What 90-year-olds Want From Doctors

Look at older patients instead of typing notes into a computer, take more time with them and answer their questions…

Periodically I go through the “Sites and Blogs I Like” (tab above)– reading, adding and updating. The Kaiser Health News site often has relevant aging articles: “Seniors Tell Medical Students What They Need From Doctors” (9/25/15) is one. (NPR picked it up.)

Sparked by the need for many more doctors (geriatricians) to meet the special needs of an aging population, Case Western Reserve Medical School recently held its annual panel discussion, “Life Over 90,” for their 2nd-year-medical students. The 90+-year-old panel members shared experience and advice–equally instructive for anyone whose elderly loved ones go to doctors. And isn’t that everyone?.

I remember Sr. Advisor R’s last trip to NY, three years ago at age 98– making the effort to navigate airports and flying cross country alone. She had two goals:
1. to see our new apartment and
2. to get a second opinion from our ophthalmologist.

The second was a disaster. After many tests, we went into the doctor’s office. He sat on the other side of the desk, his swivel chair in the right angle between his computer and R, who sat directly across from him. I was on R’s right. Perfect–in terms of where he sat and his ability to glance at the images on the computer then turn to talk. But he flunked the conversation by looking past R–to me–when he spoke.

My instinct was to redirect the conversation but before I could, R announced: “Dr. I pay my own bills, kindly address your remarks to me.” Granted, R didn’t achieve living independently, alone– in her home of 70+ years –by being a pussycat! She knew how to advocate for herself. But what about many elders who either never had–or have lost–that assertiveness?

Initially I faulted myself for not speaking up quickly enough. Then I decided it was much better that R advocated for herself, once again confirming she was in control. (Key Thoughts–right sidebar: Do actions empower or diminish? or Don’t do for aging parents what they can do for themselves.)

R’s experience highlights the fact that while doctors may be tops in their field, far too few have been trained to understand the special needs of older people now–and there will be even less as boomers and those younger age.

Past posts (several years back) emphasize the value of geriatricians for older people’s health care. Read Karen’s short letter re: her mother’s appointment with a geriatrician at Mt. Sinai in NYC.

Case Western Reserve and no doubt other medical schools realize that geriatrics is a relatively low-paying, underpopulated specialty. Even when medical students have interest, most incur huge debt from student loans that will need to be repaid, so they select a higher paying specialty.

Efforts are being made to encourage medical students to specialize in geriatrics–or at the least better understand the needs of older people. That said, a severe shortage of doctors, with an understanding of the special needs of those 65+ exists. It affects not only aging parents and older loved ones now, but portends pitfalls for us in the years ahead. While sobering, check out Related below.

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