sandy22 Asked April 2015
What do you do when disagree with doctors?
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help me advice please mom in hospital took her off of her meds she has been on put her on zyprexa do not wANT HER ON THIS SHE IS MORE confused then ever I want to bring home continue her meds was on what can I do want to send her to pysch hospital to experiment I feel no she has dementia
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Unless you have extensive medical training, you cannot possibly understand all the possibilities, downsides and upsides of each treatment. Yes, your risk stroke with certain blood thinners, but you also risk stroke NOT being on them. Yes, less is more in terms of meds for the elderly, but some meds bring better quality of life. I think we should all listen a little harder.
I asked about side effects, and the doc said yes, there is a risk of stroke. I said something like, "y'all, he's had two of those already." Which he has, and I'm surprised the doc forgot about all that. But he didn't push that blood thinner any more.
Do I have POA? Well, kinda sorta. But the doctors know me, and my type-A, borderline pushy nature does help. So does stating my objections with a few well-placed questions.
And, short answer is no, they did not teach much at all about dementia in medical school when I went through - they did not really KNOW that much back then - and even now, probably they don't do nearly enough. At UAMS we do have a strong geriatric presence and I think they do get involved in the med student curriculum, but familiarity with the legal and funding aspects (aka "systems of service") is still not great among students or residents.
You will still run into docs who seem to expect that everyone should respond to what I call cookie-cutter medicine, and just kind of get mad or frustrated and blame the patient when things do not work the way they are supposed to. Some, even most of us care deeply about our patients and will take the time and energy to think things through, revise a diagnosis or treatment plan and listen well...some of us are either burnouts or just never really cared enough in the first place. Those "80%ers" among us will meet the standard of care or practice that does work 80% of the time, but go no further. And they said if we ever stopped learning, we'd be at the bottom 10% of our profession in 10-15 years, but today its even faster than that, but some old curmudgeonly types unfortunately think ALL the old ways are better and common sense is all they really need. In their defense, you really can get burned by people who believe every d*mn thing they read on the internet or who have decided all meds are poisons and all therapies are scams, and right up front before they even know you as a human being they have clearly decided you must be getting kickbacks and withholding information and care for fun and profit.
Just my $0.02!!
my sis tried to run the intensive care unit when mom was in there based on all the med tv shows sis has watched . i generously offered to have her tossed out of the hospital .
everything is based on science , bloodwork and federal guidelines . docs arent just taking wild guesses .
There are forty good answers here, hopefully she'll be able to read them and go from there.
My only advice is not to be afraid of the drugs the doctor ordered. Like I said before, that particular drug is only ordered by a psychiatrist or at least that was how it was in both Massachusetts and FL.
And it helped my mother immensely despite the bad reviews it got from my 'kids'.
Everyone is different. What works for one may not work for another. But you have to give these drugs a certain amount of time to actually kick in. As they are kicking in, sometimes the side effects aren't so great. I'd give it a good three to four weeks, unless you are seeing something majorly wrong.
You need to rest while you can if she's still in the hospital. Also, do some homework, i.e., Google the name of the drug and try to look for references related to hospitals, not people's reviews. If you have concerns, do not be afraid to ask the doctor. S/he won't bite. S/he's a person, not a god.
I will be thinking about you.
With regard to "experimenting" at a psych hospital, i believe what is being offered is in house psychiatric unit where they can trial meds to get the patient stable. Sandy, I hope things are going better!
There are also some big egos outside it.
Doctors' communication skills are generally pretty woeful (I blame their training - it seems to cover no middle ground between e.g. cryptogenic fibrosing alveolitis and "oo dear you've got a bit of a nasty chest there") vs.
They are often trying to explain extremely specialised concepts to people who have not spent four or five years in medical school.
They do not always apply their extensive knowledge and full concentration to a particular situation vs.
"When you hear hoofbeats, think 'horses' not 'zebras.'" In other words, their own clinical experience, lack of time and gambling odds all conspire to push doctors towards the obvious answer or the easiest course of treatment - so they jump to conclusions, and unfortunately that often means that they jump over us.
Particularly in the context of the forum, many patients a) have complex, competing co-morbidities and b) have a lousy prognosis. Our loved ones are likely to decline and die no matter how gifted, thoughtful, well-equipped and efficient their medical team. We need to accept that sometimes there aren't any good answers: the doctors may not be completely right, but that doesn't make us any righter.
Communication being a two-way street, we need to play our part by dealing openly and courteously with professionals while explaining our concerns as clearly as possible. But by and large, I believe it's wrong and self-defeating to ask for medical advice and then ignore it or overrule it. That belief is currently being tested to destruction - wish me luck and I'll let you know how this morning's telephone consult. goes!
