Wednesday, December 17, 2008

The Caregiver Phenomena

A thought gelled in my mind today which has been subconsciously stirring for years. I was seeing a 90 year old women who came to the office accompanied by her daughter and caregiver. She had not been feeling well for the last few weeks. She was coughing, having chest pain, and generally feeling under the weather.

The patient didn't look sick. In fact she looked pretty good. She even voiced that she felt OK. The daughter agreed that her mother was looking fine. The only one in the room who seemed in disagreement was the caregiver. The caregiver described how her charge was getting worse and failing to turn the corner. In fact I could almost predict the care giver's responses to my questions before I gave them. Basically for any open ended question there was almost always a negative response suggesting that the patient wasn't doing well.

I have known this caregiver for years. And she does a great job. Very attentive, loving, and hard working. She is present for every cough, and sneeze, and complaint. She works tirelessly long hours. So what gives? Am I and the daughter missing something significant or is the story from the caregiver not exactly accurate? And if it's not accurate then why?

While pondering this question I quickly realized that I encounter this type of behavior regularly. In fact I often find myself going to great lengths to corroborate information given from caregivers. My experience has shown that they often overstate or occasionally exaggerate their charges complaints. In the beginning of my career I took these reports literally and found myself over treating: ordering too many tests and giving too many antibiotics.

I have coined the term the caregiver phenomena to describe this type of behavior. I suspect it stems from two different causes. First, the caregiver who is not medically trained, is often present for every complaint and is afraid that something bad will happen during their watch. They are terrified of missing something significant. Second, I believe the caregiver is often the one who blows the whistle by alerting the family and thus initiates the actions that eventually lead to the doctors visit. Many caregivers feel pressure to justify the visit by making sure the doctor knows the levity of the situation.

Whatever the cause of this effect I feel that most caregivers are genuinely interested and preoccupied with performing their job well. But I now consider the caregiver phenomena when ever I interview an elderly patient.
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By the way thanks to Tracy for this. Even if all my ten readers vote for me it still wouldn't be enough!

2 comments:

Matthew said...

Maybe the caregiver's sense of value is related to how sick the patient is? I would feel my job was much more important if I were dealing with a sicker patient instead of a generally well patient.

I have a feeling some Doctors do this too, mostly for other reasons. One diagnostic cardiologist says there is 40% stenosis in an artery, the interventionist stents it and documents 80% stenosis a day later. I doubt the artery clotted 40% over night.

Up-playing the diagnosis brings value.

tracy said...

You definately deserve it, Dr. Jordan (the award, i mean!). And, i know you have more than 10 readers! :)