Self-Care

   If you are satisfied with the clinicians at your primary care office, cherish those relationships.  For many reasons, it is getting more difficult to find primary care clinicians who go the extra mile for you and your loved ones.  If you are not content with your primary care team, I offer the following suggestions.    First, find a clinician (physician, nurse practitioner, or physician assistant) who enjoys listening to you and your stories.  The art of medicine is mostly about the art of listening.and believing what you share.  Listening and understanding build trust, essential for any good relationship.  Every city and small town in our country has such clinicians.     Second, appreciate that young nurse practitioners and physician assistants can listen to you and help sort out your problems every bit as well as a seasoned physician who is overworked and/or approaching retirement.  In my 40 + year career, Ive had the opportunity to train hundreds of NPs and PAs.  They gain the knowledge, expertise, and confidence to become great providers within 9-12 months of graduating from professional schools.  Often, they have more technical skills than older physicians.  This works to your advantage in the following ways.  Assume you have an unusual combination of symptoms.  They know how to explore the Internet and rely on specialists to find the best plan of care for you.  Now assume you need a steroid injection in a joint.  Many NPs and PAs can provide procedures that overworked physicians never learned.     Third, see the entire practice as your primary care provider.  A good practice has all members working together as a team.  The members include front office staff who greet you for in-person visits, medical assistants and nurses who answer your phone calls, and the clinicians who care for you in person or with tele-health visits.  If you find that any team member isnt respectful, you should feel free to discuss this with the office manager.  All good practices should welcome feedback.      Fourth, if you have the means and value extra attention, consider a concierge practice.  Unfortunately, concierge physicians are beyond the reach of the vast majority of seniors in our country.  Further, we are seeing a shortage of these physicians just as we are seeing a shortage of all primary care physicians.  This brings us back to my key message: you can find trust and comfort with a dedicated NP or PA.  When we consider the evolution of geriatric practice over the last 4 decades, we understand that it is NPs and PAs providing the vast majority of visits in nursing homes, assisted living facilities, and in-home visits.Finally, it is important to understand the pressure and demands on your primary care office.  The advent of the electronic health records in the 1990s added a massive burden to all practices.  The hope (and the myth) was that EHRs would lead to higher quality medical care.  The reality is that EHRs havent improved true quality.  EHRs are the main reason so many good clinicians are feeling burned out.  The clinicians feel they have to pay more attention to the EHR (and quality metrics) than to the patient in front of them.  When you express your understanding of this dilemma to your clinical team, they greatly appreciate this.  Again, building understanding and trust leads to the best quality of care and beneficial outcomes. The article was written by Dr. Don Murphy, Geriatrician and Hospice Physician who plans to run for Governor of Colorado, on behalf of. He can be reached at murphdoc@comcast.net, his cell, 720-490-6757, or his main YouTube channel, TheCrazyMurphys5560. 

