Stereotype Me

I have a personal beef with Geriatricians. It seems as though every time some elderly member of my family switches from their regular Internist to a Geriatric specialist, their health goes downhill fast. While I understand this could simply be due to advancing age, I've heard too many stories about medications given for no reason, or healthcare decisions based on age, and not on the individual. My wife's grandmother recently switched to a Geriatrician, and much to her (and my) dismay, her experience was approximately the same as every other elderly member of my family.

First, a little background information. My grandmother-in-law is 91. Her mother lived to be 113. Her aunt lived to be 111. Longevity definitely runs in her genes. She's lived a full life, and for the most part, has done a very good job at taking care of herself. She has been told she's a "borderline diabetic," and suffers from mild hypothyroidism, but all in all, she's a very healthy woman. Her new doctor decided that because of her age, she needed to be placed on a slew of medications - blood thinners, anti-depressants and so forth, and when questioned about why she needed these medications said something to the accord of, "Well, you've obviously never heard about our sacred oath. We swear to do no harm, and if I don't put you on these medications, I would be doing that." If you read the blog entry last night, you know how I feel about that statement. Anyway, the doctor also told her that she also needed imaging to "just check," and that she should probably have blood drawn "just to make sure we don't miss anything." On one hand, I can applaud the doctor for covering all of her bases from a medicolegal standpoint. On the other hand, she's playing "cover your butt" medicine, and should have to take a class in basic patient skills. The thing that really ticked me off, however, was that my grandmother-in-law spent half of her yearly income (social security and retirement) on medication, lab work and physician fees last year, the majority of which were unnecessary. The single most detrimental thing for a senior citizen is a lack of purpose, purpose that is found by doing things they enjoy, be that traveling, volunteering or a hobby. How can we expect them, therefore, to find that purpose when they can't afford to do said activities, because all of their money is tied up in unnecessary health costs?

Just because someone reaches a certain age milestone does not mean that they suddenly needed X medication, as well as a total body CT to check for badness. I'm reminded of a story about a Cardiologist, who after taking his car in for a tune up, was asked by the mechanic, "You know Doc, we both work on engines and pumps, so why is it that you make six figures, and I make little more than minimum wage?" The Cardiologist replied, "Because I do my work while the engine is running." It's true, our bodies need tune ups from time to time, but just because we hit "70,000 miles" does not mean we automatically need our transmission replaced.

Unfortunately, this medical stereotyping affects not only age, but also socioeconomic class, gender, education, or even ethnicity. We as physicians, especially nowadays, are trained to make split-second judgments based on the first few words out a patient's mouth. The advent of corporately-run clinics have made this fact even more apparent, as physicians are allotted 5, 10, maybe 15 minutes with a patient, and if you don't see your quota in a month, you're fired. Language barriers provide similar amounts of stereotyping. If a patient doesn't speak English, or speaks it very poorly, then the obvious answer is to speak the Universal Language - slow, loud English, because come on, everyone understands English. We have to remember to take the patient as a single, unique entity, with a genetic/biochemical makeup that is unrelated to randomly controlled trials, age groupings or chosen tongue. Our goal as physicians should be to treat the patient, not the disease, and we lose sight of that goal when we reduce patients to lab values, radiographs and age ranges. Never forget that at its heart, medicine is an art form, not a science. If it was a science, every treatment outcome could be reproduced in a lab 100% of the time, and our bodies would be nothing more than a collection of mathematical formulas representing current physiologic functioning. Luckily for us, this is not true, and we are all unique beings that just so happen to share similar genetic codes. Consequently, as physicians we need to respect that uniqueness, and seek to find the health that is hidden within that genetic code, irrespective of the age, economic status or gender of the body containing it.

And now, for the Juvie quote of the day,

"I'll get my GED, just you wait and see. Next time I'm in here, I'll have it, you'll be surprised."

Embrace your individuality,

-DD