First Official Post Over on PSI. I'm going to write to my Mom's doctors

[Our abuse recovery guide]

Hey guys, I'm normally over on conflicted regarding my marriage (which thankfully is much calmer).

My Dad passed away several years ago and as an only child, it falls to me to help care for my 81 year old Mother.  Retired college piano professor, very put together and respected lady.

I stumbled across and interesting "fact" about my Mom's healthcare recently.

She doesn't and hasn't had a general practioner/family doctor in years.

She kinda presented to me that her gynecologist was her GP, yearly physicals and all that.

Well, there has been some weird stuff with Mom in the last 6 months (81 years old) and I've been paying more attention and being deliberate about asking about her conditions and how things are.  Even general questions about if anything is bothering her..hurting..etc etc.

So...yesterday when she called me asking for a doctors phone number ( I had never heard the name before) because her finger had been bothering her for a long time and it was time to do something about it...an alarm bell went off.

She was either keeping it to herself or it hadn't been bothering her, yet she was trying to "push something into emergency status" by embellishing how long a problem had been unaddressed.  (yet I had been asking)

But still, I went along with things until I confirmed with her that I had found the right doctors name.  To my shock it was a plastic surgeon.

I was truly befuddled for a minute and said I didn't understand what a plastics guy would do for her finger that was hurting (she was describing a "place" on her finger and I was assuming I would find the doc was a dermatologist)

She instantly became indignant and was close to shouting at me that she knew best..etc

I stayed calm and said "Mom, I don't understand this...it seems the best thing is to show your GP in a couple of days (this Friday) and let her guide you to the best solution."

Now Mom was shouting..."No...NO!  I will not show it to her and she is not my GP.  She is "only" my gynecologist.  I don't and won't have a GP.  I only go to specialists."

Now...I knew I was off to see the wizard of oz.

"Mom..I'm confused.  Are you telling me there is not a doctor that is coordinating and keeping up with all your visits to specialists?"

She said "I don't know" (and truly seemed confused for a moment)

"Mom...which doctor is keeping track of the big picture of your health?"

Now back to being indignant and almost shouting  "No one, I don't need one, won't have one and won't change." 

"I've been lucky that I don't need a GP."

me: "Mom..has a doctor told you that you don't need a GP?"

She wouldn't answer and starting shouting at me to just give her the number for this plastic surgeon. 

I doubt she heard me because of her shouting, but I said "I'm not helping you make unwise choices for your health, you can do that by yourself." and then I hung up.

My head was spinning..  How had I missed this.

But wait..there is more.

Today she tells me...out of the blue that she sent money to a suspended zero balance credit card (made a $500 payment) because that might make them like her and turn the card back on.  (the card is in my Dad's name...long story how the card got to this point...but he passed away several years ago)

She has known it was zero balance for a while and has promised to not call them, send more money or do anything with this card, yet...she sends them $500...hoping they will like her and turn card back on.

I expressed shock..."You did what?

Mom starts making "mean faces" at me.  (I've never ever seen this)  Then she started "shushing" me like a baby.

At the time I was still fully reclined in a recliner and made a conscious decision to stay there so as not to escalate. 

Well...whatever she was wanting from the "shushing" (that I've also never experienced) probably wasn't working so she walked over and grabbed my arm and starting shaking it. "Now you hush!.."

OK...I had had it.

"Mom...let go of me and back away." (the direct military voice showed up)

To her credit she did. 

"Leave the room, we are done talking.  Don't ever grab me again."

there was a bit of protest from her

"Leave he room, we are done talking.  Don't ever grab me again."

She left the room.

I was still reclined.  It took me a minute or two and then all sorts of alarm bells started going off inside me about what just happened.

I went for a long walk...calmed down and I'm drafting something to send to this gynecologist.

She has a number of appointments with other specialists this summer.  I'll be sending letters to all of them informing them that there is no GP involved and ask for their help nudging Mom in the right direction.

I'll also be describing some of her worrisome behaviors and asking advice.

Sigh...my head is still spinning. 

I'm open to any and all suggestions.  This is all way new to me.  My Mom is obviously unwell.

Best,

FF

[formflier]

Hey guys, I'm normally over on conflicted regarding my marriage (which thankfully is much calmer).

My Dad passed away several years ago and as an only child, it falls to me to help care for my 81 year old Mother.  Retired college piano professor, very put together and respected lady.

I stumbled across and interesting "fact" about my Mom's healthcare recently.

She doesn't and hasn't had a general practioner/family doctor in years.

She kinda presented to me that her gynecologist was her GP, yearly physicals and all that.

