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Old
people use medical services much more than any other segment of
the population. Yet many of them are dissatisfied with their family
doctor or go "shopping" and continuously try a new specialist,
a different type of treatment or alternatively, due to lack of
trust, stop going to any doctor.
Yet there are some very competent, well-trained
and empathetic doctors available in every community. Some of them
are general practitioners and some have specialized in geriatric
medicine. A physician who has certain characteristics is most
likely to succeed with the older patient.
When looking for a physician for an elderly
patient choose a doctor who:
·
IS EMPATHETIC
·
LISTENS
·
IS PATIENT AND
TOLERANT
·
IS FAMILIAR
WITH THE WAYS OF THE OLD
·
CAN TACKLE ETHICAL
DILEMMAS
·
SEES THE
WHOLE PERSON, NOT JUST THE SYMPTOMS
·
RESPECTS THE
OPINIONS OF RELATIVES AND CAREGIVERS
·
TAKES A DETAILED
HISTORY
·
USES DRUGS RELUCTANTLY
·
IS SENSITIVE
TO THE NEEDS OF THE FAMILY
·
GIVES HIS
HOME PHONE NUMBER
·
MAKES HOME VISITS
IS EMPATHETIC -- A
recent research project showed that most patients, of all age
groups, are not necessarily interested in the Latin definition
of their illness or condition. They want to know that their complaints
and suffering have been registered by a competent, understanding
doctor who sincerely wants to help them.
LISTENS-- Every professional
working with the elderly has to be a good listener. There's a
famous movie which depicts a daughter who brings her mother to
the doctor. The doctor addresses all his questions to the daughter
who explains that the mother has been having back pains and has
trouble walking. Following the young woman's description, he examines
the patient's mobility, the tenor of her knees and the condition
of her spine.
All the while, the mother is trying to get
in a word. She keeps pointing to her chest, and mumbling that
"Here, it hurts here doctor," but nobody is listening
to her. Finally at the door, as the doctor is saying good bye,
and after having written a referral for a CAT scan, the older
woman is finally able to say, "But doctor, why do I have
these pains here in the chest?"
The doctor looks at the daughter in amazement
and then looks back at the mother. "What, what did you say?
You have chest pains. Why didn't you say so?" he asks, as
he quickly takes out his stethoscope.
"But I said so from the beginning,"
says the patient apologetically, and the doctor begins the examination
over again.
IS PATIENT AND TOLERANT
-- The talented geriatrician is not only good in medicine, but
is also good in inter-personal relationships. He takes time to
draw out the elder patient. He understands it's difficult to remember
details, to undress, to overcome inhibitions. So many older people
have learned to distrust medical experts and specialists, but
the wise physician won't let these prejudices get in the way of
his objective examination and diagnosis. It takes time to become
85, and it takes time to treat a patient who is 85.
IS FAMILIAR WITH THE
WAYS OF THE OLD -- Many old people complain of sundry aches and
pains. This can make an inexperienced doctor send them for unnecessary
and expensive scopes and scans, or at the other extreme, can cause
him to brush off the complainer as "nudniks" or hypochondriacs
who are wasting his valuable time. The more experienced doctor
will hear those same complaints and ask about the old person's
sleeping habits, his bowel movements and his relations with his
kids. Nine times out of ten, the latter are the real underlying
problems.
CAN TACKLE ETHICAL DILEMMAS
-- Robert came for a medical assessment. His memory wasn't as
sharp as it had been once and he admitted in confidence to the
doctor that he sometimes didn't remember how to drive home. The
examination revealed more severe mental impairment than was apparent
on the surface, and tests revealed that Robert's judgment and
orientation were especially decreased. In addition to giving his
family a rather bleak diagnosis, probable Alzheimer's disease,
the doctor was faced with a dilemma: to report Robert's condition
to the motor vehicles department or not. Robert's wife told the
physician that revoking her husband's license would probably "kill
him," but hiding the facts could lead to him killing others.
This is one example of the kind of ethical issues with which geriatricians
have to deal. There are many more.
