By Dr Stuart Jeanne Bramhall
Ageism or age discrimination seriously detracts from effective medical treatment. In contrast to developing countries, where older people are respected and revered, age discrimination is pervasive in all industrialized countries. Medical ageism, which refers to age discrimination in the health care system, is reported in the medical literature of most of the developed world. As a young doctor, I was horrified by the frank malpractice my parents and maternal grandparents experienced in their later years. In all four cases, failure to make a correct diagnosis (heart disease, Parkinsonism, lung cancer, and delirium tremens) resulted in tremendous suffering and premature death. Now that I have become a senior citizen myself, I and many of my friends experience the same dismissive treatment in the doctor’s office as my family did. Physician assistant Richard Currey tackles the issue head-on in Ageism in Health Care: Time for a Change.
The One Complaint Rule
The chief frustration of most older people is GPs who only allow them to discuss one complaint per visit. After working in private practice for 25 years in the US, I fully understand how low insurance reimbursement forces doctors to squeeze six or more patients into an hour. However, limiting any patient to a single complaint strikes me as a set-up for a missed or erroneous diagnosis. One of the first things they teach you in medical school is that 99% of a patient’s diagnosis is based on their medical history and the particular cluster of symptoms they present. In my experience, a five or ten minute visit only leaves only enough time for a doctor to ask how you are feeling, check your blood pressure, and write out a lab order for cholesterol. If you complain about fatigue or pain, you will also get a lecture about these problems being a normal part of aging and needing to adjust.
Doctors’ Misconceptions About Aging
Hello? Even 40 years ago, we studied the normal aging process in medical school. Our instructors strongly emphasized that neither fatigue, nor memory problems, nor pain, nor high blood pressure were a normal part of aging. All are due to distinct medical conditions that can be diagnosed and treated. It’s true that aging makes senior citizens more vulnerable to a wide range of medical conditions. However an individual of any age with a sudden onset of fatigue or pain, be they 80, 90, or 100, has an underlying medical condition.
As gerontologist Mark Lach writes in the November 2010 AARP Bulletin, “Patients should feel that their doctor is leaving no stone unturned, that complaints are being fairly adjudicated, and that someone is really thinking about their issues. No ailment should ever be written off as an “old age” ailment. Treating patients based on their age means you can miss very significant, treatable situations.” It’s a great pity Dr Lach wasn’t around when my parents and grandparents were being misdiagnosed.
Sadly, many doctors and nurses share the common misconception that memory, energy levels, and hearing naturally deteriorate with age. Aside from hearing aids, which aren’t covered by Medicare, they assume nothing can be done for elderly patients with these problems. In fact, most health care professionals tend to believe that older people are normally frail and dependent – that those who aren’t are atypical. This stereotyped thinking is part and parcel of medical ageism.
Early Effective Treatment Saves Money
Besides vastly improving seniors’ functioning and quality of life, accurate diagnosis and treatment of our medical problems also saves money. Even in the US, most elderly care is funded by the federal government, through Medicare and Medicaid. With the strain aging us baby boomers are expected to put on the medical system, early effective treatment will save taxpayers bundles that might otherwise be spent on lengthy hospitalizations and 24/7 nursing home care.
Richard Curry’s excellent 2008 article in Aging Well likens ageism to other forms of discrimination. All negative stereotypes are based on preconceptions fueled by fear. Whether we realize it or not, all of us have unconscious fears about the physical decline, loneliness, and ultimate death we all face in getting older. Such fears are constantly reinforced by a youth-obsessed media that disparages wrinkles, grey hair, and other hallmarks of a natural process known as aging.
More startling, however, is research showing that the negative self-image caused by age discrimination is closely linked to poor health outcomes. Curry cites several studies by Dr Becca Levy of the Yale University School of Public Health linking negative age-related self-perceptions with increased risk of elevated blood pressure and cardiovascular disease, hearing loss, poor memory performance, and reduced life expectancy. Levy has conducted other studies revealing that positive self-perceptions in the elderly improve memory, thinking, cognition, mood stability, overall physical function, and life span (adding 7.5 years).
Curry acknowledges that addressing pervasive in the medical system won’t be easy. It will require sweeping reforms in health policy and medical education. At bare minimum, every type of health provider who cares for elders, including physicians, nurses, physician assistants, nurse practitioners, psychologists, and social workers, as well as paramedics, firefighters, and other first responders, needs to receive more thorough education in basic geriatric issues. Something that will only happen if with federal and/or state legislation requiring it.
The Need to Organize
The only thing Curry leaves out of his article is how to make this happen. In 2008, he is naively optimistic about Congress and state legislatures passing legislation requiring mandatory geriatric issues classes for doctors, nurses, and other service providers. Obviously none of this has happened. If anything, age discrimination, not only in the doctor’s office but in employment and social service agencies is getting even worse with cost cutting and tight budgets. Further cuts to Medicare and Medicaid, especially, will leave little room for the extensive medical re-education that is required.
Clearly Curry hasn’t read Frederick Douglas or he would know that people in power are unlikely to grant any major reforms voluntarily. We elderly will only win our rights if we self-organize and demand them, just as minorities, women, and the disabled have been doing for the last fifty years. For a start, this means getting out in the street and protesting the threatened Social Security, Medicare, and Medicaid cuts for a start. We need to follow the example of the elderly Vietnam veterans who protested the closure of the National World War II Memorial during the government shutdown, elderly Greeks protesting pension cuts, and Irish seniors protesting cuts in their pensions (below).
Angry baby boomers can be a formidable force for change. As you can see from the video:
photo credit: ouno design via photopin cc
Dr. Bramhall is a retired American child and adolescent psychiatrist, activist and political refugee in New Zealand.
Her first book The Most Revolutionary Act: Memoir of an American Refugee describes the circumstances that led her to leave the US in 2002. She has also published two young adult novels about political activism: The Battle for Tomorrow: A Fable
She is involved in the national leadership of the New Zealand Green Party and has a political blog at StuartJeanneBramhall.com