A deficit in caregiver personal responsibility

Sometimes a patient interaction leaves you speechless. In my experience, that most often occurs when a patient refuses to acknowledge any responsibility for their condition despite massive evidence to the contrary. This is compounded when dealing with caregivers of patients who don’t just drop the ball, they kick it into the next county on purpose.

Here is an actual phone conversation between a fellow physician and a son of her two elderly patients. Names have been left out for obvious reasons. When you are finished – and the “punch line” is at the end – see if you agree this qualifies for Personal Responsibility Deficit Syndrome or PRDS for short.

On the phone:

MD:  Hi Mr. So and So.  We spoke a couple of months ago about looking for nursing home placement for your parents.  I was calling to find out what’s been going on.

Son: What do you mean, what’s going on?

MD:  I mean, what progress has been made in finding a home for them.  Your mom told me to call you, and that you were taking care of everything.

Son:  I got a few applications and gave them to her to fill out, but she lost them.

MD:  That’s because her memory is bad.  You need to fill them out.

Son:  What do you mean, I need to do it?  I don’t know their social security numbers!

MD:  Ask them.

Son:  You know, it’s not my job to do this.

MD:  Then whose job is it?

Son:  Some administrator should do it.

MD:  They are your parents.  If you don’t do it, no one else will.

Son:  Well, they don’t even know what nursing home they want to go to.

MD:  You need to take them to see some.

Son:  So what, I’m supposed to take off from work to drive them to a bunch of different nursing homes?  That’s a waste of my time.

MD:  Your parents lost their driving licenses, so, yes, they have no other way to get around.

Son:  They can take a taxi or the bus.

MD:  (suspended somewhere between disbelief and fury):  Look, if you don’t take care of this, I’m going to have to call Adult Protective Services and start proceedings to have the State take guardianship of your parents.  They are no longer safe at home.  Your dad wandered off this week and the police had to go find him.

Son:  Someone else should take care of this.  I don’t have time.  Why is it such a big emergency all the sudden?  How did you let them get so bad?

MD:  How did I let them get so bad? Look, I’ve been treating your parents’ dementia , but I can’t fix it.  I’m sorry to tell you, but it is your job to take care of this. If you don’t, no one else will.

Son: “You know, it really sucks how the healthcare system treats old people in this country.”

Dike Drummond is a family physician and provides burnout prevention and treatment services for healthcare professionals at his site, The Happy MD.

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  • JustLiz

     The real punchline is that if someone in the “healthcare system” did try to institute a program to help seniors find appropriate living situations, this is the same person who would say, “I don’t want some damn bureaucrat telling my folks where to live!”

    I hope the MD did call adult protective services.

  • http://www.thehappymd.com/ Dike Drummond MD

    I originally titled this article “Personal Responsibility Deficit Syndrome” … and you can see it in action in the very last sentence. This kind of passing the buck happens all the time. It is a big contributor to burnout for many docs.

    What would YOU Do?

    Even if this doctor called APS … the interaction is so icky … it would affect there spirits for days most likely.

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

  • CBRN

    It seems like this is a pretty easy thing to communicate if you keep the moralizing out of it. This son can either take guardianship of his parents or the state can do it.  If he cares about having a say in things later and wants particularly good care taken, then he’ll need to take responsibility.  If he really doesn’t care, then he can step out of the picture.  

    • http://www.thehappymd.com/ Dike Drummond MD

      All moralizing aside … the son is not stepping up to either of your options. He is effectively abandoning his parents, putting them at risk and blaming society. This forces the physician to actually call in Adult Protective Services to address the situation. Not moralizing … addressing safety concerns that the son can’t seem to prioritize. Because … if anything does happen to these poor people … some ambulance chaser will have a lawsuit on the doctor’s doorstep pronto. Just the way the “system” works.

      Dike
      Dike Drummond MD
      http://www.thehappymd.com

  • MuddyWaterz

    I betcha this same son will likely be around when it comes time to collect the inheritance. It illustrates how morally corrupt and selfish our society has become. As long as there is a safety net for this kind of behavior, it will indefinitely continue. Our government needs to stop coddling this country.

  • http://www.facebook.com/profile.php?id=100000008794844 Kathy Rogala

    I’m an RN case manager.  I see stuff like this all the time.  It’s pathetic. 

  • katseye1969

    This Is aweful! I thank God I have responsible POAs. As time goes o. And my condition worsens, I rely so much on my family to be my advocate. My husband is so awesome at this, though sometimes I think he’s sees things through rose colored glasses, he’s not in compete denial. I think, in some cases, a family member loves the sick person so much, they can not see the writing on the wall. That’s why I have 3 people as my POA.

  • merc

    Mail the son this article and these comments.  I am dreaming of course, but wouldn’t it be nice?:-)

  • http://www.thehappymd.com/ Dike Drummond MD

    The conversation I document in the article was relayed to me by another physician who was the doctor on the line. I obtained their permission to build the article around their dialog and I do not know anything about the son other than what is in the back and forth. To be fair … there is much information missing that would put his responses in a very different light. AND in healthcare we are so used to people not taking responsibility that we become jaded very quickly.

    My sincere hope is that both parents are in a safe place … and the crisis is past.

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

  • Dorothygreen

    “to be fair”… there is a lot of information missing..”  indeed it sounds like the doc is in solo practice without any access to or comunication with other health care workers, that the patients had been coming to him for a while and has not taken the whole picture into account - how did they get there anyway?

    Half way through the conversation it is clear the son has his own set of metal issues so why pursue it.  Just tell him what you need to do – probably should have been done “months ago”.  And if docs are concerned about the liability then tape the conversations.   As the case manager says “this happens all the time”.  Sad but true, such behavior is prevasive in our American culture.  

     

  • http://www.facebook.com/drjoe.kosterich DrJoe Kosterich

    Yes it is a “stereotypical” example but has strong validity and not just in the USA. The mentality of someone else or “the government” should fix it is a huge problem.