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Sunday, December 8, 2013
How Tell a Family Member about AD
We suspect one of our family members has AD. How do we go about first approaching them and letting them know we want them to see a doctor and get some testing? The family has a history of AD. Our father died from it and various members of his family also were suspected of this. Thank you.
Sorry for the delay in e-mailing this response. Informing a family member about what others are observing and then moving to actually getting this person to see a doctor can at times be tricky. In some cases others can share their heartfelt concerns with the person directly and the person may be willing to go to the family doctor to initiate evaluation for the memory changes. Other times it may be difficult to openly talk to the person or you might feel they will be angry or resentful if you point out the concerns. In these cases, I tend to encourage families to employ the help of the primary care doctor (PCP), if the physician is willing.
Often if families let the primary care physician know about what is being observed (either in writing or in person) the PCP will be willing to assess the patient, possibly ordering some baseline lab work and maybe even a brain scan to initiate looking for possible reversible causes of memory loss. If the primary care physician takes the lead and tells the patient that memory changes can tend to occur naturally with age, but that at times there may be other conditions that can contribute to these changes, often the patient is less resistive to a possible referral, by the primary care physician, to a memory disorders specialist. If the person is scheduled for a routine follow-up with their PCP in the near future use this as an opportunity to share concerns with the physician prior to the visit.
With the Federal Privacy Laws known as HIPPA it can be more difficult to communicate with the primary care physician about your loved one on the phone or in person. That's why I recommend a letter with a call to the PCP's office letting the staff know that the letter is being sent and that you hope it will be reviewed by the PCP and noted in the person's chart. Families along with primary care physicians can often encourage a patient to be evaluated by a memory specialist because of the rationale that memory loss conditions may possibly be reversed, may also improve with treatment, and if treatment is recommended it's always better to implement treatment earlier versus later.
What often tends to be difficult for families is when the patient does not recognize any of their own deficits and becomes defensive or angry or excuses the changes as being due to stress or that every one forgets more as they get older. Again, having a primary care physician willing to take the lead in getting the patient more thoroughly evaluated is typically the best mechanism in getting things started.
We are very used to having persons arrive her at the OSU Memory Disorders Clinic with limited or no knowledge as to why they have been sent to see a memory specialist. At times they are not happy that their family had arranged the appointment or cannot recall that their PCP had made the referral. I always tell families if you can get them through our front door we will manage the visit with lots of professional tender loving care, even in the midst of possible patient anger. I hope this helps. If there are follow-up questions please let me know.
Rebecca A Davis, RN, LISW
Clinical Research Nurse of Neurology
College of Medicine
The Ohio State University