How many Drs. is enough Drs.?

I’m a big fan of firing doctors. My experience caring for my dad and going to sooooo many various appointments was that many weren’t needed, especially those labeled “follow up” My dad went through a horrible surgery, including a skin graft, for a skin cancer. The recovery was awful, he struggled for months. When I took him back to the dermatologist my dad said to him “my daughter doesn’t think I should have done this surgery” with me standing there. The doc got all flustered and replied that dad could have died without the surgery. Dad asked when that “could” have been and the doc said “maybe in 20 years” to a man in his upper 80’s, how ridiculous! I quickly talked my dad into never going back. Same with urologist who had nothing to offer. The primary care doc can handle many of the issues and meds that the specialists do

why the sleep Dr? and what is a neuro ophthalmologist- what do they do? why a derma surgeon unless he has skin cancer? why a sleep medicine neuro, what do they do? I can't imagine your father needs to see these all that often, the eye people maybe 1 time a year, the dentist 2 times a year.......Get a calendar and mark things down, both in your purse and on a wall calender (maybe a white board) Are you taking your father to all these appts or do you have other siblings that can help? IF he is in AL, do they have transportation that can take him to appts and all they need to do (the doctors) is update you with progress, etc IF you are POA. wishing you luck.

Mom has more drs than that. Not quite 20. I started collecting biz cards and using two sided tape to put them in the back of the daytimer i bought just to track her appts, episodes, illnesses and medical conversations.

Comes in handy when a nurse, facility or whomever asks for all her dr info or a specific dr.

For those she doesn't see regularly, but has a history with, I still keep this info. If she has to see a specialist, she usually already has one at my fingertips.

Also, I've liked some of her drs, so I kept the info for my future use.

Neuro vs psychiatrist: Some neuros are stroke or physical damage specialists and do not handle mental issues such as depression or anxiety. My mom's stroke neuro would not handle or prescribe the psych meds.

You don't mention his age & whether or not further treatment will be needed. If so then he must see all those oncology & neurology specialists. If he has decided no more treatment or he signs a DNR then he would only need to see the neurologist & oncologist. He definitely needs to keep his geriatric internist, dentist, cardiologist, & psychiatrist unless he's stable from that standpoint. If he's stable with certain conditions then you might be able to reduce some of the doctors. He has very complex issues that probably require these doctors. Maybe if stable his internist can have bloodwork done & order meds for stable conditions. his future care determines the necessary doctors for him to see.

That is too many doctors. My mother lived to be 84 and had one doctor. She had seen specialist in the past but once that problem was solved, she didn’t need to see that doctor any longer. I can see having regular checkups with a cancer doctor but why the rest. I don’t know how old your father is but I think doing everything to keep someone alive when someone has nothing but problems like my mother-in-law that had Alzheimer’s and was like a toddler for 8 years is just money making schemes by doctors now.

My mother has a lot of doctors mostly specialists. Neurology for neuro meds, urologist bladder washes, and antibiotics, pediatrist cut her toenails she is a diabetic, endocrinology monotors her diabetes, dermatology checks for skin cancer and treat as needed.Primary treats her medical issues.I have a large planner and write down every doctors appointment for the first six months. I also have a pocket planner.It can get stressful and overwhelming with all the appontments. I try to keep a postive attitude and be thankful I still have my mom at 98 soon to be 99 in September, but sometimes it can be difficult getting so tired from all the running around. I think most caregivers are in the same boat. I never ran around so much in my life.I told my niece I look forward to departing this world for a long rest. She gets mad at me when I say that, LOL. Good luck and do the best you can, if you need to cut down some doctors do it but keep the most important ones. I plan on doing that in the near future.

First and foremost, YOU CAN'T KEEP TRACK OF ALL OF THEM. I would suggest you immediately find ONE doctor to serve as your family doctor who should coordinate all of the reports, care, etc. for him. Let this doctor oversee what is going on and possibly work in setting up some kind of an agenda so it can more easily be overseen. You cannot and should not be doing all of this. You have to take care of yourself and issues that directly involve you. Let someone else with professional experience get involved, probably for a fee, or your primary doctor.

There needs to be ONE person helping you coordinate his care. It could be his GP or it could be a social worker at the hospital he was treated at.

