The caregiver’s most important ally: the family physician

Glamaris Valentín Cameron
migentegrande.com

The first time I heard about “primary care physicians,” I thought the name was a tad dramatic. In my mind, the name seemed to suggest that these doctors were above and beyond mere mortals.

 As a caregiver to my parents, I have realized the importance of primary care physicians (or PCPs) and the need to select an adequate health care provider. This is one of the few professional relationships my parents have maintained for practically their entire lives —one that also involves their kids, spouses, and grandchildren. I have had good experiences and valuable lessons. During our parents’ natural aging process, primary care physicians become the family’s guide to health and wellbeing.

First Contact

Which came first: the chicken or the egg? In terms of our health, first comes an illness, and then comes the primary care physician. We humans usually carry on without concerns for our health until we get our first scare as we grow older. A visit to the ER will confirm your blood pressure or glucose are high, and then you start needing to go to your doctor regularly. Bouncing around between offices, as well as the large amounts of medications, may lead the family to beg for “a single doctor that will handle everything.” This is how we end up with a primary care physician.

Unexpected Changes

My father selected a fantastic primary care physician. The internist shared an office with his wife, who was a neurologist, both of them with excellent credentials and renown in the medical community. We only needed to say, “this analysis was ordered by Dr. López” to get the whole process expedited. Dad’s medical routines were perfect.

Then, he started having heart problems, and his cardiologist was monitoring closely, keeping an eye out for whenever an open-heart surgery would be necessary.  My father and his cardiologist had been discussing the possibility of undergoing an operation for almost a year, and when the time came for it to happen, every element was in place.  What took us by surprise was that the perfect primary care physician then decided to abandon his private practice to provide services directly through the hospital. They told us that the hospital would assign us to another internist, but we felt that it would never be the same as Dr. López. 

Dad’s open-heart surgery was a success (a story for another time). The entire procedure went so well that we barely ever saw the internist physician. His cardiologist and his surgeon handled every detail and discharged him from the hospital promptly. Two weeks later, after a follow-up appointment with the cardiologist, my father caught influenza.  We arrived that night at the ER with the cardiologist’s instructions in mind: “If your dad gets really sick, come right in and let them know he has undergone open-heart surgery.”

That late night, we got to know our primary care physician a lot better. After explaining that dad had just undergone open-heart surgery, the ER personnel called his primary care physician, and he was there at our side by 5:00 a.m. Once there, the doctor gave precise orders to hospitalize my dad in order to help him fight a dangerous bout of the flu. That was the first of two hospitalizations (the second one being for gastritis) where we ended up being impressed by the new primary care physician.

What We Are Thankful For

Although this new internist has a large number of patients under his care, he’s very diligent in visiting those who are hospitalized. During both of my father’s hospitalizations, I used to arrive at the hospital at 4:50 a.m., and the doctor would be there at 5:00 a.m. A few minutes later, he would talk with me without any rush. I had time to share his instructions with my family and arrive at my new job on time, with the peace of mind that comes with knowing every little detail about my father’s condition.

The satisfaction I felt over those months led us to develop a relationship of trust where the primary care physician became our educator. He was very patient in relaying to us the importance of giving him all the studies and documents required by the health plan. He sought alternative or non-invasive options for the less critical health conditions. We were pleased that the primary care physician limited my parents’ medications to what was strictly necessary and inspired them to lead and enjoy active and productive lives. And that’s how it was for almost a decade.

He was always direct with me as a caregiver. He opened my eyes to the reality that my dad was approaching his twilight years and that I needed to arrange for his Do-Not-Resuscitate orders, among other legal details. He also warned me about the possibility of dementia among older adults. Let’s say that, without the primary care physician, I wouldn’t be writing this, and the migentegrande.com website wouldn’t exist.

New Symptoms, Another Generation

Within one week, my father started exhibiting unusual symptoms, such as lack of mobility in his torso, inflammation, weight loss, and feeling disoriented. This time, our primary care physician could not provide a diagnosis and clearly told us, “I cannot help.”  We started a desperate search for a diagnosis, which led us through more than 10 different doctors and to the San Juan VA Medical Center.  At this hospital, we were assigned a new primary care physician, and that was when I met a geriatrician for the first time. Let me tell you that if you have an older adult in your life who is no longer independent or whose health is worsening, your best bet is to have a geriatrician as their primary care physician. 

The geriatrician suggested a diagnosis of Parkinson’s disease, which opened new doors for us and helped us improve my father’s quality of life. The doctor explained to us how important it is to have a physiatrist and physical therapies in order to strengthen a body that was quickly deteriorating. She even taught us how to help my dad get into a car —a “small” detail that has saved my lower back. What is interesting is that the doctor’s mother and grandmother had also had Parkinson’s disease, so she was very familiar with the most common concerns. The advice given by this young geriatrician was a salve for my mother as the caregiver for the love of her life. Mom identified with the geriatrician’s kindness as she spoke of the older adults in her own life. And my dad would even ask after the health of the doctor’s mother every time he went for an appointment. A patient asking after the health of another patient he had never met.

In short, I cannot say that either of his primary care physicians was better than the other. I am thankful that both of them arrived at the right time and opened the doors for us to ask any questions we had and share our concerns. I can assure you that I seized every opportunity to badger them with questions and even cry a little. At the end of the day, we caregivers need primary care physicians to serve as a combination of friend – psychologist – teacher.

The relationship between an older adult’s caregiver and their primary care physician must be direct. The caregiver is responsible for describing each symptom or behavior of their parent or spouse in detail. We cannot omit any seemingly minor things or embarrassing situations.  Being honest and frank at each medical appointment will spare you a lot of trouble, and I can assure you that you will have more peace of mind.

The author is a journalist, television producer, and editor of the migentegrande.com webpage, which offers advice for the family members and caregivers of older adults in Puerto Rico. She is also developing a digital directory of healthcare and quality-of-life services for older adults. Look for more information on Facebook and YouTube as Mi Gente Grande and become part of our community of caregivers. For more information, email info@migentegrande.com.