A Blockbuster Reader Story and Alex and Ronni Show
INTERESTING STUFF – 8 June 2019

Ageism in Medicine

Last week, I was alerted to an important new book via Judith Graham's Navigating Aging column at Kaiser Health Network.

[EDITORIAL NOTE: Judith is a friend and journalist who has reported on aging and health issues for most of her career. Last November, she published a column about my blogging about my terminal cancer.]

ElderhoodCover225px
The book in question is titled, Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life and is about ageism in medicine, something I have been known to rail against in these pages for all the 15 years I've been writing this blog.

The author, Dr. Louise Aronson, is a geriatrician, a professor of medicine at the University of California-San Francisco and a writer. Judith sat down with Dr. Aronson for an interview about her new book. Three short excerpts:

First, I was knocked out to hear a doctor finally saying out loud what many of us laymen interested in ageing have known and been repeating for many years:

”People age differently — in different ways and at different rates. Sometimes people skip stages. Or they move from an earlier stage to a later stage but then move back again,” said Dr. Aronson.

If you've been around this blog for a good while, you have probably read words similar or almost identical to those of Dr. Aronson ad nauseum. That's because they are true and bear restating until people get it. But it carries a lot more weight coming from a physician.

Here's another from Dr. Aronson about something that drives me nuts:

”Medicine pretends that this part of life isn’t really different from young adulthood or middle age. But it is. And that needs a lot more recognition than it currently gets.”

No kidding. In addition to all the obvious physical changes, we aren't even included in many drug trials so doctors can only guess at what dosage and frequency to assign to a 60- or 70- or 80-year-old body. Good luck with that.

And third, blatant ageism, which too many people who willingly campaign against racism and sexism, for example, refuse to recognize. Dr. Aronson:

”Do you know the famous anecdote about the 97-year-old man with the painful left knee? He goes to a doctor who takes a history and does an exam. There’s no sign of trauma, and the doctor says, 'Hey, the knee is 97 years old. What do you expect?'

“And the patient says, 'But my right knee is 97 and it doesn’t hurt a bit.'

“That’s ageism: dismissing an older person’s concerns simply because the person is old. It happens all the time.”

Dr. Aronson has more compelling things to say about medicine and ageism. You can read Judith's entire interview here.

I'm pleased to report that in my two years of treatment at Oregon Health & Sciences University, not once have I run into an instance of ageism. Of course, I'm being treated mainly in the oncology unit and I'd guess if you choose that specialty with which to make your career, you had better like old people – we get most of the cancers.

Dr. Aronson has been compared – as well she should be - to Atul Gawande and the late Oliver Sacks, two other doctor-authors I greatly admire. Dr. Aronson's book will be published next Tuesday, 11 June and I've got it on pre-order.

You can find Judith Graham's full archive of KHN Navigating Aging columns here.

I'll leave you today with this lecture by Dr. Aronson speaking in Dublin at a dotMD conference in 2014, published in March 2019 to YouTube. She is an engaging speaker, her points are compelling and no medical jargon allowed.



Comments

Thanks for all the information Ronni. I'm off to the doctor this morning. She is probably the only internist/geriatrician for many miles in our area and I love and respect her. Thank God she is half my age. I worry that she might leave some day. I travel nearly 100 miles to see a pulmonologist as the only one here is basically the "shut up and do as I say" variety. I'm living with serious lung disease including many nodules which so far are benign. When I watch you on the Alex and Ronni Show (which I love by the way) my heart is with you listening to you breathe and describing how hard it is to get the mail or toss the garbage. The most simple exertions are hard labor, I know first hand. Hugs and love to you. And thanks again for all your useful information.

My post should say Celia, can't spell my name this morning. :-)

Thanks for this one. I hope every medical professional -- doctor, nurse, and every other in this field -- has the good sense to learn these things. Where and when I grew up, the old-time country doctors knew this well! His or her mere presence had a calming and reassuring effect on people.

I have been incredibly lucky for the past nearly 20 years with the GPs, specialists, and surgeons I have had at Kaiser-Permanent here in San Diego County, California.
At age 82 I am at an age of having or developing pieces and parts of my body getting worn down and slowing down. I am able to both phone and email directly to my GP or other doctors -- with all the information on accessing them online on the K-P Web site. And they or their nurse responds very quickly, listens to my concerns or wishes and I get quick action every time. And every doctor there gives me personal attention and remembers things I have said in prior visits.

I am so glad I found this particular group. It seems to me that they have been coached and taught by someone like Dr. Louise Aronson ... perhaps this person herself, which seems quite possible as she is a professor of medicine at the University of California in San Francisco.

Much more powerful and intimidating is the stigma and prejudice against poverty.

All my doctors are at OHSU and the speciality doctors I have been seeing for years are excellent and very caring.

However, my PC doctors have all been women and are some of the most alienating and discriminatory doctors I have ever seen.

I have been through 5 different PC doctors in OHSU's Women's Health and only one did I feel comfortable with. (Each one left Women's Health after merely a few months so there may also be something not quite right about management.)

But the thing is they discriminated against me more because of poverty than age. I do think they also had a problem working with seniors and it may very well be a fear of aging in themselves.

Regardless, to be poor and older can be very ostracizing.
People automatically assume that there must be something wrong with you if you are poor.


I must ad my thanks and get her book. Once I read it I may gift it to my primary. While I consider him an excellent doctor I am now facing appt's to talk about my husbands dementia.

I find the comment about both knees' being the same age rather off-putting. The knees may be the same age, but they may not have developed the same during his early years, injuries may have differed, and/or the two knees may have seen highly different wear and treatment.