SEES THE WHOLE PERSON,
NOT JUST THE SYMPTOMS -- A baby comes to the pediatrician and
he's a complete package with great potential, all the genes in
place, but a blank board as far as environmental influence is
concerned. An elderly person presents a history book of experiences,
a rich past (no matter what kind of influence he has had on society)
and a reflection of his generation. When a doctor meets a man
of 80 or 90 he must relate to the period in which that person
lived and who he was. A Holocaust survivor, a former Hollywood
star or the self-made man who pulled himself up out of an impoverished
childhood, all carry remnants of their past in their personality,
in their outlook and in their physical make-up. These elements
cannot be ignored.
RESPECTS THE OPINIONS
OF RELATIVES AND CAREGIVERS -- A famous geriatrician once wrote:
"Those best qualified to teach geriatric medicine are patients,
relatives, neighbors and caregivers. Use them."
Often in an emergency room the harried staff
will say, "There's nothing wrong with that man. He should
go home." His spouse or family caregiver will insist, "No
he's not himself. I know. I've been taking care of him for many
years."
The emergency room doctor or nurse may think,
"These people want a vacation; that's why they refuse to
take their relative home." But in most cases the family caregivers
are justified in the end. Even if they're convinced or forced
to take their relative home, one, two or even three times, in
the end it will turn out that the patient had a silent heart attack,
a stroke in evolution, a change in their metabolism or whatnot...and
it was the caregivers' untrained but sensitive sense that something
was wrong that first alerted medical staff to the symptoms.
TAKES A DETAILED HISTORY
-- Sarah came into the hospital with acute confusion. She attacked
anyone who came near her, didn't sleep for two nights and days,
talked nonsense and hallucinated that all kinds of animals and
strange figures were coming to attack her. The doctors thought
she must have some severe infection, or unbalanced diabetes; the
psychiatrist thought she was psychotic; the social worker advised
placement in a closed unit. It was the intern who took the trouble
to get her past and present history and it was he who discovered
l) that Sarah had just arrived from a foreign country and didn't
understand a word of the local language; 2) she had been in a
plane for the first time in her life and for many hours during
which time she hardly ate or drank; and 3) she hadn't taken her
regular medication for the past two weeks. Once these facts were
taken into account Sarah's condition improved dramatically and
she was able to return home to her family.
USES DRUGS RELUCTANTLY --
During a recent doctor's strike in Israel it was found that the
national death rate actually decreased. Could it be that fewer
people suffered from mixing medicines or overdoses? It has been
shown that in our modern society many people suffer the consequences
of modern medicine, especially the adverse effect of powerful
drugs that are often misused or misunderstood. Old people who
have memory problems as well as sight impairment are especially
prone to mixing up instructions or prescriptions. Old people also
tend to visit different doctors and get different medicines without
telling one about the other. Therefore the discerning physician
will keep prescriptions to a minimum or prescribe natural and
non-harmful drugs whenever possible.
IS SENSITIVE TO THE
NEEDS OF THE FAMILY -- As in pediatrics, the state of the family
and their well being have a direct effect on the well being of
the elderly patient.
GIVES HIS HOME PHONE NUMBER
-- A study conducted by a home care team in Canada found that
families of the elderly who received the home phone numbers of
the physician in charge rarely used it, but had a much higher
feeling of confidence and security than did those who were not
given the number.
MAKES HOME VISITS -- Prof.
Bernard Isaacs once wrote: "To know your patient visit him
at home (in his natural environment); become his guest."
Dr. Weiss couldn't understand why Carl, an elderly gentleman with
courtly European manners, was continually being hospitalized for
pneumonia and respiratory infections. He had been a senior government
official, and had a lovely, cultured wife. The family lived in
one of the nicer neighborhoods of the city. So the doctor made
a house call and then he understood it all.
Although the childless couple had a beautiful
home their income was very limited. They were ashamed to apply
for welfare. Instead they cut back on food and couldn't pay heating
costs, or even fix a broken window in the apartment. Dr. Weiss
saw that the house was practically empty of furniture and that
it was freezing. His recommendation that oxygen be installed to
alleviate Carl's breathing problems was not followed because there
was no one to bring the oxygen cannisters to the apartment. Once
these problems were brought to the attention of a municipal social
worker, Carl's condition improved immensely.
Prof. Isaacs also wrote: "A geriatrician
is a doctor with a soft heart, a hard head, a thick skin and a
chip on the shoulder... With his soft heart he feels; with
his hard head he decides; with his thick skin he fights (for his
patients); with his chip on the shoulder he suffers." It
is encouraging that there are a good number of doctors who fulfill
these "requirements" in the field of aging today.
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