Death by Intensive Care

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Geriatrician, Dennis McCullough wrote an excellent book titled:

My Mother, Your Mother: Embracing Slow Medicine

Keep in mind that although he writes about our elderly parents (those over age eighty), the principles he puts forward apply equally to a spouse or partner, sibling, or good friend.  If you are invested in a loved one’s well-being, please consider reading this book.  Bear with me as I provide a lengthy quote that characterizes this physician’s concerns:

Families must come to appreciate that “medicalized” care is very different in nature and cost from the personal health support and hands-on caring so essential for your parent.  In reality, our American medical system is best at managing acute crises and supplying excellent specialized elective procedures – joint replacements, organ transplants, eye improvements, cosmetic changes – all modern technological wonders.

As for the more ordinary and common management and support of elders and families dealing with chronic problems of aging and slow-moving diseases, our medical care system has not done so well.  Some elderly patients are fruitlessly subjected to what some critics now call “death by intensive care  …  “

Now let’s put ourselves into the shoes of a vulnerable adult sitting in an examination room waiting for the almighty doctor to walk through the door.  Answer this question for me: When was the last time you personally felt rushed during a doctor’s visit for yourself?  (Mine occurred last week – but I digress.)  Many of us think faster than the vulnerable adult, are able to keep track of what the doctor is saying, and have sufficient cognitive awareness to discern the doctor’s recommendations or treatment options.  Dr. McCullough wonders how an elderly person could possibly be treated effectively during a fifteen-minute office appointment by a doctor who peers into a computer screen, barely acknowledging the presence of the patient.  How can that physician possibly treat the complexities of an elder’s needs if he/she is not fully engaged in examining the patient?  Most often, the elder patient will not volunteer information that is not in direct response to a doctor’s insightful inquiries.  They are of a generation that does not question a medical professional – “after all, they have the medical degree, not me.”  The elderly patient may exit the exam room having not even discussed his or her medical concerns – simply because the doctor didn’t give her an opportunity to do so.

Dr. McCullough emphasizes how important it is that each vulnerable patient have a “Circle of Concern” – a group of people that provides steady support and insight into the patient’s needs.  That group may consist of immediate family members, friends, neighbors – anyone dedicated to providing an “active, extended advocacy partnership” that will not only attend to the patient’s technical needs, but also the emotional and human needs that are perhaps in need of greater attention.

My article, Caregiving: The Ultimate Team Sport, promotes a similar type of caring, using the analogy of a team’s various members, and their collective roles on the team.  Each person has a skill that supports the other team members’ skills.  The Circle of Concern serves this same purpose.

Perhaps we should all consider how we would like to be treated by others if/when we become dependent upon their contributions to our quality of life.  Dr. McCullough offers this snippet of Tibetan wisdom:  Make haste slowly.

Not all decisions are emergent ones.  Isn’t a person’s quality of life worth stepping back so that appropriate, “guided” decisions can be made?  Rushed judgment should not take the place of carefully considered care.  As Dr. McCullough states, “Time to begin to ask for more time.  Short of a crisis, don’t be rushed.”

Senior Health Specialists? Geriatricians? Where are you?

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The heading from an Associated Press story by Matt Sedensky, “Who’s going to take care of our aging population?” should wake ALL of us up; not just us Baby Boomers, but ALL of us because at this stage of our world’s existence, no one has created a magic elixir that cures old age and dying.

Talk to anybody who is in med school, or considering med school, ask them what specialty they would like to focus on and you’ll hear: orthopedics, pediatrics, heart disease, cancer treatment – all worthy fields but I would venture to guess that not one of whom you ask that question has said, Geriatrics or Senior Health.  “What about geriatrics?” I ask them.  “We’re living longer so you’ll ALWAYS have a job taking care of a civilization that’s fighting to stay alive as long as it can!”  They don’t buy it, especially since Geriatricians are  one of the lowest paid medical specialties amongst the medical community.

Square Dancing class at my town's Senior Center.

Ugh!  Who wants to deal with the wrinkly, saggy, hard-of-hearing, loud complaining geezers among us?  Not very many according to the linked article above.  According to Mr. Sedensky’s research, there is roughly one Geriatrician for every 2,600 people 75 and older.  No wonder people can’t find a doctor who specializes in Senior Health!  I facilitate an Alzheimer’s Caregiver support group in my town wherein these family members expound on their frustrating efforts to locate a doctor who: a) will spend the time needed to have a productive appointment with their aging parent; b) who knows enough about elder health issues to suggest a treatment that will provide quality of life for the patient; and c) who has a medical staff that is sufficiently trained to interact with their elderly patients.   Unfortunately, the General Practitioner or Internist quite frequently provide the same treatment, and the same method of communicating, to their elderly patients – even those with Alzheimer’s or other dementia –  as they do their patients in their 20’s thru 70’s.  That just won’t cut it.

Older patients have more complex conditions – and more of them.  If a medical professional isn’t accurately trained, he or she might discount an elderly patient’s symptoms as those expected during the normal aging process and therefore offer no effective treatment.  “What can you expect at your age Mrs. Jones?  Be glad that you’ve lived this long!”  I know – that sounds really callous – but I dare say too many elderly patients are treated dismissively, and as a result their quality of life decreases greatly.

My wonderful Dad, pre-Alzheimer's, on my wedding day.

Think about it my fellow Baby Boomers.  Are you willing to be dismissed just because your doctor doesn’t know what the heck he’s doing?  I know that all of us have been to doctors who we’ve “fired” because of their lack of understanding and/or their failure to provide proactive treatment.  The vulnerable adults among us might not realize that they have choices.   They might not feel confident enough to challenge the highly educated medical professional to whom they have entrusted their lives.  Who loses in that equation?  We all do.  If our aging relatives don’t have appropriate medical care options at this time in their lives, why do we think that there will suddenly be an influx of Geriatricians to treat us when we’re their age?

Maybe this is a lost cause for us but it doesn’t have to be that way for those coming up in the aging ranks behind us.  What are your thoughts about this glut of Senior Health professionals?  How can we hope to live in a world where quality of life – something we value greatly – is an unreachable, yet much desired goal?