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The Need for a Few Good Geriatricians

There are not a lot of geriatricians in the United States and their numbers dwindle each year because medical students believe the specialty is depressing, one survey tells us, and it pays a lot less than other fields of medicine.

”A key issue in the U.S., [Desmond O'Neill] emphasized,” reported the Irish Times in January, “is the relative scarcity of geriatric health professionals like him. That this country has so few geriatricians here compared to other industrialized nations is a serious flaw in the system, he believes.

“O’Neill used the hypothetical of example of an emergency room with two options for the older patient: behind Door A is a geriatrician and behind Door B, the general medical service.

“'You reduce the chances of death or going into a nursing home by 25 percent by going into the geriatrician,' O’Neill said, adding, 'It can happen and it can change [in the U.S.]. The Canadians have changed direction.'”

Desmond O'Neill is a Dublin geriatrician who is also one of world’s leading researchers in his field. Last year, he became the first European honored by the Gerontological Society of America (GSA) with its Samuel T. Freeman Award, given to a “prominent physician in the field of aging - both in research and practice.”

Pay for geriatricians in Australia, for example, is much higher than in the U.S., O'Neill says, where fees fall well below those for physicians in high-tech specialities. Ireland falls somewhere in the middle.

Nevertheless, he detects a coming “seismic shift” in attitudes toward ageing within medicine and society at large. If that is true, I certainly hope Dr. O'Neill's recognition in the United States will be an inspiration to those who run our healthcare system.

“'People used to talk about ‘successful aging.’ It means that if you didn’t reach the criteria of successful aging, you’d failed,” said O’Neill.

“Henri Matisse did not successfully age in a physical sense. After decades painting standing up, he was forced to adjust his style radically sitting down. 'Through his disability, he grew and changed and produced something new,' O’Neill said.

“So what we’re actually talking about is ‘optimal aging’ that understands the existential hits that we’re going to take in terms of disability and creates a system that frees you from unnecessary constriction by that disability,' O’Neill said.”

The growing movement to create age-friendly cities will help bring this about. O'Neill

Other changes coming, says O'Neill, involve a reversal of the long-held simplistic belief that ageing is only about loss and decline. Whew! Refusing to believe that, is the reason I started this blog and it's great to have a credentialed professional saying these things. Take a listen:

“'We’ve got to recognize growth in later life. And also not only recognize growth, but also the extraordinary abilities of people in later life to cope with the existential problems they have.'

“O’Neill noted, “Older drivers have the highest levels of illnesses that might affect driving, yet they’re the safest group of drivers on the road. So, their adaptive abilities, their mastery of how they engage with their environment, is brilliant.'

“There is now a fascinating body of literature on the older worker, according to the Dublin physician.

“'If you have come down in the Hudson and survive, do you want an almost 60-year-old with all his life experience or do you want a 25-year-old?' O’Neill said, alluding to Chesley 'Sully' Sullenberger’s successful navigation of Flight 1549 on Jan. 15, 2009.

“O’Neill, a frequent writer for the Irish Times and British Medical Journal, reported that research has shown older workers take less time off and are more productive than younger colleagues in many jobs.

“'Older roofers, for example, seem to spend a little bit more time per tile, but actually get the job done faster because they know the shape of it,' he said.

“Older hotel receptionists, he said, 'take a bit long longer on the phone call, but they get more second reservations.'”

In our 21st century world where it is widely believed that speed is everything, those last two items are of particular importance. There are still a few of us alive who understand the payoff in the fable about the tortoise and the hare.

I'll have more to tell you about Dr. O'Neill when I've finished reading his book, Ageing and Caring: A Guide for Later Life. Meanwhile you can read a bit more at The Irish Echo story..

We need a lot more geriatricians like Desmond O'Neill.


Thanks for such a valuable & informative post today. I'm motivated to looking further into this subject. Your blog is the highlight of my days. Thanks, once again for "sparking" my interest. Dee

Great post Ronni. I remember a doctor I saw years ago asked me about my mother who was quite ill with emphysema and after I responded he was sympathetic but said he "was glad she was not his patient," because of the constant emergencies and no way to improve her life for her. That it just got him down. I think it takes special people with ongoing health issues, the aging or young. Sadly I don't think our 'me first' culture is producing many of those kinds of people.

Oops! I meant a special kind of person to treat persons with ongoing health problems.

I very much enjoyed reading about O'Neill. I was not familiar with him prior to this. His comments about the value of age and experience are so profound, but so simple and obvious. Why is it so difficult for so many to embrace hiring older workers and holding onto them? They love to have us volunteer, but are reluctant to hire and pay. Go figure.

There is only one geriatric physician in my list of primary care doctors.

It has been my experience that my doctor tries, but he does not know what to offer me when I give him my list of aging issues. Doctors know that the body gives out and, since it's the normal way of things, it's simply to be accepted.

It's difficult to make young doctors who are not geriatric physicians, understand that being old is not automatically being sick. Yes, there are things we can't do anymore like pole vault, bench press 300 lbs. or run up a flight of stairs, but this is normal, for us. Prescribing medications for age related maladies (that aren't illnesses at all) when they should be concentrating on quality of life issues does every elderly person a disservice.

Although my doctor probably thinks she is being helpful, she immediately thinks in terms of prescriptions for every symptom rather than seeing that all my maladies are related -- and that some of my medications are the problem and not the answer. It makes no sense to me to take meds that have worse side-effects than the symptom they are supposed to help alleviate.