I don't expect two "identical" machine parts to have identical lifetimes; although, I must admit that when one tire on my car wears out I probably replace them all. There are safety margins considered in design to account for unknowables. [I don't know what margin of safety is built into the design of the human body - lol.]

This is a brief cautionary tale stimulated by your fine Friday piece, Ronni.

Now in my 80s and hoping to stay independent, I wanted to find a Primary Care Dr. closer to where I live when the man I was seeing in Lake Oswego retired abruptly. He gave little notice to long time patients and was unwilling or unable to recommend another Dr. A nurse practitioner in my neighborhood recommended a woman only a mile or so away with a family practice. Great!

I called to run the gauntlet of questions the receptionists always want to know about Medicare, age, health status, other insurance,etc. She was kind and efficient and said she would talk to the Dr. and get back to me. When I told her I had been a breast feeding consultant for our small town's local Doctors for many years she spent another 30 minutes on the phone with her own 1st time mother questions for me.

2 days later she called and said this particular Dr. did not want me as a patient (remember it is listed as a family practice) because she said "I was SO OLD she would likely have to refer me out for second opinions too often and can't make any money that way!" That is a direct quote. You can't make this stuff up ! I was literally speechless, and if you have read any of my former comments you know how rare that would be. :-)

A final thought...In Dr. Aronson's book her only suggestion was to change Doctors. Yet with a shortage of Dr.s and growing aging population it is not easy. My own 5 P's for dealing with Dr.s... Prompt, Personal, Precise, Polite and Persistent. Sometimes it actually works!

When it doesn't, I follow Dr. Aronson's advice; gear up my safari again and go into the "Try and Get it" healthcare jungle here in Portland. BTW.... I left out Pugilistic....to maintain my almost' ladylike' demeanor.
​​

The difficulty of finding a primary care doctor who is compatible and empathic while also being a first-rate medical practitioner can’t be exaggerated. For more than 25 years, I have been getting my care at a major university medical center because of the general superiority of its medical personnel even though its hospital is a nightmare due to its designation as the regional trauma center.

For a number of years I had an excellent PCP. Since he left, I have had to change physicians three times, never finding anyone I could really trust and rely upon. After awhile, I essentially gave in to healthcare lite, which seems to be the preferred method of operation, and on my regular visits we just go through my medication list as the current doctor checks things off on his computer.

Fortunately, I also see two specialists in cardiology and ophthalmology, both of whom are women, and both of whom are top notch. I am quite sure that my age has been a barrier to good, empathic medical care by the PCPs, so maybe Bonnie has a good idea about gifting your PCP with this book.

BTW, sorry Cop Car, but I have to admit that the story about the 97-year old man’s knees made me laugh out loud, whether he is medically accurate or not.

I had read about this book and intend to have a copy, too. One reason I continued to work part time into my 79th year was because I was serving a close-by retirement community sensitive to aging issues. I found there are always individual professionals who are more-attuned to elders than others.

I had an opportunity to serve in numerous such communities, hospitals in and outpatient, rehab settings skilled nursing and of varying quality. What I observed in some settings did arouse my awareness and concern about ageism which I was best able to address as an advocate for each of my patients. There definitely were others with whom I worked who did the same, from the doctors to nursing aides and non-medical staff.

But years ago when I came across the writings evidencing an awareness of the significance of language in our society being used in relation to older people on an internet site called a blog, published by some woman named Ronni Bennett, I was elated — older people had an advocate who was educating others and had a forum from which to do it.

I probably expected the power of this new-to-me World Wide Web exposing the ageism issue on such an intelligent but fun classy blog to finally bring about fairly rapid change. Duh! How naive! Such wishful thinking. I’ve had to remind myself that accomplishing attitudinal changes to end ageism is one like so many isms — that may take awhile. — even then, there can be setbacks.

I’m so glad for the voices here, especially since I’m now one of those truly older or elder people in my eighth decade, glad Ronni keeps addressing the issue and am encouraged there are so many of us carrying the torch. Generations after us are going to confront ageism but, hopefully, thoughts and concerns expressed here will aid in keeping the impetus to nullify ageism strong, long after we’re gone, but for our children and grandchildren.

As the only remaining grandparent with a college degree, I am involved in mentoring/supporting my granddaughter as she moves into her junior year of college. She wants to be a surgeon; however I’m not convinced she is prepared to make the sacrifices that a female surgeon will inevitably have to make… In any event she will be doing something in the medical arena.

In planning her classes we decided on a minor in gerontology along with her biology major. She’s taking her first course now, and I am thrilled about the new perspectives she has about all things aging. She is very compassionate and genuinely caring towards the elderly, but in just a few weeks of a summer course she has found that there are many aging issues she had no idea existed. At age 19, how could she really?

I think all medical students should be required to take several classes in gerontology. The future elderly will make up a huge percentage of their patients, regardless of the specific practice area they enter.

I am so proud of my granddaughter! She is learning so much that will help her in her future medical career PLUS she will now have more understanding and empathy for her own family members. Win-win.

Baby steps… We change attitudes one small step at a time!

After reading this post I realize I am blessed to have a primary care physician who "gets it." He has never dismissed any symptom I may have with " A lot of it has to do with your age." I don't want to hear that my aching back or swollen toe has no other cause other than my advanced years. If a 17-yeqr-old came into the office complaining of an arthritic knee I guarantee he would not be told "that's expected at your age."

I am so very fortunate as a 70-year-old to have a doctor who's 78!! He's practical, has lots of common sense, and doesn't push meds. He accepts me for who I am in my aging body.

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