'This shouldn't happen'
I write this after reading an op-ed piece in The New York Times that made me angry. I am generally a mellow person — it takes a lot. This is a big deal.
It all started when an aging neighbor knocked on our door, handed me a photocopied newspaper article and said something like, "Read this ... now." The headline was, "The Patients Doctors Don't Know."
Dr. Rosanne L. Leipzig, a physician-professor at Mount Sinai School of Medicine, authored the article.
The second sentence said it all, "American Medical Schools require no training in geriatric medicine." I knew there weren't many training expectations — but "none?"
As related in the Times and verified with a little additional research, "All medical students are required to have experience in pediatrics and obstetrics, eventhough after they graduate they'll probably never treat a child or deliver a baby." However, there is "absolutely no requirement" for clinical training focused on the treatment of aging adults, i.e. geriatrics — even though patients 65 and older can make up as much as 50 percent of a typical practitioner's patient population.
Does this make any sense? Say it with me — "no." Or as the doctor-author put it, "This shouldn't happen." And here's the real capper, eight million Medicare dollars each year go into training medical residents. See why am I so agitated? Deep breath ... .
This means graduating docs are less likely to understand that a 70-year-old with severe depression may present very different symptoms than a 30-year-old person with a diagnosis of depression. (For the record, in an aging person there's more physical-in-nature complaints — more aches and pains, and less sadness, moodiness.)
There are loads of disease conditions that present themselves differently as we age. For example, bladder infections and the confusion that accompanies them can easily be diagnosed as dementia. A knowing doctor may understand the complex nature of urinary tract infections in aging adults — and there are those who do — but experience is likely to be their teacher.
I am just getting started here — but I have found a few things that give me hope. A group of caring health providers, clearly worried and aware of the exploding demographic of aging adults, have developed something they refer to as the "don't kill Granny" list which apparently contains reminders about such things as the importance of fall-prevention discussions with older adults. I could not find the actual list (still looking) but understand it includes reference to the often unrecognized hazards of hospitalization for someone in their eighth decade. (Example: sensory difficulties go unrecognized; the nurse asks a question and gets no answer, or the wrong answer, and assumes the patient status incorrectly — what's needed here may be as simple as the pair of hearing aids sitting in a nearby closet.
Good news, the 2008 Institute of Medicine report, "Retooling for an Aging America" (www.iom.edu/?ID=53452) discusses this issue comprehensively with recommendations. I looked at the report and was encouraged, but frankly I want more than just words. And it's not just me — it's all my friends, those graying, bespectacled grannies. We have our hearing aids turned up — we are waiting and watching.
Sharon Johnson is an associate professor in health and human sciences at Oregon State University and on the faculty of the OSU Extension. E-mail her at email@example.com or call 776-7371, Ext. 210.