DO realize that most people do not get most side effects, or nothing would be left on the market :-) and keep a running list of definite side effects, especially if you can confirm them and they are to things that are most commonly used.
I think the reason you got questioned at first is that something happened that could have made someone ask if the previous meds were actually not working. I think all of us have had cases where the person thinks they are having a side effect but it is really the condition changing. I have people who come back after a surgery that was hopefully going to help their child walk - they may say something like 2 years ago my child was walking and now after the operation they can't anymore! But, what they are not remembering is that they had stopped walking and that is why they decided to have the surgery...it just did not turn out as well as hoped.
I always question doctors when they give me a vague answer.
My Mom's kidney doctor had her on four different high blood pressure medications!
I ran out of one of them, and it made no difference in her high blood pressure level.
I asked the doctor if we could discontinue the medication since it did nothing.
She didn't have an answer, but wanted her to continue taking it.
I think they were more interested in pushing drugs and making money than my Mom's health.
It is not hypercritical to be request enough clarity to understand what has been asked. We all understand and forgive typos. The text does not have to be elegant.
Had my dad put on Ativan in the hospital and he got confused, went right to the Director of Nursing and got him off it.
Doctors sometimes need to be put in check.
Anyway, as it turned out, this drug worked wonders in that it stopped the delusional thinking along with the paranoia that came along with her problem, age related dementia, higher than normal blood sugar readings (she wasn't taking her insulin correctly, and the list goes on).
It was when another doctor in another state (FL, not trained in geriatric psychiatry) told me the drug had been given to her for appetite, not for paranoia, adjusted the dosage to half that the problems began. I didn't go along with HIM, so I got rid of him and went to another doctor, who adjusted the medications again. BTW, in FL Zyprexa can only be prescribed by a psychiatrist
My children were totally against Zyprexa because of what they read on the internet. I, gave it a chance to work and work it did, now going on fourteen months. While she is now in a nursing home, she is somewhat aware, not paranoid or delusional anymore, and functioning well for her medical condition, i.e., loss of executive function, dementia, and the list goes on. She's in there because she fell, we placed in rehab, and I decided this was the best place for her given the social aspects, etc. While you need to keep tabs on doctors, you also need to trust them somewhat (SOMEWHAT). You need to ask intelligent questions and to do that you need to do some homework. It's not easy. My mother is going on 92. I've come to accept her time is limited given her age. I believe we have to also do that in order to survive caregiving.
2. Why is she in the hospital?
3. What were her symptoms?
4. Why did the doctors feel the need for Zyprexa (generic form is Olanzapine)
Then we can go on from there.
That's exactly why I insisted on more tests. I was worried about her having a "brain bleed". My mother suffered from a brain bleed that went undiagnosed for over a month because it did not show up in the initial tests....my step father did not care that her behavior had deteriorated as he was ready for her to die and so did nothing. I happened by for an unannounced visit and saw her practically lying in her plate and he said "Oh, she's been doing that for about two weeks now".... I won't go into the rest of the story on that right now and please fellow posters don't jump me for not being more aware of my moms situation as my step father wouldn't allow anyone in the home....I surprised him at lunch one day and could see her at the table,he was unable to tell me she was asleep and to try some other time.....
Back to my MIL, she had dementia and was in assisted living. She fell in the middle of the night but was able to get herself back in the bed. So casually mentioned it the next day to one of the staff. Since she was 82 they called the ambulance and the emergency dr ran a few tests and released her before I got there. A few days later, right back to ER, this time I was there for all of the tests and admitting to the hospital. Still I had to insist that she not be sent home after three days of "observation" and that more test be done. She never recovered and after four months passed away. She was under hospice care and got to live out her final days in her own room at Assisted Living. They loved her and she loved them, it was the best place for her final days.
Getting help from the PCP or another clinician you know can help. Otherwise getting a friend or relative to support you is always a good idea.
Otherwise, you can do things like:
- Take notes on what's going on and who you talk to
- Ask repeatedly to talk to the doctor and say you are concerned and want to understand what's going on
- Ask to speak to a supervisor if someone is stonewalling
- Consider putting your concerns in writing and giving them to the supervisors of the hospital. Things in writing often carry weight, and they move up the management chain.
- Consider voicing your concerns on social media. I have found this often gets a very fast response from a customer relations team. Try to be diplomatic and constructive, it's better to say "I'm frustrated w XX hospital; can't get a clear answer on why they are changing my mom's meds" than "They're horrible and messing up my mom's meds!"
There are good resources at NextStepInCare.org re hospital discharge...I cannot remember the details but I think there are people you can call if you object to the care provided to a Medicare patient.
Good luck!!