Ageism in the health care industry

 We live in a time of medical specialization. We learn about the family doctor by watching ancient “Little House on the Prairie” re-runs. Where once one doctor oversaw all medical care and actually knew their patients, now it seems there is a specialist for each body part. Add to that the reality that as we age our body parts start malfunctioning; thus we end up seeing a lot of doctors.

Right now I’m in touch with my primary care physician (PCP), an audiologist, a neurologist who specializes in migraines, and a dermatologist. I accompany Hal on his visits to his urologist, gastrologist, an orthopedic specialist in hands and another one who focuses on backs. I may have missed one. All of these doctors are young (from my mature perspective), in their 40s or early 50s. Curiously, my doctors are all female, which I have nothing against. But Hal’s specialists are all male. We have the same PCP, a young woman in her 40s.

Another fact: more often than not these days, when we go to see one of these doctors, we’re likely to instead get the physician’s assistant (PA), usually someone in their mid-30s.

But we need their help, so we humble ourselves before the wisdom and skill of youth. And hope for the best.

I’ve been reading a fascinating book by award-winning scholar and geriatrician Louise Aronson. The book is entitled Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life (2019). Aronson, herself a woman in the prime of life, traveled a twisting path before choosing geriatrics as her specialization. She tells this story in her book.

Among other topics, Aronson gives a penetrating view of ageism (age discrimination, especially against the elderly) in the medical system, beginning with the training of physicians. She writes that

Over their four years in medical school and three to ten years of residency and fellowship training, doctors in training are taught that human beings come in two age categories that matter: children and adults. After required classes and rotations elucidating differences in physiology, social behaviors, and health needs between those two age groups, they choose whether to work in children’s hospitals or adult hospitals, and as pediatric specialists or adult specialists. If they happen to notice that older adults make up to 16 percent of the population but over 40 percent of hospitalized adults, or that patients over sixty-five are the group most likely to be harmed by medical care, that knowledge will be tempered not only by medicine’s predilections for saves and cures but also by comments from their teachers and mentors such as “Unless you really like changing adult diapers, don’t waste your time” learning geriatrics.” (5-6)

Aronson goes on to show how this kind of discrimination in training carries over into medical practice, with many doctors treating and medicating older persons just as they would younger adults, without considering that the aging body has different needs and reactions. She claims that “The second-class citizenship of older patients is entrenched and systemic” in the health care industry.

At this point I need to stop and say that all of my doctors have treated me with kindness and respect. (I can’t say the same for some of the PAs). I’ve detected no obvious ageism.

Yet there is something subtle going on, an uncomfortable itch that only gets worse as I scratch it.

About eight years ago, just as I was entering retirement age, I began experiencing symptoms of head-pressure and dizziness. (I’ve told this story in other blogposts.) I began reporting it to my doctor. Aronson notes that “When a patient uses the word ‘dizzy’ most clinicians will tell you that something inside them clutches, if only for a second.” Even more so if the patient is older. After several years of my mentioning this (probably not forcefully enough), my doctor began ordering tests and referring me to specialists. Lots of them. After two years of exploring the options, every doctor involved told me they found nothing wrong. One even said, “Don’t worry. Most old people have some degree of dizziness. It’s aging.” My PCP said, “I’m sorry. I can’t do anything for you.” And smiled sympathetically.

It felt like no one believed me. So I changed insurance plans and found a neurologist at a research hospital who finally gave me a diagnosis. Like I said, I’ve already told this story.

I really don’t know how many of the obstacles in my journey were due to my age. Probably not all of them. Even so, having read Aronson and made my own observations, I recognize that age discrimination is widespread.

Here are some preliminary conclusions I’ve reached:

1.     I am thankful for people like Louise Aronson on the forefront of a change of attitude in the health care industry, a positive change I believe is coming.

2.     I will prepare myself better for each medical visit, reminding myself that I am a person of value, that my health matters as much as anyone’s. I will gently insist on being heard.

3.     I will prepare to treat my doctors with respect, no matter how young they are, a respect I trust will be returned, no matter how old I am.

The quote at the beginning of Aronson’s book is by Cicero. Apparently ageism has been around for a long time. He said that “Old age will only be respected if it fights for itself, maintains its rights … and asserts control over its own to its last breath.”