Have you heard the story about the man who goes to see his doctor about a pain in his knee? The doctor says, Well, you are 101. To which the centenarian says, Yes, but my other knee is 101 too, and it doesn’t hurt.
The story was told by famed gerontologist Robert Butler and has been told again many times by people who want to make a particular point: Like everyone else – including our selves – doctors tend to make assumptions about age. And that seriously affects how they communicate with us, the advice that they give us and recommendations they make when it comes to everything from exercise and surgery to our sex lives. As Mark Lachs says in his book “Treat Me, Not My Age,” Ageism in American medicine and society is a matter of life and death, as dangerous as any incorrectly prescribed medication or slipped scalpel.”
You may be so accustomed to your medical concerns being brushed off due to age that you don’t notice anymore. But you should! Here’s how to recognize ageism in health care and how to avoid or correct it.
How Is Your Doctor Treating You? Know the Red Flags.
If you’ve gone to the same doctor for years, you may have little to compare him or her to. But think back to recent conversations and interactions you’ve had during your routine visits. Does any of this sound familiar?
- ”You say you’re tired, but most of my patients over 60 say they are.”
- ”The guidelines say that everyone over age 65 should….”
- “Does your mother…” That’s you — the doctor is talking about you, the patient, to your daughter, who came along as a second ear.
- “Just take two of these.”
- “Oh, you have grandkids?”
Prescribing medication is fine in certain cases, but a doctor who routinely gives you something for your symptoms rather than looking for causes may be thinking, “Well, of course she has pain — she’s old.” And a doctor who has been your primary health care provider for any length of time should know whether you have grandkids or not. Being a grandparent might be a big part of your life and can drive your need to stay mobile.
All five examples above are warning signs that your doctor is treating you as a senior, a number — not as an individual, patient advocates say.
How a Doctor Should “Address Your Personhood”
Busy doctors often cite lack of time as a barrier to getting to know patients individually, says Quratulain Syed, MD, assistant professor of medicine at the Emory University and a member of the public education committee for the American Geriatrics Society.
But she says it’s not a valid excuse. If doctors don’t take time to get to know their patients, they can’t individualize treatment. “It’s important to know patients’ functioning, their goals, their priorities, so you can tailor a treatment plan,” she says.
Guidelines for blood pressure, cholesterol, physical activity and other health matters are developed with the general senior population in mind, she says. A doctor’s job is to individualize those guidelines to their patients. One 75-year-old may be barely mobile, while another may be exercising vigorously. An older adult who eats meals out frequently may need different advice on limiting cholesterol or salty foods than one who eats most meals at home.
Your doctor should be asking you not only about your medical history, but also about your life history, says Ronald D. Adelman, MD, co-chief of geriatric and palliative medicine at Weill Cornell Medical College. Doctors should ”access the personhood” of the patient, he says. To do that, your doctor would be asking about your needs and goals. “Once you hear a patient’s story, the stereotype of age goes away,” Adelman says.
A doctor who knows your goals, he adds, will also start believing in your future — that means focusing not just on treatments for ailments, but on disease prevention and health promotion, too.
Is It Time to Fire Your Doctor?
What if your doctor doesn’t treat you as an individual or think about your future? You may be able to improve the communication, experts say. If possible, schedule a visit that allows extra time. Explain to your doctor your wishes and goals, Syed says. Be specific:
“I want to live longer and I want to be mobile.”
“I want to be able to keep up with a tour group.”
“I want to be able to continue working for several more years.”
“I want my sex life to improve.”
Your doctor should be comfortable with you asking questions, too, Syed says. Most patients these days browse the Internet and come in with numerous questions. “That puts pressure on a doctor in a good way. Patients should never get intimidated and not ask questions.”
“If you have discussed your concerns with your doctor and you feel your physician is not paying attention to your concerns, then I think it’s very reasonable to look for another provider,” Syed says.
How do you know that it’s time to move on? I did when I went to a new-to-me podiatrist with a painful condition called Morton’s neuroma. The thickening of tissue around the nerves had made my toes go numb. When I told him I wanted relief so I could continue my long-standing participation in long-distance running events, he offered me an injection of cortisone for the symptoms and told me to give up long-distance running. I moved on.
Likewise, for example, if you confide in your doctor that sex has become painful, you should expect to get more than an informational brochure. Just as he or she probably would if you were 20-something, your doctor should ask for details and suggest remedies, if not a referral to a specialist.
How to Find the Doctor for You
How can you find a more enlightened, non-ageist doctor?
- Ask friends and relatives who have some of the same goals as you who they go to. You could try posting your question to Facebook, too.
- If friends live in a retirement community, ask to visit at lunch or dinner time; interview the residents and get their best suggestions. You’ll likely gather many names of doctors they love, along with ones they don’t like.
- Browse online reviews of physicians. Be aware, Syed says, that some are helpful, some are not. (There’s always the possibility that you’re reading the review of a high-maintenance patient.)
- Check the doctor’s credentials. If they’re not on the healthcare plan’s website, you can ask when you call the office for basics such as education, board certification and other details.
- Schedule a first appointment and listen to your gut. If you have found a doctor who, as Syed says, “puts you at ease and isn’t looking at his watch every two minutes, who wants to get to know you,” you may have just found your doctor. Technology is wonderful, but if the doctor looks at the computer screen for test results or other information more than at you, bad sign.
- Geriatrician or internist? Choosing a geriatrician doesn’t guarantee a good fit, Adelman says. But it does give you a ”good chance” to find a doctor in tune with the issues of aging, he says.
- The National Institute on Aging’s “Talking With Your Doctor: A Guide for Older People” has a few helpful recommendations.
- The nonprofit Health in Aging offers a search tool for patients looking for a geriatric physician. Click here.
- “What Your Doctor Won’t Tell You About Getting Older: An Insider’s Survival Manual for Outsmarting the Health-Care System,” by Mark Lachs, MD is available on Amazon.com
“Is it Time to Fire Your Doctor?” first appeared on Senior Planet. To learn more about finding the right doctor, here are six reasons you need a good primary care doctor in this age of specialization.