Helping a loved one who may not want it
While I'm away, readers give the advice.
On helping a loved one whose health is at risk • I often wish advice columnists would counsel neighbors, family and friends who are concerned about someone to send a letter to the patient's doctor. It's usually easy enough to find out names of people's doctors: Most people keep their meds in the bathroom medicine cabinet or on the kitchen counter, and the doctor's name and phone number are right on the pill bottle. Include the patient's full name, date of birth and/or address so we can connect the letter to the correct patient's file, and then be as specific as possible about any observations and concerns. We can't respond to the letter because of HIPAA regulations, but a reputable doctor will take it under advisement. While I can't guarantee the patient won't put two-and-two together, it's usually not too hard for me to make up a pretext about why I need to see the patient, and with a few routine questions and physical exam maneuvers, I can usually come up with enough evidence to take good care of my patients without disclosing the letter. This could be useful for concerns about driving safety, dementia, mental illness, elder abuse, domestic violence, sexual abuse, child abuse or substance abuse. These are all situations in which neighbors, friends and family are well positioned to provide collateral history that patients may hide, and thus doctors may miss unless prompted. Of course, we can't "cure" any of these problems, but with this information in hand, we can offer the patient our candid professional assessment, support and the appropriate referrals. Physicians are legally obligated to report cases of potential child abuse, so writing a credible letter about that may trigger an alert to the relevant authorities. For patients with drug and alcohol problems, we can choose medications less likely to have harmful interactions. Writing a letter probably won't fix the immediate situation, but it could help us do everything possible to keep the patient alive until they're ready to choose the help they need.
Carolyn Hax's column runs Mondays, Wednesdays and Fridays.