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Caring for the caregiver: AMA resource shows how doctors can take active role

Physicians should focus attention on the well-being of this hidden, at-risk population, as well as the patient they are treating.

Editorial. Nov. 24, 2003.

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You see them often -- but they are rarely the focus of the office visit. They bring a parent, a spouse, or other relative who is living with Alzheimer's disease, cancer, the ravages of a stroke or a debilitating disease. And they see to it, day in and day out, that your patient receives the medicines, treatments and other care you prescribe.

Frequently, they cast aside their own health and well-being in the process.

They are caregivers, and they serve a vital role in the American health system. Approximately 80% of home care services in this country are provided by them. If tallied, the value of their services would exceed $200 billion a year.

Generally, these caregivers are women, either elderly themselves or daughters or daughters-in-law juggling multiple responsibilities -- a job, children, financial pressures. But they also have a responsibility to themselves to which physicians can help them attend.

They are the hidden patients, according to the AMA, and their physical and emotional health is at risk -- marked by increased morbidity and mortality associated with burnout, self-neglect, excessive use of drugs or alcohol, and depression. Often they are so focused on the patient, the person for whom they provide care, that they fail to recognize that they need help, too.

Therefore, physicians who want to reach them must take the initiative and ask them how they are coping. To this end, AMA policy encourages training at the medical school and residency program level to prepare physicians to assess and manage caregiver stress and burden.