The greatest challenge for all who practice geriatrics is reducing polypharmacy, the addition of medications that either provide no benefit or cause harm to seniors.  Millions of seniors end up on many medications that are not helping them and could be causing side effects.  Geriatricians are the experts in what we call de-prescription, cutting down on unnecessary medications.        The key reasons seniors end up on too many medications are the following.  First, all physicians, including young geriatricians (as I was 30 years ago), have hope that newer medications will actually benefit our seniors.  The four medications we have used to treat dementia turn out to provide no benefit at all.  We cant appreciate this until we have been in practice for decades and know how to review all of the studies that suggest there might be some marginal benefit.  Also, one must practice for many years to understand how all medications, including over-the-counter medications, can cause difficult to diagnose side effects.  For the dementia medications, we had hoped that they either alleviated symptoms, delayed the onset of dementia, or slowed the progression of dementia.  It takes years of practice and experience to realize that these medications fail to help our seniors.      Second, many primary care clinicians (say, family medicine physicians) and specialists (say, cardiologists) tend to overvalue medical benefit for medications used for the most common conditions.  The best example would be blood pressure medications.  All geriatricians know that we approach frail seniors differently than we approach a robust 70-year-old or a healthy 45-year-old.  Many clinicians will treat everyone the same, such as trying to keep the systolic blood pressure around 120 and the diastolic pressure around 80.  Often, these pressures are simply too low for frail seniors and even for some robust seniors.  The medications can cause lightheadedness, falls, and fractures (to name just a few side effects).      Third, clinicians in traditional medicine often fail to appreciate the value of alternative healing and the value of the placebo effect.  Lets return to medications for dementia.  In recent years, we havent seen any commercials for the four medications I referred to above.  Weve seen many advertisements for Prevagen and Neuriva.  These medications have not been studied extensively like the four that required many studies and FDA approval.  If seniors feel more comfortable on these OTC medications, its probably from the placebo effect.  That is, they feel that they are at least doing something to counter the onset or progression of dementia.  The cost is affordable, and these individuals dont need a prescription from their doctor.  If the individual thinks Prevagen isnt helping, or may be causing side effects, he or she can stop it at any time.  They dont need permission from their physician.        Fourth, the pharmaceutical industry has specialized in direct-to-consumer advertising.  These are entertaining and convincing ads.  It doesnt matter what disease condition we are considering.  Every expert in marketing knows that these creative, subliminal messages get through.and result in more prescriptions.        Before sharing my suggestions for cutting down on your medications, let me share a story about Elsie, a 90-year-old woman I took care of in 1992.  She was feisty and funny.  She was on the 6 medications our team had prescribed for her.  Benign positional vertigo was one of her conditions.  One of my most memorable clinic visits was the one when Elsie reported that she followed that Harvard newsletter you gave me, Dr. Murphy, and it worked.  She did this complex maneuver all on her own, and it eliminated her dizziness.  Then she added, oh, and by the way, doctor, I threw all those doggone pills in the garbage.and I feel great now. So be it.  This approach worked well for Elsie, but I dont recommend it for others.  Here is what I suggest.       First, find the courage to question your clinicians.  Its not easy when you have put so much trust in your doctors recommendations.  Try the soft approach.  For example, you could say, Doctor, Im on a lot of medications and I worry that one of them might be causing some problems. You could mention a symptom youve been wondering about.  Then you ask, could I cut down on the dose of one of these medicines to see how I do?  If your physician agrees with this trial of dose reduction, you could ask which medication he or she would select to reduce the dose.        Second, you continue with the honest communication you have established.  You dont need to let your doctor know how you are doing a week or two later.  However, you should report that you are doing fine by calling the office staff that can document your success with the dose reduction.  Believe it or not, you are educating your primary care office about the value of dose reductions.        Third, when you have more confidence in the dose reduction approach, you can specify which medication(s) you would eventually like to discontinue.  You can share feedback youve received from family members and friends or from the research you or they have done.         Ever since the 1950s we have been moving from a paternalistic approach to health care (i.e., the doctor decides everything for your health) to a more patient-centered approach to health care.  This makes sense.  You know whats best for your overall health, including physical, psychological, social, spiritual, and any other dimensions of health.  Your clinicians job is to reflect your preferences.  Dose reductions of useless or harmful medications is just part of this evolution in health care.     Dr. Don Murphy, MD, FACP The article was written by Dr. Don Murphy, Geriatrician and Hospice Physician who plans to run for Governor of Colorado. He can be reached at murphdoc@comcast.net, or calling 720-490-6757, or his main YouTube channel, TheCrazyMurphys5560.  