Well, there has been some weird stuff with Mom in the last 6 months (81 years old) and I've been paying more attention and being deliberate about asking about her conditions and how things are.  Even general questions about if anything is bothering her..hurting..etc etc.

So...yesterday when she called me asking for a doctors phone number ( I had never heard the name before) because her finger had been bothering her for a long time and it was time to do something about it...an alarm bell went off.

She was either keeping it to herself or it hadn't been bothering her, yet she was trying to "push something into emergency status" by embellishing how long a problem had been unaddressed.  (yet I had been asking)

But still, I went along with things until I confirmed with her that I had found the right doctors name.  To my shock it was a plastic surgeon.

I was truly befuddled for a minute and said I didn't understand what a plastics guy would do for her finger that was hurting (she was describing a "place" on her finger and I was assuming I would find the doc was a dermatologist)

She instantly became indignant and was close to shouting at me that she knew best..etc

I stayed calm and said "Mom, I don't understand this...it seems the best thing is to show your GP in a couple of days (this Friday) and let her guide you to the best solution."

Now Mom was shouting..."No...NO!  I will not show it to her and she is not my GP.  She is "only" my gynecologist.  I don't and won't have a GP.  I only go to specialists."

Now...I knew I was off to see the wizard of oz.

"Mom..I'm confused.  Are you telling me there is not a doctor that is coordinating and keeping up with all your visits to specialists?"

She said "I don't know" (and truly seemed confused for a moment)

"Mom...which doctor is keeping track of the big picture of your health?"

Now back to being indignant and almost shouting  "No one, I don't need one, won't have one and won't change." 

"I've been lucky that I don't need a GP."

me: "Mom..has a doctor told you that you don't need a GP?"

She wouldn't answer and starting shouting at me to just give her the number for this plastic surgeon. 

I doubt she heard me because of her shouting, but I said "I'm not helping you make unwise choices for your health, you can do that by yourself." and then I hung up.

My head was spinning..  How had I missed this.

But wait..there is more.

Today she tells me...out of the blue that she sent money to a suspended zero balance credit card (made a $500 payment) because that might make them like her and turn the card back on.  (the card is in my Dad's name...long story how the card got to this point...but he passed away several years ago)

She has known it was zero balance for a while and has promised to not call them, send more money or do anything with this card, yet...she sends them $500...hoping they will like her and turn card back on.

I expressed shock..."You did what?

Mom starts making "mean faces" at me.  (I've never ever seen this)  Then she started "shushing" me like a baby.

At the time I was still fully reclined in a recliner and made a conscious decision to stay there so as not to escalate. 

Well...whatever she was wanting from the "shushing" (that I've also never experienced) probably wasn't working so she walked over and grabbed my arm and starting shaking it. "Now you hush!.."

OK...I had had it.

"Mom...let go of me and back away." (the direct military voice showed up)

To her credit she did. 

"Leave the room, we are done talking.  Don't ever grab me again."

there was a bit of protest from her

"Leave he room, we are done talking.  Don't ever grab me again."

She left the room.

I was still reclined.  It took me a minute or two and then all sorts of alarm bells started going off inside me about what just happened.

I went for a long walk...calmed down and I'm drafting something to send to this gynecologist.

She has a number of appointments with other specialists this summer.  I'll be sending letters to all of them informing them that there is no GP involved and ask for their help nudging Mom in the right direction.

I'll also be describing some of her worrisome behaviors and asking advice.

Sigh...my head is still spinning. 

I'm open to any and all suggestions.  This is all way new to me.  My Mom is obviously unwell.

Best,

FF

[GaGrl]

From one Only Child caregiver of an elderly parent to another -- I feel for you! Oh, my...those are worrisome behaviors.

Let me start with an easy practicality. In writing to her gynecologist and other specialists, can you ask that they refer her to a board-certified Internist as her Primary Physician? Your mother might respond better to having an Internist than a General Practitioner. Same function, different designation.

Next...it might be useful for an Internist to assess whether your mom needs to see a Geriatrics specialist. I'll get your mom would resist that, so getting her to the geriatrics assessment could be tricky. My ex's mom had problems around age 90 that required a geriatrics psychiatrist, who quickly determined she was having small strokes.

I'm not sure what you can do til you get some advice from her specialists.

It may be that the grabbing and arm-shaking won't happen again with your strong reaction. I found recently that my mom (94 now) quit an irritating "poor me, nobody ever listens to me" behavior after I finally and strongly told her, " Mother, just stop that! It isn't true, and I don't like it when you go there." And she definitely responds to my husband's military voice!

The credit card situation is concerning. Do you know why it is important to her? I'm assuming she has credit cards in her own name, right? Her reasoning is definitely "off."

