Tuesday, September 15, 2009

Young Doctors - Mature Patients - Health issues

Young Doctors and Older Patients

By Glenda Beall in 2007

We live in an area with a large number of retirees, but it seems most of the doctors I see are all still wet behind the ears. I’ve lived with this body of mine for over a half century, but the young girl with the stethoscope sized me up immediately, and put on her smuggest smile as I recited to her all the ailments I sought medical help for in the past 10 years. No point in going back any further. I’ve tried that and I’ve seen the eyes glaze like a talk show host who has Bill Cosby for a guest. I could see the wheels turning inside that pretty little head, and I knew she was thinking about how fast she could get rid of me. The doctor wanted to hear about one symptom she could prescribe for right now, get me on my way, so she could get on to the next fifteen minute appointment.

I usually prefer women doctors as I think they might understand a woman’s particular problems better than a man, but a young man or a young woman has no idea what it feels like to be old enough to be a member of AARP. I’ve had medical assistants and nurses talk to me like I was five years old.

“Come on, Sweetie, come right in here.” She held my chart in her hand, but couldn’t call me by name. I’ve been seated between two technicians who acted like I didn’t exist as they talked over my head about shopping or people they both knew. That kind of behavior dehumanizes a person.

Now -- if I were frail and deaf and blind, maybe she would need to talk to me in a way that was different from the way she talked to the 40 year old who came in ahead of me. But I am an active, busy person with a schedule that keeps me going from morning until night. I have no hearing problem. I walk in under my own steam and I can see just fine.

In all the books, magazines, and online websites having to do with being a smart patient, it says take an active part in your health management. Talk freely to your doctor about what you want and need. When I do this, I get an “attitude” from some of the young doctors. It is almost like they are afraid I might know something about my own health that they don’t know, and they feel I’m challenging them. That is the last thing I want to do. Those of my generation have been taught to listen and do everything a doctor tells them to do. Sometimes that can be a big mistake.

An older friend of mine fell last week for no apparent reason. She didn’t trip. She didn’t break any bones. Just got up to go to the bathroom and fell in the doorway. After I talked with her, I found she was taking so many prescription drugs I’m surprised she could get out of bed. Besides two Atavan every day, she took Ambian and 50 mg of Elavil every night. And she couldn’t figure out why she felt so “tired” all day and had no energy.

It breaks my heart to see people, like my eighty-four year old friend, go to the doctor with no advocate by her side. Once she went in to have the batteries replaced in her pacemaker, but she was sent to the hospital for a replacement and an overnight stay. She had no time to prepare mentally or physically and the whole experience was traumatic for her.

“I have to do what my doctor tells me to do,” she said.

My husband Barry fired his doctor and I was proud of him. After a number of years with a man who truly seemed to understand older patients, he had to go to a new doctor in the same practice. Barry is a gentle and charming man, but this young fellow who was cold and unfriendly, told my husband, “At your age, you can’t expect to feel good.” Now Barry has a new doctor who is nearly as old as he is and they get along fine.

I refuse to become a victim of the medical world, but what can you do? If I had a heart attack, I’d need a doctor. If I develop serious symptoms, I need a doctor to diagnose my problem. But I’ve had three members of my family die, not from a disease, but from medical mistakes. One died from being prescribed the wrong drug. My father died from being over-sedated while sick with pneumonia, and one died, not from cancer, but from MSRA, the infection he caught while in the hospital.

My young, arrogant endocrinologist fires off questions so fast I can’t understand them. She doesn’t want to take time to listen, but just wants to pinpoint one symptom and go after it with ten thousand dollars worth of tests. Someday these sassy self-confident doctors will reach my age, if they are lucky. They will look back and realize they could have been a little more considerate and patient with the Medicare group who often don’t have just one problem, but have a number of things going on as time wears on us and eats away at our main frame.

I don’t know what is taught in medical schools these days, but I’m beginning to believe the TV shows are imitating life. The competition and ego evident in medicine is no different than in any business. I believe we have made great strides in caring for seriously ill patients with cancer, heart disease and specialty surgeries, and in other fields, but where are the doctors who want to treat the not so rare common aches or pains or help prevent them in the first place. Where are the doctors who understand why most of us have sleep problems and need a little help getting our rest so we can feel like volunteering at the Food Pantry the next day? What doctor listens when told I have piercing pain in my head for a few days once or twice a year and it has been going on for twenty years. I’ve been told it is some kind of neuralgia, but no one has identified it.