It does take a special mindset to treat people with multiple health issues related to aging. Hypertension is easy - throw a pill at it; ditto high cholesterol, type 2 diabetes, osteoporosis, and yes...even dementia. Can you imagine how they must feel though when they suggest a diet and exercise plan because it's proven to help, for some conditions, and the patient wants a pill to fix it?

I found a physician's assistant who at least tries, and says he's sorry he couldn't help. I'm also straight with him and tell him what I'm willing to try and why I'm not willing to try something else.

Luckily I have a female doctor who is in her 50s who cares about all of my 70-year-old ailments and is dedicated to making sure that I live another 20 or so years.

My husband retired about 5 years ago from a job that required him to take telephone orders and process them--from woodworkers and cabinet shops, etc. His supervisors were always on his back about him taking too much time on the calls, talking to the callers rather than taking more calls. But he was consistently in the top two of the sales people for the entire company in the $$ value of the sales he made and the %% value of the income he brought in He worked for that company almost 13 years---for 11 of those years he was THE top salesman for the company--whether on the retail floor or on the phone.
I often said that he could sell deep-freezes to penguins if he had the chance--and he got call-back after call-back from "his" customers and, even after five years, people still call that company asking for him and ask for a referral phone number so they can talk about a particular tool or process.
He worked for the company for nearly 13 years - he missed exactly four days for illness in that four years--even during his treatment for prostate cancer! They didn't give a damn when he retired---exactly 7 people showed up for his retirement party!

Just to let you know - your comment process needs a preview and/or an edit function - that last paragraph should read 'missed exactly four days for illness in that 13 years' -- didn't catch it before I posted it.

Are you having trouble reading the "Preview" button right next to the "Post" button?

Dear Ronni

Do you know how the old age subject is treated in Japan?
Thanks for the post

Warm regards

While the business world measures everything with turn around time and every month higher productivity, we old people don't stand a chance.

Statistically they have proven that speed allows more chances for a successful outcome or profit over the short run --- and that is all that counts.

I spent the last 5 years of my career as a trainer and I really hated to admit it but--- the young caught on at lightening speed compared to even the middle-aged.

The older people were stable and steady and dependable but the young could work circles around their elders.

With few new geriatricians in the wings, it seems to me that changes have to be made in training primary care physicians to understand how elders require a different approach.

Of course, if billing codes continue to encourage individual disease diagnoses, training alone won't do it. The whole point is a mind shift to a more holistic view of aging bodies and ways of coping with multiple interrelated conditions.

I've been reading some studies of "successful aging." Whatever you call it, it's interesting to see a shift from 20-30 years ago when the phrase meant "staying healthy" (hah!) to a more realistic view of help with prevention when possible but mostly help with coping with what is, where interventions are carefully weighed against possible results and include living conditions and emotional support.

Super post and comments.

Sullenberger is a great example of the experience that comes with age, and it's interesting that at the time of the so-called Miracle on the Hudson, the FAA had a mandatory retirement age of 60 for pilots.

@Classof65, The tradeoff between medical problems, prescription drugs and side-effects is a huge problem. One example is a drug for over-active bladder which can cause intense dizziness.

Lasergirlnm, your husband deserves a standing ovation!

Big respect.

Ronni, fabulous post.

I will do almost anything to avoid pill popping. Too many TV ads extol the benefits of this or that pill, and then come the list of side effects.

Dizzy spells, itchy butt, burning nostrils, toe jam, constipation, whatever else.

Forget it.

Just thinking:

Some jobs don't require speed.

Private Detective
Tattoo Artist
Home inspector
Telephone Help Line

Jobs where accuracy counts more than speed.

Lasergirlnm, at least your spouse GOT a retirement party, clueless and unappreciative though his co-workers were! I got a layoff notice after almost 40 years with my nonprofit agency (I'd intended to retire sometime after my 40th anniversary). In a state of total shock, I chose to retire although, in retrospect, it probably would have been more astute financially to accept the layoff and file for unemployment! I didn't do so because I'd have had to prove that I was "actively looking for work". At 78!

The days when years of hard work, commitment and going the extra mile were actually valued and appreciated are long gone. In today's speed-obsessed world, "What have you done for me lately?" has been replaced by "What can you do for me NOW?" It may indeed be that young people can "work circles around" older employees in some fields, but many don't have the work ethic or loyalty that make companies great over the long term. But then, why care? The company will probably be bought out in 6 months anyway!

Company loyalty is a thing of the past, indeed. But that's not young people's fault. Most companies have been systematically destroying all of their employees' reasons to be loyal since the early 1990s. When a company clearly doesn't care about its employees' welfare at all, only a fool is going to keep on feeling any emotional attachment to it.

Me, I woke up when management of the highly profitable company I'd worked at for seventeen years decided they were going to get with the program and be lean and mean like all the other cool kid CEOs in Fortune Magazine. There were layoffs, which didn't hit me right away, and performance reviews, and then more layoffs, and more yet, and benefits were slashed over and over and over again, and hey, the propaganda about how "our employees are our greatest asset" was cranked up to eleven.

There was a bit of a grieving process, because I'd truly thought this company was something special. But it wasn't. They didn't care about me. I wasn't going to let myself care about them any more. Day's work, day's pay, nothing more.

The fact that not many doctors want to become geriatricians simply makes it more important that we stay abreast of research into the field of gerontology, and take responsibility for our own health. This column goes a long way to help us in that regard.

As far as the disillusionment of finding out at the end of your career that your long years of work and commitment are unappreciated, that is an unfortunate fact that most of us are forced to face sooner or later.

And, yes, young people are faster, physically and mentally. Because I have the good fortune to be around lots of the beautiful young creatures, I can also testify to the fact that sometimes they do not have common, good sense to go along with all that lightning speed. lol

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