Family member ill but refusing to see doctor - any idea what symptoms might mean?

[Isitmybathtimeyet]

I do know that the real answer is talk to a doctor here, but for now that just isn’t going to happen and it’s worrying others out of their minds, so I thought asking on here might be more constructive than a google of doom.

Male relative, early 70s, long history of refusing to engage with doctors and self-medicating (which hasn’t gone well to say the least). Severe anxiety in general which has worsened over the years. Has gout, high blood pressure and chronic kidney disease. Had made some diet modifications (forced on him) but continued to drink to excess and do almost no exercise at all. Medications reviews were showing health stable by basic measurements.

Six months ago he got what appeared to be a serious stomach bug. Constant vomiting etc for three weeks or so. Improved a little but basically has not eaten much since and has lost close to four stone (was overweight before and is tall). His tastes have changed and he has stopped drinking. He can’t talk for very long without losing his voice a bit. Self measurement of blood pressure was 100/60 so has come off a blood pressure med at his own decision. Appears to be increasingly frail. Hasn’t seen a doctor at any point.

Any ideas at all? I am wondering if it’s just not eating turning into a bigger problem and the eating has become (another) source of anxiety after the bug. Or of course google does suggest the Big C. He’s apparently in no pain at all and seems rather cheerful to me when I speak to him.

You could try calling his doctor and letting them know - they probably won't be able to discuss with you without his consent but will at least alert them.

I am no doctor so don't know what's wrong - encouraging he's not drinking, seems happy and sticking to a diet. If his blood pressure is that low wouldn't have thought should be on blood pressure meds but check with a doctor - a doctor may not be able to discuss him but maybe able to give generic advice.

Doctor may have ideas on how to help. My DH refused doctors and I phoned doctor and doctor said to get him there saying it was appointment for me and I needed him there. It worked.

From what you say the court of protection could say he is no longer competent and award medical power of attorney to his next of kin or drs. Adult social services is your first step if he won't go to the gp

He needs his U&Es checking at the very least after a prolonged bout of gastroenteritis on the back of the already diagnosed CKD, and the anti-hypertensives, etc.

I don’t know what the answer is but he could really do with seeing someone. Would he agree to a GP home visit, even if it just reopens communication between him and healthcare to begin with?

@stucknoue

I don’t think the OP has given anywhere near enough information to suggest he might not have capacity. Certainly not if he’s got insight enough to be monitoring his own BP and making (ill advised) adjustments to medications for his BP.

This sounds like someone who has disengaged from healthcare for another reason, and although it can be devastating for bystanders, people are free to self govern and self neglect, if that is their wish.

I think trying to speak to his GP is the first point of call, ring the surgery and request a call back from the duty doctor, so you can at least bounce the situation off someone. Even if they can’t disclose anything to you, perhaps they can help you suggest a way to get him seen.

Thanks, all. He certainly isn’t Court of Protection material. And there is No Way his other half would go along with that idea anyway.

He has a medication review in July and worried family are hoping the practice nurse will take one look at him and get him ‘to consultants’. I am a bit more on that one but you never know. He won’t see the GP at all before that. I’ve suggested calling the GP to express concern but apparently he would see through any attempt to get them there through subtle means.

He’s not sticking to a diet. He’s barely eating. The not drinking is an incidental positive I agree.

His history of self-medicating is the reason he now has CKD. So dropping one of his BP meds at his own instigation is a worry as who knows whether it’s the right one?

But I am going to suggest that the GP is rung. At the very least so they are primed to give chase if he tries to wriggle out of his review. Although goodness knows what state he might be in by then.

Liver problem?

So difficult if he won't engage, but is deemed competent.

Any point asking him gently why he won't engage? Is it fear, cynicism, etc?

I’d have him at a&e with those symptoms- if you can possibly induce him to go.

I say that as someone who spent the best part of a year shadowing a&e and trauma doctors at the Royal London. I know those doctors would say the same.

No way at all he’ll go to A&E until he’s unconscious.

He is enormously anxious (doesn’t leave the house apart from the odd occasion, doesn’t like talking to anyone, has loads of rituals about life) so it’s partly that, and partly that he has hated doctors all his life and is very stubborn. In the past he has gone for the sake of others but it’s taken years. This time he’s not budging. Ironically of course he has a history of causing potentially minor issues to get worse and therefore blames doctors for being no good because they can’t make things go away (because they haven’t been given a chance).

Nothing about this sounds like an A&E job. And A&E can’t get him on a 2 week wait, they can only ask the GP to do it.

Softly, softly catchy monkey on this one I think, gentle persuasion.