Do I have it now? No. But can I have something for the pain so I can endure it next time? No, just come to see me when it happens next time.

I don’t bother to tell her that it often happens in the night or on weekends or many times when she is not available. What good would it do? I’ll just go to the ER if I can’t stand the pain like I’ve had to do many times before.

I made the mistake of going to a doctor for congestion and a cough which had affected my voice so badly I could no longer sing in the church choir. Now, after three years, about twenty thousand dollars worth of tests, many chemicals ingested from the prescription medicine I’ve taken like a guinea pig, and after seeing three different specialists, I’m told I probably will just have to live with it. I didn’t need to be told, I had already figured that out.

But what can you do when the ENT doctor says the inhalers prescribed by the pulmonologist are causing the throat problem, but the endocrinologist says it is the thyroid gland causing the hoarseness? I want to do what one lovely gray-haired lady told me as we both sat in the waiting room of yet another young lady doctor.

“I just don’t go to doctors,” she said. “I’m only here to bring my sister who had a stroke.”

She smiled and appeared very pleased with herself. I was envious. Later, after seeing the doctor, when I made my appointment for an MRA and an MRI, I wondered what would happen if I fired all my doctors. After all the tests, I know I’m pretty healthy except for a few things I’ve managed for many years already. I know someone who goes to the public health department every so often and gets blood work done, but never sees a doctor.

My favorite medical person is a nurse practitioner who listens and really cares about her patients. I never feel like she is trying to get rid of me so she can get to the next appointment. She allows me to take a part in my own care. She understands when I tell her I know what I need to do about my diabetes, but I need her to order the blood tests. She understands when I get emotional about a loss, and she is sympathetic, not uncomfortable. She understands when I am frustrated with all the tests a specialist ordered which found absolutely nothing, and she assures me that I own my body and can make decisions whether to continue a treatment or not.

If she held seminars and taught some of these young doctors and nurses about bedside manner and how to interact with older people, our medical profession would be enhanced in this area. But who can tell a doctor anything? These fresh-faced kids come out of school already knowing everything ─ everything except how to recognize and respect the needs of older people.


Anonymous said...

Hi Glenda –

I could have written the comments about doctors on your blog – as, I’m sure, could many others. My feelings exactly.

I really dislike being called “sweetie” or “honey” or “dear” by younger people. The first time I was called “ma’am” instead of “miss” was a shock, I’ll admit – but what’s wrong with a simple ma’am or sir for older people? I want to tell them I don’t appreciate them acting as if I’m either a member of their family or not very smart, or borderline senile, and have to be cajoled. It IS dehumanizing and I, too, have often wanted to tell some of them that they will someday be my age – if they’re lucky and will also, surely, resent being categorized and dehumanized.

Joan Ellen Gage said...

I agree with your assessment. I think you just have to keep looking until you find the right doctor, hopefully!

I do think that doctors are overbooked these days, cramming as many patients in as they can to satisfy the plans they sign up with.

JLC said...

Join my voice to yours, and for the same reasons. Besides being just bad manners to treat those of us who are clearly in a generation so far removed from theirs, these young people who may have degrees and prestige seem to have all too little humanity, and virtually no interest in empathy.

The only trouble with firing a doctor and finding someone else is that it's not easy to do. There seem not to be enough to go around as it is. The mere fact that a doctor is young isn't necessarily a disqualifying characteristic, but lack of some sort of humility is!

Recent experiences have proved to me that I am going to have to unlearn much of my early training in respect for authority (and manners). The trouble is, it's already too late for the person I was trying to advocate for.

Bravo, Glenda. Maybe we need to organize in some way?


Glenda C. Beall said...

As for me, at this time, I just can't go to any doctor. I'm angry at the situation which hastened the death of my husband, but I also have to say that at Emory and at Crawford Long Hospital, I've never seen more caring nurses. Too bad the doctors didn't have the same knack for compassion.
And, JLC, you are right. We have a shortage here in the mountains of qualified physicians, but to live here in this lovely setting, we have to take what we can get.
I think the problem with the doctors and staff I speak of in this post is they haven't been told or taught how to behave with older patients, especially those of us who have some gumption about us. We must speak up for ourselves and we must be sure we are heard.

Tipper said...

Very well said!! I'd be tempted to send it to the sassy doc if I was you.