Yes, some people have 10, 15, 20 doctors, because many conditions have cross-over affects. The goal is to have a triage list of them: which doctors MUST be kept in the loop at all times, and which ones are "one and done"?

There should be a GP, the main neurologist (who coordinates or at least is aware of the others), psychiatrist, and dentist. But you should not be his Uber - if he has no one else to go with him to appointments, look into a senior transportation service in his town or literally use Uber or Lyft. If he is too impaired, then you start getting into other questions - does he live alone? Does he needs 24/7 care?

Some of the other responses are unrealistic - yes, maybe he should be followed up less frequently by some of them, but the goal is to have him at home and get the same care as if he was in the hospital and the specialists would visit him. Except much cheaper.

The transportation is the key issue, and the time it takes. Look into getting help specifically for that - a teenaged niece or nephew could drive him to appointments?

With our medical systems, every MD is another income source. That's part of the issue as well.

Can I suggest, just not counting? I never stopped to do that for my dad, but he has nearly as many, Most are great, a couple we'll be weeding out. I don't know how I keep it straight, but I have a couple business card cases...one for theiers. one for mine....It is an exhausting task to keep track of it all.

We finally got a gerontologist from our hospitals Senior Care Center. He has been a godsend about managing referrals, insurance, discussing options with us. We see him every three to six months (more if urgent), and he helps to figure out what next. I didn't like the idea of needing a gerontologist, and we were both perturbed when my husband's cardiologist sent us to one. What fools we mortals be! I don't know if that is an option for your Dad, but I would ask someone at the AL place if they know one who comes there.

I keep a little 5”x8” binder with tabs for Medicaid, Medicare, Social Security, hospice, skilled nursing facility, etc., titled Dave’s Stuff for my brother who has a glioblastoma. In the front inside pocket I have a card with all his info—member ID numbers, case number for social services and Medicaid, his daughter’s information, etc. The binder is where I keep notes and information from phone calls, PIN numbers, etc. So you could customize it and make a tab for each doctor. Prioritize the tabs— I’m sure there are doctors he sees more frequently than others. Put those in the front.

I also have file folders similarly arranged—this is where I put EOBs—explanation of benefits, discharge notes, letters from Social Security, etc. Again, prioritize the files so the more frequently seen doctor files are more easily accessible. I live 1500 miles from my brother and I couldn’t do anything without this. The smaller size lets me put it in a tote bag easily if I need to. I generally take it on the road with me when I have errands. I never know who’s going to call.

Reading all of the other responses, it appears that you have gotten sound advise. Unfortunately, today everyone is a specialist. I would ask the advise of his primary care doctor, to see if each is necessary. I believe that once a year appointments may be adequate for some specialists. Insurance also drives a lot of our medical system.
At age 72, I have 2 cardiologists, 2 primary care, 2 Rhuematologists, 1 orthopedic surgeon, 2 ENT 's, 1 cardiac surgeon, 1 dermatologist, 1 opthamologist, 1 dentist, 2 podiatrists. I have double of some, because we split our residency. It's often difficult to keep track of blood work and tests, between doctors.
My only other advise is to ask the purpose and necessity of some tests recommended for your dad.
I also keep a notebook for some of my tests to share with other doctors.
Best wishes.

It seems there is a separate doctor for each body organ or limb.

It can seem excessive even for people who are a bit younger and have fewer issues.

The specialized knowledge might be beneficial as long as there are not conflicting therapies or medications among the various treatments. Each doctor should have access to all medications and treatments their patient is getting elsewhere but I don't know how carefully all doctors pay attention or consider contraindications.

SusanHeart
My mother is 89, I am her POA, and she also has 12 DRs. Not to mention 13 meds. She has Kaiser Ins., so the vast majority of her appointments, and her pharmacy are in one, of two locations. Where we live, the two Kaiser facilities are less than 1 mile from each other, so this usually helps. She has so many appointments, with so many doctors that I went to the wrong campus on several occasions. So, I now have a file on my computer with all her doctors listed as follows:
I did a Table (Microsoft word) with 5 columns.
Merged the top line, centered and bold with the
Name of the building, address and phone number
Below that the five columns are labeled as follows:
Specialty, Doctor, Phone (some have their own number), 1st year seen and the 5th I left blank for any short notes.
I made one for both locations
I have another Table with other care givers and the Pharmacy number.
It all fits on 1 sheet of paper and I keep it updated with a hard copy in the folder I take to every visit.
In addition, I did the same thing with all her diagnoses (oh, so many.), and medications. Including the supplements and medications she has discontinued and why.
Now, when she has an appointment and they ask me questions, I have the answers right there.
Being responsible for another person can be overwhelming for anyone.
I hope things improve for you and your loved one.
Hang in there, you can do this.

