Arthur Riven's op-ed last year in the Los Angeles Times has stayed with me. It's about being both a physician and an Alzheimer's patient, and perhaps one of the best pieces I've read about living life, and living life on life's terms with grace. Dr. Riven, who practiced internal medicine and is a professor emeritus at UCLA, writes about the struggle to accept that his mind was deteriorating, and how his wife, knowing something was wrong, urged him to see a doctor. "Doctors are often not willing patients," he says. The piece is not preachy at all, not Pollyanna-ish and full of practical things people with memory disorders can do.
Having spent more than a decade working with families of the elderly—and having watched my own parents pass away—one question I think about still: What should a patient and family expect from a physician?
I write about this because it seems like, often, families feel they have to choose between someone who is a genius or who is compassionate. Many docs are both. But if you are struggling with the question about what's reasonable to expect from a physician, chances are you haven't met a healthcare provider with the qualities you're looking for (sounds a little like dating, no?).
But, as Dr. Riven's editorial remains poignant nearly one year after I first read it. He brings home the fact that doctors are people, real people (not gods!). They are not perfect. They are trying to do a job that, perhaps, overwhelms or even frightens them at times.
It seemed fitting, then, in rounding up this 3-part series about Alzheimer's disease (AD), that we address the issue with our expert, Dr. Barry Rovner. What to expect, that is, from another human being who is said expert. I asked what, exactly, should patients--and caregivers--expect from their doctor? Keep in mind, his answer was provided in the context of AD. But substitute the specific exams he discusses and, really, these are good guidelines for evaluating your relationship with any healthcare provider. I could 11 general areas...but that doesn't mean there are not more.
"Patients and families should expect that the physician is familiar with and has the time to spend diagnosing and treating memory disorders in late life," he said. "That expertise involves being able to obtain an accurate history, conduct a mental status exam, test cognitive function using brief rating scales such as a Mini-Mental Status Examination, formulate a differential diagnosis, evaluate current medications to determine whether they impair memory, order appropriate laboratory and neuroimaging studies to identify medical or neurological conditions that cause memory loss, prescribe indicated medications, be familiar with community resources, and make a commitment to provide care to the patient and family throughout the course of the disease. The physician should be willing to talk with multiple family members and assess caregiver burden and depression."
As Dr. Riven writes: "Doctors are often not willing patients," he says. Perhaps that's one reason why some--not all, for sure, but some--might falter at the bedside manner?
