I recently reviewed a book full of practical and legal advice for Baby Boomers and their loved ones called Alive and Kicking. I learned a lot from the book, and the authors were kind enough to send me some columns to use as guest posts. Here’s the last one.

Questions to Ask Your Doctor

It’s flu season. Your spouse wakes up with the classic signs: fever, cough, aches and pains. What do you conclude?

Flu.

You’re not alone. Most probably, your doctor would too. “A lot of that going around.” Both of you might be wrong.

In a terrific new book, How Doctors Think, Dr. Jerome Groopan warns that doctors often misdiagnose, perhaps 1 out of 10 times, perhaps slightly more. Like the rest of us, they tend to jump to conclusions. To make sure they haven’t, Dr. Groopan recommends we ask three questions:

1. What else could it be? (“Well, now that you mention it, it could be . . .”)
2. Is there anything in the exam or tests that doesn’t fit? (“Well, now that you mention it, your fever isn’t typical.”)
3. Is it possible I have more than one problem? (“Well, now that you mention it, sometimes folks get the flu because they are already sick with . . .”)

A good friend, Dr. Jack Boyer, suggests a fourth question: Have you considered whether I want to get the treatment or not?

This question shifts focus from sickness to treatment, a treatment which may be routine, proscribed without much thought: what are its costs and benefits?

Of course, it is easy for me (and probably Dr. Groopan) to sit safely behind our computers urging you to be brave, urging you, recalling the 60′s, to “Question Authority!”

It is always a good idea to take someone with you, not only to ask to the difficult questions, but to actually hear what the doctor says – often patients are so emotionally involved that they really don’t hear what’s said. If you can’t get someone to go with you, when it comes to the difficult questions, blame me:

“Doc, I know you are absolutely correct in your diagnosis but a column I’ve read tells me I should feel guilty if I don’t ask you . . .”

Many of us feel we are imposing on our doctor’s time. Our job is to quickly state our compliant (“Sore throat, doc”) and then sit back and answer questions – and, of course, to breathe deeply and, perhaps, cough. In most office visits, doctors start asking questions in the first 18 seconds of the visit. The best advice Dr. Groopan received in his medical training:

“If you listen to your patient, he is telling you the diagnosis.”

The best advice you might receive:

“You are not wasting your doctors’ time; you are telling them the diagnosis.”

What we have to say matters. Don’t just state your complaint and sit back and let your doctor do the driving. Insist on disclosing all your symptoms even if they seem trivial. Even if they are embarrassing. (I could give examples but fear the wrath of my editor.) Remember this: doctors have heard it all before and they come to cure you, not judge you.

“Am I dying?” “Is my mother dying?” There will come a time, and you know it, when these questions will be very much on our minds. Yet we shudder at the very idea of asking them. Don’t expect your doctors to volunteer the information. In A Death Foretold, Dr. Nicholas Christakis tells us that doctors shy away from terminal prognosis. Why? There are many reasons. For one, it tends to undercut their sense of professional competence, their belief that they can cure most anything. Further, many doctors are as uncomfortable with the idea of death as are the rest of us. And they fear making self-fulfilling prophecies. In Oscar Wilde’s The Importance of Being Earnest, a character is told that another died after his doctors have given him only weeks to live.

“He seems to have had great confidence in the opinion of his physicians.”

So there you have it. Patients and their families don’t ask about death and doctors don’t volunteer. The result?

“The great majority of American die in institutions rather than at home as many would prefer; most die in pain being in the care of health providers; many die alone; and many have deaths that are financially devastating for their families.”

So writes Dr. Christakis.

“Am I dying?” “Is my mother dying?” You will need to know. As long as everyone is in denial, intensive care treatment continues. Doctors will not terminate it on their own. Living Wills indicating that treatment should not be continued are generally ineffective unless that decision is supported by members of the family. But that won’t happen as long as family and physicians don’t discuss death.

Avoiding a bad death is not our only concern. We want a good death, a natural death, not in an hospital among strangers, but at home surrounded by family and friends. Hospice care can do that. It provides medical help (doctors, nurses, and pain medications) as well as grief counseling for patient and family. Medicare picks up almost all of the costs, not only in the last days or weeks of life, but for the last six months of life.

