrateful Old Lady" appeared in the New York Times. It is a story of a very angry lady in her mid-80s who resents the help her children are willing and trying to provide. She relishes her defiance and challenges the idea that she should ever bend to anyone's wishes. They have a saying here in the UK: "It'll all end in tears," to describe a disaster waiting to happen. This will most likely all end in tears for all involved.
In this woman's quest to not be a burden, she takes some dramatic health risks. One fall, a UTI, or medication mix up, and a hospitalization is pretty much guaranteed. She will then require lots of attention from her family, the healthcare system, and Medicare money, all of which could have been avoided. I doubt this person would ever listen to a PT, a doctor, or anyone. I've had a few patients like that over the years. I've never actually said, "I told you so," but I have been tempted.