If you alert the GP they maybe able to get a doctor to pop-in to his medication review if pre-warned. Obviously its up to him whether he talks to them but don't think a nurse would refer to consultants - I have only been referred to specialists by GP (or once A&E).

I am nervous about doctors and my doctor will do phone consultations for 90% of things for me, does depend on doctor but does mean can get help without leaving house and receptionist will always argue they don't do that. He leaves prescriptions at front desk or sends direct to chemist. If doctor is willing to do that might be worth seeing if he would do that.

I mean you have to get past receptionist but I just ask if doctor can call me back. Receptionist says they don't do that. I say well ask him and if he says no I will come in. He always calls.

If he is as happy as anybody can be with anxiety and the problems you present, why not let them be in charge of their own medical issues? I know that sounds harsh, but the symptoms along with general health would indicate a possibility he doesn't have that long anyway.

My doctor will also do hospital referrals with me just phoning and that's great if you are anxious as cuts number of visits to minimum. Obviously he still needs to engage and think I have an exceptionally kind doctor.

I am not a doctor but having had a mother die of Oesophagael cancer, I am wondering if it might be something stomach/gullet related. Mum's voice changed a bit, she had a lot of reflux, difficulty eating caused a huge and fast loss of weight. She didn't ignore her symptoms at all, but unfortunately it was too late. My Mum also loved wine, drank far too much of it, but also went completely off it and other alcohol. Just a thought. I really have no idea how you make him seek medical assistance though. I had a situation with my ex-husband where he really needed to see a doctor but refused or put it off (I thought he had prostate cancer). I ended up ringing doctor and putting him in the picture and he called ex and said he wanted to review his migraine medication and could he go in. He did and it was a bloody good job too as he had a bladder condition that was about to cause kidney failure. Literally nick of time. I don't know if perhaps it would be worth sending an email to the practice or dropping a note in and seeing if they could bring the review forward? It must be such a worry for you all. I do hope you find a solution and nothing has been left too late. Good luck

Calling the GP to make sure a doctor is at the review is a really good idea. (I don’t think even the more optimistic family members think the nurse will refer him directly to a consultant, just to the GP, but it removes a layer of action.)

He may not have long left but equally he may have something easily treatable that will get worse for lack of treatment. He has previous on this. I agree to an extent that it’s down to him but he also has people who love him who are out of their minds and will be heartbroken to lose him, so if there is a way to help him and them it seems a shame not to find it. Especially when he’s not depressed per se, just anxious and stubborn. If he is diagnosed with something horrible and wants to decline treatment I think everyone would respect that because he would find endless hospitals so distressing.

Very difficult if he won't do anything to help himself

I’m sorry about your mum, MrsC. That’s so hard. Oesophageal and stomach cancer do seem to be possibilities and that is obviously a worrying thought.

Isitmybathtimeyet, thank you, that's very kind. I do think they appear to be possibilities unfortunately. If it is OC, that remains very difficult to treat even now (my mum died 15 years ago) so in some ways, if he's comfortable and happy in himself then you just have to leave him be. I think the medication review that you mentioned is your best hope, I would definitely give the surgery a heads up on this. They don't have to tell you anything (and won't) but you have nothing to lose by giving as much information as you can in advance. Fingers crossed it is something that is easily treatable, all of these symptoms could be treatable gastric issues and of course Dr Google always gives you the very worst outcomes. I really hope you make some progress!

Not entirely surprisingly, now something has actually been said rather than everyone worrying in silence, his appetite has apparently picked up and all is well again overnight.

Just wanted to update, six weeks later. Still not eating, now living on three supplement shakes a day. Now very hoarse and not able to say much before getting tired/out of breath. Has now agreed to see the GP in two weeks and an appointment has been made. It’s just infuriating but no more to be done. I just feel for the rest of the family. Please let me never become this stubborn.

Hello. Just to satisfy people who like to know how things turn out, there is (hopefully) a resolution here.

He had his six monthly blood tests to check medication levels and unsurprisingly was called immediately into hospital on the back of the results. A bile duct obstruction was identified and it has turned out to be a kidney stone. Obviously this is a huge relief but the amount of worry and stress that could have been avoided...

I am so pleased it has had a good outcome.

That's remarkably good news given the symptoms! Congrats to everyone.
It's probably too much to hope that this'll be a learning experience for him, given it does have a relatively easy fix, but worth pointing out to him repeatedly that he's had eight months of serious pain which could have been resolved immediately if he'd not been a dick about it.

That's actually a great outcome given the possibilities. I'm really glad he's ok and sorry for all the stress you've been through.