Do you know if your mother has released her specialists to provide medical into to you? I would be surprised if she has. My mom has released all info to me, plus I have her medical POA.

My dad started having short term memory loss at age 90. When he passed at 93, we found his doctor had classified it as dementia. I wish I had had more info on that earlier, because I could have looked closer at his behaviors. But he was discussing politics, current events, and theology up to several weeks before he went into hospice care.

It's so hard!

[Naughty Nibbler]

Hey Formflier

My mom & dad both passed a couple of years ago.  They never took the HMO route with their supplemental Medicare policies & had one of the higher end supplemental policies (Type "F" I believe)  In light of that, they were able to go directly to certain specialists, without a primary care doctor's referral. There can be an advantage with that, as primary care HMO doctors usually have an incentive to NOT refer patients to specialists (or to delay/resist).

My mom didn't get a primary care doctor, until she was close to 90.  Most of her doctor visits, in her latter years, were with a cardiologist.

As GaGrl stated, an internist or geriatric doctor could be a good choice for a primary doctor.  Geriatric doctors generally accept patients 55 yrs. & older (at least in my State). Geriatric specialists  are allowed to spend more time with each patient (from an insurance billing prospective).

Now Mom was shouting..."No...NO!  I will not show it to her and she is not my GP.  She is "only" my gynecologist.  I don't and won't have a GP.  I only go to specialists."       

A geriatric doctor is a specialist, as is an internist, but I believe they can be used as primary care doctors (at least if you don't have to deal with an HMO).

Tell her that by getting established with one of these two above mentioned "specialists", that she can gain a benefit of being able to get a quick appt. or a prescription phoned into a pharmacy between annual visits.  Her recourse would be to go to an urgent care facility or wait for hours in an ER room. It's generally not a matter of if you will ever get sick & need to get a quick doctor's appt., but when.

I'd recommend getting her established with a geriatric doctor.  So she isn't offended, advise her that they take patients as young as 55.

But still, I went along with things until I confirmed with her that I had found the right doctors name.  To my shock it was a plastic surgeon.

  Some people use plastic surgeons to deal with cancerous or precancerous skin lesions.  A couple of women I used to work with used a plastic surgeon a couple of times to remove some skin lesions.  Cosmetically, they get a better result.
 

The one thing I learned with my mom is that infections, such as a urinary tract infection (UTI), can cause mental confusion in the elderly.  Sometimes, the symptoms of an UTI with an elderly person can be subtle.  In my mom's case, she started getting confused about her medications just before a UTI was diagnosed.

The credit card situation is alarming.  Your mom sounds like a stubborn and independent woman.  She may need some oversight with her finances & sounds like she may fight that.  Maybe the initial goal is to get her examined by a "specialist"/primary care physician and get established. (blood work, urinalysis, etc.)  Once established, you could possibly have a chat with the doctor in regard to memory issues.

Does your mom take any regular meds, perhaps for something like high blood pressure?

[Methuen]

I don't and won't have a GP.  I only go to specialists."

Wow.  
Not sure where you live, but where I live there's no seeing a specialist without the proper referral from a GP.  Your mom must have some special contacts to have that work-a-round.  

So the dialogue you had with your mom, which you recounted so well, could have been a dialogue I had with my mom before I had any clue about BPD, or knowledge on how to manage a relationship with a BPD.  Could your mom be BPD?

I doubt she heard me because of her shouting, but I said "I'm not helping you make unwise choices for your health, you can do that by yourself." and then I hung up.

Well this takes some courage to do.  I'm making notes for myself

Today she tells me...out of the blue that she sent money to a suspended zero balance credit card (made a $500 payment) because that might make them like her and turn the card back on.

This could be my mom!

"Mom...let go of me and back away." (the direct military voice showed up)

FYI:  I'm making more notes to self!

She has a number of appointments with other specialists this summer.  I'll be sending letters to all of them informing them that there is no GP involved and ask for their help nudging Mom in the right direction.

Yes, but maybe after objectively establishing the fact that there is no GP with at least one of them...
That just doesn't seem possible.  When it comes to things my mom tells me, I always have to consider the source.  Could it be that your mom has some reason not tell you about her GP?  Or maybe she just "fired" or lost her GP because her GP dared to disagree with her about her health? That could explain the confused look on her face which you referred to.  I'm not really suggesting any of those things are likely, but having all those specialist appts without a GP, just seems "off".

When I got desperate enough that my mom was affecting my mental health, I went to my  GP with my story, and asked for advice.  He was helpful.  While your mental health isn't in question, I'm even thinking you could pose this scenario to your GP to enquire if its truly possible to get all those specialist appts without a GP.  The whole situation with your mom, sounds like a complicated health concern, and your GP might be able to shed some facts on how referrals how handled, which could help guide you on how to move forward.