For women, eldercare should not mean sacrificing your careerMany women, especially those in mid-career, find themselves facing the difficult decision of whether to leave the workforce to care for aging parents. The demands of eldercare can pile up with little warning or predictability and quickly become overwhelming. The "easiest" solution for many women in this position may seem like stepping away from their professional lives altogether.However, leaving the workforce can have long-term, unseen consequencesfinancially, emotionally, and professionally. Before women make this decision, we want to bring to light to some of the costs of stepping away, as well as share options that are available to help women care for aging parents or loved ones without sacrificing their career.The elephant in the room - what about men?It's a systemic problem that the large majority of caregiving responsibilities fall on women. We believe fully this should not be the case - and will continue to advocate for a future where men and women are expected to share, and do share, these responsibilities more equally. That said, this article is going to focus on the impact of eldercare on women, and options available, because the data shows the women are the ones who are much more likely to pay the price of eldercare.Female caregivers are more likely than males to ask for a less demanding job, take unpaid leave, or give up work entirely to support caregivingWomen lose an estimated $325K over their lifetime due to caregivingThe Unseen Costs of Leaving the WorkforceWomen who exit the workforce early face immediate income loss, diminished retirement savings, and a reduction in Social Security benefits. AARP reports that caregivers can expect to spend an average of $7K annually on out-of-pocket expenses.Additionally, exiting the workforce comes with professional setbacks that may be hard to recover from. Studies show that women who take time off for caregiving often find it difficult to re-enter their fields, and when they do, they may face lower wages, fewer opportunities for advancement, or the need to start in less demanding roles.The Unseen Costs of "Daughterhood"A less recognized aspect of womens caregiving burden is eldercare (i.e. daughterhood), which is frequently overshadowed by the attention given to childcare (i.e. motherhood). While businesses have made strides in supporting working mothers, they have largely ignored the unique challenges posed by eldercare. The emotional and physical toll of eldercare, which often includes managing chronic illnesses, dementia, and end-of-life care, cannot be underestimated.According to the Federal Reserve, four times as many people have left the workforce due to adult caregiving compared to childcare, yet corporate policies and benefits packages rarely address these realities.Why You Shouldn't Quit: There Are OptionsBalancing work, children, aging parents, mental and physical health, a "clean" home, and the semblance of a social life - it's simply not sustainable. It would make Superwoman run for the exit. It's no wonder that women leave their jobs in order to quickly take something off their plate. But before putting in your notice, let's talk about resources and options that may be available.Workplace Benefits: Find out what your company offers. Some offer paid caregiver leave, flexible work schedules, Employee Assistance Programs (EAPs) that provide counseling and eldercare resources.Even if your employer is moving away from remote work post-pandemic, you can advocate for more flexibility, such as flexible hours or a partial work-from-home arrangement.According to experts, a flexible workplace arrangement is often the most important factor for caregivers trying to juggle their professional and personal lives.External Support Systems: there are local and national organizations that can provide assistance. Naborforce is one of these organizations - our founder Paige Wilson lived all of the stark truths discussed in this article, and that is why she decided to do something about it! And if Naborforce isn't in your area or isn't an option for you - there are other resources to check out: care.com, Bright Horizons, home care agencies, caregiving forums, etc.Note: Naborforce partners with employers to provide discounted hourly rates. If your employer doesn't have Naborforce as an option, reach out to us and we will see if there is an opportunity to collaborate!Talk to your people: Many organizations are beginning to create employee resource groups for caregivers, offering a safe space to share experiences and tips for managing eldercare. These groups can be a lifeline for employees who feel isolated in their caregiving roles.Making Eldercare an Employee BenefitEmployers play a crucial role in supporting women who are caregivers. Unfortunately, 79% of caregivers do not have access to benefits that support them in this role.Supporting working women is not just about helping parents; its about addressing the needs of adult daughters (and sons) who are balancing caregiving with their professional lives. As 10,000 people turn 65 every day in the U.S., this challenge is only going to grow. Employers must adapt to this reality if they want to retain top female talent.The Bottom Line: You Have OptionsWhile caregiving can feel like an all-consuming role, women should not have to choose between their careers and their families. By tapping into workplace benefits, seeking flexible arrangements, and exploring external resources, women can navigate the challenges of eldercare without sacrificing their professional futures.