A 57-year-old patient with controlled hypertension and prediabetes recently came to see me for his annual exam. He was accompanied by his wife, who struggles with many complications from her severe diabetes.
With no new complaints to address, I performed an exam and reviewed his health maintenance goals. As we neared the end of his visit, I asked him if I had addressed all of his health concerns. He was quiet, but I noticed his eyebrows shoot up as he glanced at his wife, while hers lowered and constricted, as if to say, “Are you sure?”
I looked over and awaited his reply.
“Well, there is this other issue,” he said.
He went on — reluctantly — to describe episodes of chest heaviness with exertion, which occurred two or three times a week for the last month. I tried to keep my expression neutral and asked as calmly as I could why he didn’t mention this right away.
He said he thought I’d send him for tests and prescribe treatments that would interfere with his ability to care for his wife. Thankfully, her concern for her husband pushed him to tell me what was really happening.
This was a powerful reminder of the importance of creating some unfilled space during office visits to help bring out issues that are more difficult for patients to acknowledge. We discussed how his symptoms could indicate a heart problem, and he agreed to have a stress test along with a cardiology consultation. Most importantly, he said he would call right away or go to the emergency room if his symptoms became more frequent or severe.
If you are caring for a loved one who has health challenges, you deserve not only praise, but also support. Unfortunately, the same good-natured altruism which inspires caregiving may lead you to ignore your own symptoms or postpone preventive self-care. Sacrificing your health care can be counterproductive.
Primary-care practices are increasingly focused on complex social, economic, and environmental issues which impact health. These social determinants of health (SDOH) are considered at least as important to good health as genetic and physical factors. Caregiving is an example of SDOH, and your medical practice may be able to help you address this challenge.
Beyond being more attuned to how your caregiver role may impact your health, office-based care teams may have resources to assist you. For example, in our practice clinicians can engage a social worker and care manager who help our patients find community resources for caregiver burden, provide emotional support, and assist with scheduling appointments around caregiver constraints.
Communities have a long way to go in developing support services for caregiving and other SDOH. Yet momentum is swinging in the right direction, and your primary care practice can be your advocate. It all begins with accepting that caregiving and self-care is not an either-or proposition. They are interdependent, and should both be part of the conversation with your health-care team.
Jeffrey Millstein is a primary-care physician and medical director for patient experience-regional practices at Penn Medicine.