How can I get the doctor to be more responsive when my mother has side effects from chemotherapy?

A fellow caregiver asked...
Following chemotherapy treatments for breast cancer, my 82-year-old mother has had many painful side effects. But when I call the doctor, he doesn't return my calls promptly, or he says the side effects are to be expected and doesn't offer many helpful suggestions. How can I get more help for my mother?

Expert Answer

Redwing Keyssar coordinates the Palliative Care Program for Jewish Family and Children's Services of San Francisco.

I hear this question all the time from family members, because so often we don't have a personal relationship with our doctors anymore. As a caregiver, you are your parent's representative, and you may have to be very assertive about asking the doctor to help you provide good care.

You need to get the doctor or his nurse on the phone and communicate very clearly and directly that there's a serious problem and you expect immediate help. Whether it's swollen feet, vomiting, or pain, you should describe the symptoms precisely and say to the doctor, "This is what's interfering with my parent's quality of life right now, and we need to address it."

If pain is the main problem, ask for a specific solution. You can say, "The pain medication my mother is taking isn't working, and we need you to prescribe something different." Doctors have an arsenal of pain medications available, and you'd be surprised how often the first one they prescribe doesn't work. Once you've explained what your parent is experiencing, the doctor can reevaluate the situation. Sometimes it's really about anxiety -- the pain itself can set up a vicious cycle in which your parent worries about being in pain even when medication is lessening it. So you can ask the doctor about prescribing an antidepressant or other medication to help with the anxiety. Pain itself takes a toll on every system in the body, and when the pain isn't addressed, everything else goes downhill.

One more thing: if you find that a member of the doctor's staff is particularly helpful, request that person's direct contact information and ask if you can call her directly the next time your parent experiences a side effect or symptom. As your parent's main advocate, your job is to establish an ongoing conversation and enlist the doctor or nurse to help you solve each problem as it occurs.