 

[formflier]

I'll be back with meds soon.

She is visiting her gyno today and I confirmed with her staff that the letter got to the doc.  Same doc also delivered one of my children and I really like this doc.  Very hopeful about this visit.

Other nuance that I don't think I explained that I put in the letter is that my Mom now lives up close to me for 10 months or so out of the year.  (maybe more in the future)

We were lucky enough to find and buy her a house literally just 5 minutes away from me.  It's got some land, single level.  I couldn't have asked for a better place to help someone age and "keep them out of the nursing home as long as possible".  (my Mom's "ask" of me)

Well, part of the request in the letter is for my Mom to establish most of her medical care up there, instead of trying to pack everything into a couple of months in the summer "down here".

As far as BPD.  Who knows.  I doubt it.  She has always been a pretty solid person, with a few "targeted eccentricities" mainly around music.

She was a piano professor/performer for her adult life and can still play.  Very talented.

Let's just say she can be "particular" and a bit "obsessive" or "perfectionist" about music/performing.  But...then...I think it's that way for most "high level" performers..isn't it?

Best,

FF

[GaGrl]

Depending on the type of Medicare Supplemental Plan your mother has, it is possible she is not required to go through a primary physician to see a specialist. We just went through Medicare setup this past year, and we have a Plan G that is not a PPO or HMO.  So not I want a dermatologist to look at a spot on my arm, and I then want a plastic surgeon to remove it, I can do that.I

Your mom definitely needs to set up medical care in your current town -- that's a good way to approach it.

[formflier]

Correct, there is no requirement for her to go to a primary care.

That said, she raised me to have a "coordinating" or "central" doctor and that's the way she lived her life, until?  I'm not sure when the change or why.

That there is not one doctor tasked with "the big picture" is worrisome, especially when odd stuff is coming up.

Sigh.

Best,

FF

[GaGrl]

Absolutely agree! The primary physician (and I prefer that it be an internist) is the diagnostician. They are the ones who put everything together. They communicate with the specialists -- make referrals and receive results. They treat the Whole Person.

I fact, my husband and I were unimpressed with my parent's internist that, when we retired and moved here, we now see her. So for me, she not only gets my medical history and current situation, she knows my family medical history first-hand.

[juju2]

Hi ff

No one mentioned Hipaa and protected health information.phi.

I am non clinical in med profession.

wish you much success and also do not be surprised by getting stopped with the above stuff. 
A friend with power of attorney, caring for her mom who has diagnosed dementia, 80; my friend was left completely out of the loop during an e.r. visit(chest pains)
no family was allowed in to the e.r. or the hosp because of covid restrictions...
disaster hosp visit, her mom was o.k.

Just mentioning those letters. Hipaa and PHI in case someone tries to stop you.

Sincerely

J

[GaGrl]

Absolutely agree! The primary physician (and I prefer that it be an internist) is the diagnostician. They are the ones who put everything together. They communicate with the specialists -- make referrals and receive results. They treat the Whole Person.

I fact, my husband and I were unimpressed with my parent's internist that, when we retired and moved here, we now see her. So for me, she not only gets my medical history and current situation, she knows my family medical history first-hand.

Argh! I meant "so impressed" -- not "unimpressed."

[Notwendy]

Juju has a good point. Due to HIPPA, your mother's health care providers won't be able to discuss her care with you.

I hope she will still be agreeable to signing health care POI and HIPPA forms giving them permission to speak to you.

My father did, and I was allowed to speak to his heath care providers. My BPD mother did not. However, recently she did sign for that. I hope your mother will sign them.

[Harri]

Hi FF.

I just want to pop in and say that a lot of women use their gyno as their PCP.   It is not something I would recommend for people with a lot of health issues or elderly people though.   

Just wanted to let you know that it is not uncommon and it may be something your mom has done all of her life. 

Good luck.

[formflier]

I haven't yet had a conversation with Mom about her appointment on this past Friday.  I have been curious what would come out of it, what she would bring up...unprompted.

Her demeanor has been different.  It seems like after her allergist sat her down and gave her a good talking to about the dangers of COVID.  He also gave her some paper with details of what she could and couldn't do and where she could and couldn't go.

Mom was on best behavior after that talk for several weeks, in fact there were no more (to my knowledge) "jail breaks" after that.


I do need to look  through all my paper work and see where I am at on health care power of attorney.

I think I have one ( I know I have a general) but I've never tried to file it with doctors or anything (yet).

Best,

FF