I appreciate the supportive comments about my mother’s confrontation with the medical system. I hadn’t been aware of the ethical considerations, and will be in touch with the Florida Medical Society. The comments stimulated some further thoughts about attitudes in the health care system and how they affect not only elderly patients, but all of us.
One of the things that struck me about my mother’s most recent trip to the hospital a couple months back—prompted by her inability one morning to move her body so as to get out of bed, followed by some confusion—was the diagnosis that resulted. While she seemed to have recovered by later the same day, the episode sounded to me like classic minor stroke symptoms. Yet the followup exam at the hospital didn’t confirm a stroke (not sure the exam was as complete as it should have been), so on her discharge (later that day) the printout of the hosptial records labeled her problem as “anemia.”
I think Dave Milano is correct when he says that my mother’s previous physician isn’t much different from the bulk of doctors in that they are simply performing at “accepted standards of practice;” but I sense there is more involved, especially with the elderly. I get the feeling that my mother’s previous doctor, and many other doctors as well, are heavily focused on trying to avoid making a mistake that leads the patient to die on their “watch,” or on missing some terminal illness. If the patient isn’t in danger of imminent death or a terminal illness isn’t obvious, then everything is okay.
It’s a totally defensive approach to treatment. You don’t try to make the patient better, but rather you try to make sure the patient isn’t about to die.
The doctors blame the poor insurance and Medicare reimbursements for preventing them for spending enough time with patients, but of course it’s not that simple. Part of the problem is that most doctors simply don’t know much about making patients better because they are taught mainly to treat disease, not to educate or to rely on the body’s innate healing powers. (Let alone learn the realities and special demands of elder care as described in the excellent April 30 New Yorker article Kirsten refers to.)
The even bigger problem is that they teach their patients to believe the same narrow lessons. One of the reasons it took me so long to convince my mother to consider switching doctors was because she assumed her doctor simply wasn’t able to hone in on her particular “disease.” Once he did, she was sure he would give her a medication and “cure” her.
Even now that she has come to the realization that nothing positive could come from staying with the old doctor, she is still a ways from truly acknowledging possible connections between her various conditions and to her lifestyle…and I fear she may be looking to the new doctor to come up with a “magic bullet” of some kind to make her better.
The media encourages this magic bullet psychology with tear-jerker stories like the one in yesterday’s Wall Street Journal about getting experimental drugs more quickly into the hands of patients with desperate illnesses. I’m not talking about the specifics of one child’s terrible illness, but rather the mentality that “the cure” to cancer and other such diseases is just around the corner, being produced by the genius scientists at our wonderful pharmaceutical companies.
That mentality is just so far afield from the mentality implicit in the comments that continue to come in on the “Resistance Tales” posting April 22—enlightening comments about the amazing subtleties and dynamics of microorganisms and their influence on our health. Two different mindsets from two different planets.
My mom’s long-term doctor recently abruptly left to form another practice at a long-term care facility, leaving his other patients to a young and untried doctor. This put things in quite a muddle. My mom was put on a diuretic, like the one cited in the article, even though her other doctor had never said she had hypertension. I am going down this week-end and try to determine how her BP is doing. Since she doesn’t like taking meds and isn’t very compliant, I may try her on dark chocolate or cocoa instead. Due to her non-compliance with pills, I think this may yield a better outcome for her.
BTW, you mentioned blood thinners for your mom. If she is taking Coumadin (warfarin), you may wish to know that elderly patients are at significant risks for bleeding events if the drug levels aren’t carefully monitored. Furthermore, although this can help prevent a stroke due to a clot, it does nothing to ameliorate the symptoms of atrial fibrillation. Since warfarin has alot of drug and food interactions you will want to keep an eye on bruising and bleeding (gums, nose, dark tarry stools) if a new conventional or herbal medication is introduced.
The whole idea of concierge medicine is interesting. I would think that an annual "membership" would invite more patient care and a better relationship. To think that it would require exclusivity makes it a strange dynamic in my opinion. Why would we want an exclusive relationship with one physician? How could that help the patient? I’m glad you shared that story because it is eye-opening for me in thinking about how the business of medicine really works.
You are right, I think, that for modern medicine, "there is more involved" in treating the elderly than other age groups. I also think that you’re getting close to the root when you suggest that doctors can be too focused on preventing a terminal illness or death. But the real interesting part of this issue is in the explanation of why physicians seem to gloss over non-life-threatening illness in the elderly.
I think it comes down to this: Insults to biological systems tend to have a cumulative effect, and in this era of obsessive attention paid to early detection and treatment (along with aggressive ignorance of prevention) by the time we reach old age our medical conditions have become markedly less treatable. Those fortunate enough to life long often suffer overlapping medical problems, and have extremely weak inherent healing powers.
What is a physician to do at that point? His tools are no longer as effective as he would like, so his natural response is to simply downplay the symptoms. It is not uncommon for the elderly to hear, for example, that trace edema is normal in their age group, or that some confusion can be expected, or that incontinence is simply a part of aging. None of that is true, except by comparison to the demographic of an aging, modern, industrialized society.
I dont know if you will even read this. Your post was on May 2nd. It is now May 11th.
I am the medical power of attorney for my maternal grandmother. I took on this responsibility 4 years ago when she was diagnosed, at age 92 with Alzheimers. Instinctually, I know that her annual flu shots caused this disease, but of course there is no way to prove it.
My grandmother is a role model for all women. She was born in 1910, raised her 4 children in the depression with a husband who suffered from a mental disorder. She divorced him when she was in her 40s and from then on lived an extremely an independent life. She started selling real-estate in her 50s and also participated in local theater productions. She retired from real-estate in her late 70s and sometime in her 80s became a docent at the Richard Nixon Library (shes a diehard republican).
She was an amazing, disciplined woman. She ate simple, healthy foods and exercised daily. I say was, even though she is still alive. The woman I know today, challenged with Alzheimers, hearing loss and cataracts, is not my grandmother. She is now just a deteriorated woman in a human body barely surviving.
She is somewhere in the dying process, having been on hospice since last August. My greatest struggle has been accepting our traditional allopathic treatment for her aging process.drugs, drugs and more drugs! At some point, I just gave up.
There is mercy in a quick heart attack or stroke and then youre gone! This grandmother is now 96 years old. My paternal grandmother lived until 98 (she laid in a bed with dementia for 2 years before she died). All of my great Aunts on both sides of the family lived until their 90s.I can already predict my future. Longevity does have a negative side.
During the last 4 years, I have realized how uncomfortable we are as a society with dying. I asked her hospice nurse the other day if we could quit feeding my grandmother her Ensure. In my opinion, we are just dragging out the dying process. She told me that would be cruel. I think to myself, what did we do100 hundred years ago when someone was dying.we let them die! If they didnt drink water or eat food, they died. Everyone was o.k. with this. It was part of the cycle of life. Death was honored, not feared. We have lost our natural intuition and spiritual understanding about this process. Unfortunately, it is a loss that on one knows that they have lost and therefore, the cycle of keeping someone alive for as long as possible continues on.