Obviously each person is different with their own needs. My father was on 9 different meds and seeing lots of different doctors before he moved out near me so I could help care for him. I brought his list of meds to the pharmacist & asked if he saw any chance of reducing the meds Dad was taking. Problem is each may help, but also has side effects which contributed to needing another. We got down to 5 from the 9. I brought Dad to our doctor and asked that he be evaluated. We felt this was helpful. Other factors must be considered though. Is your LO on hospice, what prognosis comes with current afflictions, how big a factor is pain, etc. are therapists needed to aid mobility or motor functions? There’s no one size fits all answer unfortunately. We utilized CBD and THC to help with mood and pain which worked great until his cancer got too advanced. Wishing you the best- it’s not easy…

A group of Cancer Dr's are usually at least 5.
And depending on your problems, you'll have a Dr for each one.
So, no in your Dad's case he's seeing a lot if Dr's because he's got a lot of problems.
You can't see a foot Dr if you have a tooth problem 😊

SusanHeart,

OMG! Please if you know the answer to how many doctor's is enough, I'm begging you to let me know it.
My mother's collection is so far at nine different doctors (she hasn't caught up to your father yet). This month we're celebrating the addition of doctor number TEN. Totally unnecessary of course.
I hate to say so, but it seems to me like the doctor collections are a kind of social calendar for the elderly. It is with my mother. She has some health issues and at almost 84 that's to be expected. However, she believe nothing they tell her if their diagnosis doesn't match what she thinks she has. She also refuses to follow any of their recommendations or care plans. God help us all.

LOL. Sounds like a full social life he’s got going on.

Imho, as an elder ages, they do see a lot of specialists, though this seems to be on the high end.

Talk to his internal medicine doctor about your father's care. Discuss what the goals are for your father: beat cancer, heling of all health issues, kept comfortable...? He/She may be able to streamline the number of doctors you dad sees based on the goals of his care.

Another option is to talk to each of his doctors about his prognosis for the problem each is treating. Try to talk about ceasing care with those where the prognosis is poor. Also, try get as many of his appointments lined up on the same day.

You are correct is realizing you only have so many hours in the day to work, take care of others, and take care of yourself. May I suggest that you need more help. If your father is amenable to living in a fulltime skilled nursing facility, the staff will make sure he gets to his appointments and you can ask for copies of all the doctors' notes.

We have a similar situation and FIL also has VA doctors he sees. Additionally because he is nearly immobile and mostly homebound he uses doctor's visits as his social outlet. We finally had to start weeding out who he truly needs to see vs the ones he didn't actually need to see regularly because he would just willy nilly schedule appointments with them to get out of the house. As it takes 2 people to take him to the doctor every single time and at least 1/2 of his doctors (VA based) are over 90 minutes away we had to put a stop to the non-required appointments pretty quickly because it meant at least a half day off work for at least one family member each time to assist SIL in transporting him every single appointment and he was scheduling these every week.

