Why a geriatrician can be the best choice to direct elder care
by Carol Bradley Bursack, Editor-in-Chief
Many people see the same physician for years, if not decades, and that can be good. If they need a specialist, they are referred. So, why isn't the family doctor always the best doctor for your aging parents? The answer doesn't apply to every situation, but most doctors are trained to cure ailments. Many elders get to a stage where treatment is worse than the disease and often doesn't cure the problem. Elders often need trained physicians to help them live better, if not longer. Geriatricians specialize in finding the line between cure and comfort.
As our medical system now stands, our elders are at a decided disadvantage. Often there are signs of dementia present that family doctors may miss because most doctors are trained to cure younger people and they may view many changes that occur over time as just old age. At the other extreme is the doctor who wants to cure elders of diseases when the attempt to cure may either kill the elder or push him or her over the edge into dementia.
By definition, surgeons operate. If the family doctor refers your 80-year-old mother to a surgeon because of a lump on her breast, the surgeon may not consider the age of the patient and the rate of possible cancer growth. The surgeon's training kicks and an operation is likely to be scheduled.
Elder Care: Turn to a Geriatrician
This approach may or may not be the right route. A geriatrician is trained to extend the quality of life of elders. They study how different drugs and procedures generally affect the aged, and make decisions based on the whole person. Is this elderly woman generally healthy and likely to survive an operation for aggressive cancer? The geriatrician will consider all sides of the issue and may decide an operation is the right approach. Is this elderly man diabetic and a veteran of several heart attacks? Then, maybe letting his slow growing prostate alone is the answer.
Dr. Dennis McCullough, M.D. wrote the book My Mother, Your Mother: Embracing "Slow Medicine," The Compassionate Approach to Caring for Your Aging Loved Ones. Dr. McCullough, a respected geriatrician with 30 years of practice behind him, answers questions here on ElderCarelink.com. He was a caregiver for his mother, so he can identify with caregivers as well as medical professionals.
During his medical practice, Dr. McCullough developed his own philosophy for elder care which is what he calls "slow medicine." While Dr. McCullough put a name it, this is the approach taken by most geriatricians. They aren't out to cure old age. Their aim is to improve the quality of life for their patients. This means considering whether a procedure could help or hurt. A geriatrician can help you and your elder decide the right course of treatment.
Elder Care: The Distressing Shortage of Geriatricians
Our medical system has long been based on cures. That, of course, is a prudent approach for many people. However, as I mentioned earlier, for many elders that mindset followed through can actually shorten or destroy the quality of life for many elders. So why don't all elders see geriatricians? Sometimes it's because they are attached to the doctor they've been seeing for years, and this is not always bad. This doctor may be right on and they can continue the partnership. Sometimes it's because they don't know that there are better options.
Unfortunately, there is a shortage of geriatricians so even those folks who are well informed can't always find one. The combination of an increase in numbers of elderly people because of good medical practice during the past decades, plus the fact that geriatrics is not a well paying specialty compared to say, surgeons, who make a lot of money for each procedure done, makes it hard to attract young doctors to study gerontology.
While some members of Congress have worked on bills that would offer programs which pay back doctor's education costs if they go into geriatrics, not much action has occurred at this time. It could take decades to attract enough geriatricians to treat the aging population, particularly in more rural areas of the country.
Elder Care: What if You Can't Find a Geriatrician?
You, the caregiver, are your elders' advocate. Monitor their doctor visits as best you can. Watch the interaction of the doctor and your parents. Does this doctor brush off the memory issues as old age, even though you are worried because you see more than that? Then, it's time to get a second opinion. If you can't find a geriatrician, find a family doctor or an internist for that second opinion.
If you are especially worried about dementia, you may want to try a neurologist or even a psychiatrist. The idea is that if you can't find a specialist in geriatrics to be the primary physician, you need to brush up on health issues and the needs of elders. Then, you need to evaluate the doctors your parents see. You could learn by talking with other adult children of elders. Who do their parents see? Ask around.
There are many family doctors who do know the right approach to elder care. So don't give up. Just be watchful for two main things:
- Does the doctor brush off your parents' (or your) concerns as just old age?
- Is this doctor in too big a rush to send your folks into a situation that could damage them? If surgery is an issue, consider a second opinion and make sure you are told the risks as well as the benefits. Make yourself an educated advocate and you should do well by your folks.
If you are lucky and a geriatrician is available, I'd give this person a try. See if this is a good fit for your parents' needs.
In the end, slow medicine can be the best medicine for the 80 plus group.