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Patient Empowerment
Caregiving: Taking Care of Elders - Dr Aniruddha Malpani

Posted On Sunday, November 23, 2008 - Times Wellness

Taking care of the elderly can be a daunting task. However, if done right, it can be a rewarding experience
Posted On Sunday, November 23, 2008
Thanks to the rapid advances in the field of medicine, more and more people live to a ripe old age, it is increasingly likely that you will be taking care of older relatives at home. While this has always been a traditional practice in the joint Indian family, caregiving can prove to be quite a burden in Mumbai, where most of us lived in small cramped flats, and space is at a premium.

While many people think of caregiving as a burden, in reality entering into a caregiving relationship offers a valuable chance to reconnect with someone for whom you care deeply. And don't forget that you'll be setting an example for your children, so that when it's time for them to take care of you when you become old, they'll do a good job too.

Taking care of the elderly as they become more infirm and demanding with each passing day can create a lot of stress. If you're trying to shoulder the burden all alone, the frustrations may overwhelm you. An amicable situation can turn sour and, in some cases, mistreatment or abuse of the older person could be the tragic result. As testimony to this disquieting but indisputable reality, the media is reporting more and more cases of abuse and neglect of the elderly in India. Many parents have even been forced to commit suicide when they have got fed up of the ill-treatment they have received.

To sidestep an unpleasant situation and to ensure that you handle caregiving as successfully as possible, you should go in for a little thought, education and preplanning.

To start with, hold a family session when your parents are well. Talk about the future, and what they would like you to do for them in case they fall stick. Involve your brothers and sisters in the discussion and hold it in a positive atmosphere. Although talking about old age and impending debility can be uncomfortable, and disconcerting, this could be the most positive approach in the long run.

Consider covering the following areas:
Division of labour: Decide who will do what - in an unambiguous manner - when your parents need help. If one relative lives close by and decides to be the primary caregiver, it's crucial that the other siblings play a supportive role. One should also find answers to the following important queries: Who will give the primary caregiver a break when he or she needs it? Who will help financially? Who will lend a sympathetic ear when the primary caregiver feels overwhelmed?
Money: To plan for the years ahead, you should know your parents' financial resources. Such information helps you avoid the pitfalls of arranging for your parents to live beyond or below their means. If you're the main caregiver, decide well ahead of time if you want financial compensation for your efforts. This attitude might seem very commercial , but may actually help in the long run.
Insurance: Make sure your parents have taken adequate medical insurance to cover their medical expenses.
Living will: This document puts into writing what medical measures your family member does and doesn't want to be taken in the event of a terminal illness or condition.
Power of attorney: This legal document allows a designated person to make specified legal and financial decisions if your parent or elderly relative becomes unable to manage his or her affairs.
Try to make your caregiving relationship as positive as possible, while, at the same time, being realistic. The relationship you had with your parent as a child doesn't disappear, and if you had a friendly, easygoing rapport with your mother or father when you were younger, it's likely to continue. However, if the relationship was subject to stresses, they may re-emerge. Also remember that prominent personality traits tend to become exaggerated as both of you grow older.

Caring for an older adult is very different from caring for a child. With the passage of time older persons become more dependent on others, not less. On some days, the experience may feel like an emotional roller-coaster ride: you quickly move from pity and guilt to love and on to anger and frustration.

Telephonic Troubles- By Dr.Aniruddha Malpani, Article in Times Wellness - 17th August'08

Times Wellness
Telephonic troubles
Sunday, August 17, 2008


Learning the right way to communicate with your doctor over the telephone is an important etiquette every patient should know
Dr Aniruddha Malpani


Often you can save yourself a long wait for the doctor at the clinic by getting advice on the telephone. Such a trend is becoming increasingly important today, when time is at a premium and commuting is so arduous, thanks to frequent traffic jams. You need to learn to make intelligent use of the phone to get appropriate help from the doctor. However, when you're sick or hurt, it becomes difficult to think clearly and the following routine may help get the necessary care you need over the telephone:

· Keep a pen and paper ready so that you can write down the relevant instructions.

· Make sure all your medical records are at hand, so that you can answer questions about your medical problem intelligently and accurately.

· Identify yourself properly, giving your full name as well as your diagnosis. Avoid taxing your doctor's memory.

· Respect your doctor's time. Don't insist on talking only to the doctor every time you call. For example, if you just need to make an appointment, or merely clarify a doubt, the nursing staff or receptionist may be able to help you.

· When you don't know what you need (for example, you may not be sure how serious the illness is and whether you require to visit the clinic), tell the staff you're uncertain and request that you speak to a nurse or the doctor's assistant over the phone. If you're feeling concerned or anxious, let the clinic staff know.

· Ask if you can take a few minutes of the doctor's time now, or whether you should call back again later – this is common courtesy.

· Report specific symptoms. For example, rather than just saying, 'I don't feel well, or I've got the flu,' which can be interpreted in different ways, be prepared to describe your symptoms precisely; for instance, fever, sore throat, cough, and/or bodyache. Similarly, instead of just saying, 'my baby has a fever', specify the exact temperature and the duration of the fever as well as other signs or symptoms.

· Don't misuse the phone by trying to wangle a free consultation. Not only is this unfair to the doctor, but also such a consultation is likely to be very unreliable.

· Ask the doctor what you should do and write down his instructions carefully. Ask the doctor to spell out any word if you are unsure about it.

· Ask if and when you should call back, or if you should come to the clinic.

· Ascertain what complications could occur that may require you to hurry to the emergency room.

· Don't forget to thank the doctor for talking to you on the telephone!

If you have the doctor’s mobile number or residence number, please treat with respect. This is a privilege he has granted you, so don’t abuse it for routine calls, which are better handled by calling the clinic or the secretary.

It’s a good idea to find out what the clinic policy is about phone calls in advance.

· When is the best time to call?
· What is the doctor's rule for returning calls?
· Whom should you speak with (e.g., assistant, nurse) if the doctor can't come to the phone?
· What is the phone number for making emergency calls or for calls when the office is closed?
· Whom can you call if your doctor is out of town?

Sometimes, you may have to call a doctor after the clinic has been closed. Remember when you call a doctor after hours, he is trying to help you solve your immediate problem, not provide advice about your entire medical situation. Try to be specific in your complaint; you should know what medications you are currently taking and which of them has proved successful in the past. If you are not happy with the physician's advice or if you feel you are getting worse, go to the nearest emergency room at once.

Let me give an example of a precise and useful telephone call: 'I am an asthma patient and have had increasing wheezing today. I am not coughing up any mucus. I am using my albuterol inhaler every three hours but it doesn't seem to work. Last year when I suffered a similar episode, the doctor gave me prednisone and it worked, but the prescription is a year old. What should I do now?

On the contrary, here is an example of a bad telephone call: 'I don't feel good. The doctor treats me for breathing problem. I take three breathing pills, one is green, one is white and one is real, and I ran out of the red one last week. While I have you on the phone, I think I have a fungus on my feet, can you suggest a prescription for something for that as well….'

Making effective use of the telephone can help to save both your doctor’s and your time, effort and money. Learn to use this instrument wisely and well.

Personally, I prefer email to talking to patients on the phone for many reasons.


· Everything is documented
· There is no scope for confusion or misunderstanding
· I can refer to the patient’s medical records, to ensure my advise is correct
· We don’t have to play telephone tag, which means I can answer at my own convenience. This is especially important for overseas patients, because of the timezone differences

Smart patients need to learn how to communicate with their doctors – and using the phone and email effectively can help them they save the doctor’s time, as well as their own.