Treat Me, Not My Age
A conversation with Mark Lachs, MD, director of geriatrics, New York–Presbyterian Healthcare System
Q. In your new book, Treat Me, Not My Age: A Doctor’s Guide to Getting the Best Care as You or a Loved One Gets Older [Viking 2010], you write that just as there is “ageism” in society, there is “ageist” medicine. How can a woman tell if she has an aging-friendly doctor?
A. Age is not a disease, and to be quick to ascribe all your complaints to aging as an explanation for symptoms is not a default position for a physician.
Q. How do you find an aging-friendly primary-care physician in a city where it’s very difficult to find new primary MDs?
A. The lack of primary-care MDs is a crisis in the city. One approach is to find a geriatric (or a “gero-friendly”) primary-care physician, or a women’s-health practice, through a major teaching hospital. [Geriatricians, like pediatricians, are trained to look at the whole patient. Unlike so many youth-oriented Americans, including “ageist” physicians, they like older people, see age not as an illness or a disease, and do their best to support active, healthy aging.]
In many geriatric or women’s health settings, specialized programs have been created to address the specific needs of those populations. And because of the teaching nature of these practices, the doctors may have more time to spend with patients. One way to find a new MD is to go to a hospital’s website and search the list of clinical departments or offerings to see if such a program exists.
A second alternative is to find a nurse practitioner in private practice, typically in association with another physician. Many individuals view nurse practitioners as unacceptable substitutes, but nurse practitioners can be highly enlightened—and as informed as some MDs. And they too may have much more time to spend with patients than their collaborating physicians.
Q. What about choosing concierge medicine? Are you in favor it?
A. Good primary health care should be a basic right. But the economics of primary care are so bad that concierge practices, for those patients with resources, may be a very reasonable alternative. Many MDs want to spend more time with patients, and charging more enables them to reduce their patient load and give patients the time they need and deserve. But you have to do due diligence with any new doctor you choose and make certain the doctor you select is worth the money you will spend.
Q. I am terrified of landing in an ER in the middle of the night at a hospital where my doctor has no affiliation—or is out of town and unavailable, even if he is affiliated with that hospital. Can you share some of your tips and advice?
A. Everyone should have a repository of basic medical information—a list of medications, the numbers of your physicians and contacts—as well as information about your chronic conditions. Keep these at home, online, and take them with you when you are traveling. If possible, you should try to get to an emergency room where your primary care physician is affiliated, because in many cases your physician’s medical records about you will be available to ER physicians as part of an integrated electronic medical record. If it’s not possible to call your MD, take your cellphone with you so you can call later.
Another tip: If you are ill, try to contact your primary-care physician soon after you experience symptoms. Don’t tough it out and call late in the day when the office is about to close. If your doctor recommends that you go to an ER, he or she can call the emergency department to kind of “reserve a table” and let the ER know you are coming. This will not put you ahead of gunshot wounds or someone’s heart attack, but it sends a very compelling message to the ER physician. It also creates a plan of continuity when you are discharged. Of course, if you become ill or have an accident in the middle of the night, you may have to go to the nearest ER, where your doctor is not affiliated.
Also, try to have someone accompany you or meet you there. It’s good to have someone who can advocate for you. Remember that in the ER the squeaky wheel gets the grease. Of course there are squeaky wheels and there are Mack Trucks. You don’t want to become an irritant, but you do want to fundamentally understand what’s going to happen next.
Q. You say that hospitals are no place for sick people—especially for older sick people.
A. I want to emphasize that, number one, it’s not because hospitals are mean. It’s because the system, architecture, and culture of hospital care was created 50 to 100 years ago, when most patients went to hospitals to give birth or have their tonsils removed. Nowadays, it’s mostly older people with chronic illnesses who are in hospitals. And many of the things we physicians were taught to do for younger folk—such as ordering bed rest when a patient comes to the hospital—are not always the right things to do for older folks. We now know that mobilizing older patients as quickly as possible is very important so as not to cause muscles to atrophy, bedsores to develop, or fluids to redistribute. Sleep-wake disruption is another example. We’re now learning that it is one of the most important provocateurs of confusion and delirium in the hospital.
Q. Is that just for people in their seventies and eighties?
A. Age is a risk factor for delirium, but I can make any person delirious at any age. These risks grow as we get older. Some hospitals are beginning to implement interventions that try to reduce the prospect of delirium and what I call “hospitalitis”—becoming ill from just being in the hospital. My book gives very specific tips on mobility, orientation, keeping patients intellectually stimulated, having a schedule of visitors, bringing pictures, eyeglasses, hearing aids, and mentally stimulating games from home, and paying attention to hydration and nutrition. There is really an enormous amount that patients and families can do. Confusion is just the tip of the iceberg. It snowballs. One thing leads to another.
Q. Finally, in your book you talk about “Creating a Personal Business Plan for Aging.” What do you recommend for women in their fifties, sixties, or seventies?
A. There is no one plan. Your job is to sit down and make your list in a way that’s aging friendly, understanding what resources you have and who your allies are in this process. Obviously, no one can precisely predict the future, but there are some common-sense approaches to the process that everyone can embrace. My general advice is, Don’t buy into media or pop-culture stereotypes of what older people should look like or be doing; be specific about the things you’ve always wanted to do; think about role models—who do you want to be like at each decade to come; and work out your financial issues and family issues now, not later.
Eleanor Foa Dienstag has written extensively on health and aging for the John A. Hartford Foundation. Her articles on health and medical issues have also appeared in Medical Life, Upstate, Catalyst, and Discoveries magazines.