We finally got him down to seeing his VA Primary and his regular Primary - they are the ones that handle all of his medications (now THAT list....goodness!), his eye doctor, his cardiologist (this one is down to annually now), his podiatrist (diabetic and they have to do his toes and check his feet), dermatologist, and urologist. Now by my count that is 7...but in the last 6 months he has had 13 doctors appointments and that is us "controlling" it, so yeah...thankfully, he only has those 7 now. If he had his way he would go to to the doctor every day. He LOVES it. He LOVES going to the hospital too. He will ask to go to the ER for a cold. He was offended a few years ago when they wouldn't admit him when he went to the ER with cold symptoms. We had to practically sit on him during the worst of COVID in our area because we knew it wouldn't be the same experience he was used to and part of the reason he enjoys it so much is that he enjoys the attention he gets while in the hospital. We explained that if he went into the hospital during COVID and really didn't need to be there, he would be going in alone first of all, and that we wouldn't be allowed in at all for the duration. And that the nurses that normally gave him so much attention barely had time to breathe, were understaffed, were praying they didn't get sick themselves, didn't have time for his usual brand of humor that calls them into his room 10 times a day just to chat and that he was exposing himself to something that could potentially kill him for no reason whatsoever. So miraculously he stayed home and we didn't have a single health crisis or hospital visit the entire time. We are making this stretch as long as possible. That is not to say that if he had a true medical emergency that we wouldn't rush him to medical care right away. But he absolutely craves medical attention like nothing I have ever seen, it's like an addiction for him. And we had to find some way to curtail it.

The sheer number of medications he is taking, and the fact that they actually counteract each other boggles the mind. The side effects of the list combined! And the fact that the doctors don't interact and even the pharmacies that he uses aren't tied together. (VA vs retail vs mail order) At last count I think he is on 30+ medications. He actually asked him primary for another medication one day and his primary said "We are trying to get you on LESS medication not more!!" If he could take a pill for it, he is on board!

I had a similar experience with my mom.

When she moved to Independent Living, there was an on-site geriatrics doc.

He sent her to a geriatric psychiatrist (also on-site) and they were able to get her anxiety under control.

Suddendly, her BP was no longer such a big problem and we ended the endless cycle of anxiety-fueled visits to her PCP, referral to a specialist and more meds.

She continued to see her dentist (which the IL place could get her to) and I took her to occasional opthamology appointments.

Yes..I understand this too well..My mom had a 10 MDs with 4 appts monthly....then I put my foot down. I became her POA. I asked her internist what he could handle. She was 86 and hating the visits. And all the meds. We stopped a lot of meds…we no longer chase an allergist, Ra doc, podiatrist {I trim her toe nails}, ear nose throat guy, cardiologist, urinary guy, lung specialist etc. She now sees an internist and a dentist..yup thats it. She has improved getting off all the high powered {high priced meds}. I even had her taken off the injectable osteoporosis med, the RA infusion meds and the overpriced blood thinner. She takes a baby aspirin and Fosamax once a week by mouth {osteoporosis}…we are using old school drugs for blood pressure…2 years later she functions better and is more alert. She regained her weight. She is thriving! She moved out of memory care {her memory got better} to an assisted living. After 27 years as a geriatric nutrition staff member I saw so much over medicating due to the elderly non stop complaints to doctors. After I took over moms affairs I stopped the constant MD visits and both of us are a lot happier…Discuss the problem with the internist and weed out the unnecessary drugs and MDs ….doctors are now air traffic controllers…the more complaints the more specialists…

How many one needs should vary from time to time. Sometimes an acute problem may need a number of Drs who become irrelevant once the acute problem has been dealt with. Sure one can stay on someone's list in case of future need but it is unlikely regular visits to all these people are necessary constantly. One cannot be needing surgeons every day - only when one of the specialists identifies a need. I note that nowhere in your list is a general elder practitioner - someone who can walk through the list with you and understand what each is for at this particular time and which your father does not need regular contact with.

Just like polypharmacy Your dad is in a polyhealthcare provider situation. Only you can decide if the situation beneficial for him. If not then you need to manage his healthcare. You have just started by asking your question. You need to set priorities and remove redundancies. Do not let the doctors manage you (and your dad) you need to manage the doctors.

To your reply to me

No, you are not approaching his care the wrong way. In the beginning of Moms care I went along with everything. As time went on I started to question. Why was she going to her PCP every two months when there was nothing wrong with her. She was on B/P and Cholesterol meds only. State only requires every 6 months for prescription renewals. When I took her the Nurse ask me why I was back. Told her I had no idea but if he says "so why are we here" She won't be back unless we need a refill or she is sick. He asked and no more every two months. One Dr was a recommendation because of a thickening of her stomach. He felt it was caused by her Gerd so saw him every 6 months with mo change. So we went to a year. Once her Thyroid numbers were normal, went to a year with labs in 6 months. Both times I asked if we could make it a year. I went 3 years without seeing any of my doctors. Dentist I worked in. I stopped Moms urologist because she had been Cancer free for five years and at 85 he still wanted to do a scope. She was in the early stages of Dementia so I would never have put her thru an operation.