How do you get this wonderful care for your mother? For yourself? It may be difficult and you may not want to know, but all you have to do is ask.

Kenney Hegland is a Professor of Law at the University of Arizona and has taught at Harvard and UCLA. Robert Fleming in one of the nation’s leading elder law lawyers. Visit their website at www.legaladviceforboomers.com.

I recently reviewed a book full of practical and legal advice for Baby Boomers and their loved ones called Alive and Kicking. I learned a lot from the book, and the authors were kind enough to send me some columns to use as guest posts. This one is about raising grandchildren.

Raising Grandchildren

After all the years, after all the alarm clocks, after all our work, it has become our time, our time to be that quiet person, sitting with our sleepy grandchildren, whispering “Hush.”

Well, maybe not.

Many grandparents not only put their grandchildren to bed, they wake them in the morning, feed them, get them off to school, and, as the years go by, stay up late, fretting until they come home.

The US Census Bureau reports that more than six million children (that is, about one in 12 of all children) are being raised by relatives other than their parents. Of that number about 3/4 are being cared for by grandparents. If that’s you, read on.

First, support groups. The AARP’s “Grandparent Information Center” offers information on raising grandkids. Email: gic@aarp.org or phone 1-888-OUR-AARP. Another source of help: Generations United: www.gu.org.

Second, financial help. If you are retired and your grandchildren are under 18 (or older if disabled), they may be entitled to Social Security benefits, particularly if you have adopted them. If you are having difficultly making ends meet, contact your local welfare office or Area Agency on Aging. Don’t overlook the possibility of claiming your grandchildren who are living with you as dependents on your income taxes.

What are the legal concerns?

Housing. Some “adult” communities prohibit kids. Best to try to work things out with whoever is in charge, hopefully not Darth Vader. If you are threatened with eviction or other legal action, a good lawyer may, by careful reading, find that the documents do not, after all, apply to your situation – these insights are known by your bitterly disappointed adversary as “loopholes.” (Never do anything simply because an adversary tells you that the law requires it; always check with a lawyer: if there are no loopholes, there may be nitpicks or at least a good quibble.)

Custody. Physical custody does not equal legal custody. Not having legal custody can lead to problems — doctors may insist on a parent’s consent to a medical treatment, and school and welfare officials might also require it. If the child’s stay with you is to be temporary, say over the summer or until the parents can relocate, then a Parental Power of Attorney should suffice in most states. Signed by the parent (better yet, notarized – bells and whistles always help), it will give you power to act in the parent’s stead in relation to medical and educational decisions. Even a letter, signed by one parent, is better than nothing.

Things become much more complicated if your grandchildren are living with you more or less permanently.

Sally, 22 and unwed, leaves her six-month-old baby with her parents “until she can work things out.” She has an irregular work history, a minor drug problem, and a scuzzy boyfriend. Two weeks ago she went out for a pack of cigarettes; other than one collect phone call from Oklahoma, she hasn’t been heard from since.

Our advice: adopt.

Unless you have legal custody, Sally can reappear, years later, and pick up the child, insisting “This time I will make a go of it.” Children need love and permanence. A general Power of Attorney does not guarantee permanence. It can always be revoked by the parent – or even by the other parent. Without legal custody, both you and the children will be hostage to the whims of the parents.(If you adopt your grandchild, it need not be forever. If the parents gets their act together, you can return physical custody to them.)

You’ll need legal help here. However, having seen the tremendous heartbreak that can flow from leaving things up in the air, we strongly advise that you get legal custody of the children: the cost will be well worth it, both for you and your grandchildren.

If you adopt, you have all the rights and obligations of a parent, including the legal duty to support the child. (But you are probably already supporting the child – it has been our experience that young, unwed moms, with drug problems and scuzzy boyfriends, living somewhere in Oklahoma, don’t contribute much financial support anyhow.)

Inheritance. If you die without a will, your children, not your grandchildren, will get what you have. If you want to leave your grandchildren money, there are a host of problems (giving money to minors can create problems) and a host of alternatives such as trusts. Again a trip to your lawyer is advised.

Kenney Hegland is a Professor of Law at the University of Arizona and has taught at Harvard and UCLA. Robert Fleming in one of the nation’s leading elder law lawyers. Visit their website at www.legaladviceforboomers.com.