Just listed all ur Dads doctors. As said, don't see where a neurologist and Psychiatrist are both needed. If its for his cognitive problems, a neurologist is all you need. Also Sleep Med neuro, why can't the neurologist take care of this.

Surgeons - once the operation or procedure is done and there is a follow up why do you need to take him back. Once he is off Chemo, why the need for an oncologist?

Ophthalmologist/ Ophthalmologist neuro. I understand why the need but the Ophalmologist can't see a any differences then send Dad to a neuro if needed.

Just rambling here but do you see what I am trying to say. You may have too many hands in the pot. If ur not happy with the new doctor, look for another. My Moms doctor was not a generic doctor but the people my Moms age loved him. He was very good with them. I found him easy to work with when questioning why Mom was on certain meds still after the problem was resolved. Thats another story. Hospitals and how they don't work with the patients PCP when they don't have Privledges at that Hospital.

Curious, did u call his former Drs office and ask why they dropped him as a patient? Why would the AL be sending his Dr. test results? Was Dad using an "in house" Dr?

Ha! I have 17 and am considered healthy. I had 3 bouts of cancer over 11 years ago but since it was different cancers, each one refers more doctors. First the diagnostician, then the oncologist and then the surgeon and then the radiologist. Along with this is my PC, opthamologist, dermatologist, urologist, gynecologist, gastroenterologist, psychiatrist, ENT. I spend my life at appointments and much as I’d like to give up some of these visits (and don’t see all of them that often), it is hard to figure out which ones are really unnecessary.

I'm currently reading a book by Atul Gawande, M.D. called Being Mortal: Medicine and What Matters in the End.

I think you and your dad should read it.

Ah, yes, the revolving door of one doctor leading to another doctor, often times with them giving you conflicting advice. My mom had CHF; she saw a cardiologist. After every trip to the hospital, she was told to follow up with her cardiologist, as well as a kidney specialist. We decided (her, me and her cardiologist) that the kidney doctor was superfluous: I *knew* the kidney doctor would tell her she was taking too many diuretics, and she should cut back on them, which of course would lead to fluid buildup from the CHF, and then a trip back into the hospital where they would, invariably, put her on diuretics. Since she had no other kidney issues, the effects of fluid buildup would do her more harm than reduced kidney function, because the chances were that the CHF was going to kill her long before kidney failure would set it. It was a harsh decision; but I didn't want her final months spent doing nothing but being shuttled back and forth to doctors all day.

Right from the get go - why is dad seeing both a Neurologist and a Psychiatrist? My daughter has a psychiatrist, and he has told us that a neurologist can prescribe mental health drugs as well as a psychiatrist can; you might want to check with dad's neurologist to see if he/she can take over the care dad's getting from his psychiatrist. It seems to me that your dad is being referred to a lot more doctors than he really needs, as well as getting a lot of unnecessary tests.

How old is dad? What is the prognosis for him after the cancer? These are all things to take into consideration when deciding how much medical intervention to proceed with. This might be where you want to find a geriatric doctor with a case manager on staff. This might also be a time when you ask the various doctors, point blank "what good is this test/treatment/etc. going to do for my dad and his conditions?" If you're starting to get answers from different people that seem to put dad's care at cross-purposes, like I did with mom, then consider which of dad's illnesses are the most debilitating and maybe choose to concentrate on those.

See, here's my concern for you. You have your dad and all of his doctor appointments; your husband, recovering from a stroke and all of those subsequent doctor appointments, and a sick pet, whom I am sure is also being shuttled back and forth to the vet. So when was the last time YOU went to the doctor for a check up? Dentist? Because when I was in your shoes, the very last thing I wanted to do was to sit in yet ANOTHER doctor's office for my own appointments. I had to make a firm promise to myself to NOT neglect my own health; and many were the times I had to mentally give myself a kick in the backside to make me keep my promise to myself.

Cutting back on the unnecessary doctors and tests is NOT elder abuse. Really, try and find a PCP for dad that will work WITH you on eliminating some of the unnecessary appointments, for your own sake.

Good luck.