I find that when I talk with patients who are in the “older” age bracket (and I am in my fifties, so I am in that bracket myself), on almost any topic, much of the discussion turns to their perceptions of how difficult it is to get the kinds of treatments and medications they think they are entitled to. They often ask me how they can get the healthcare they feel they need. I listen to them and realize I have many of the same questions they are asking. I notice that as I age I am just as worried about those entitlements that have been promised to me, too.
However, my hybrid professional role has also provided me with a unique perspective on how both patients and providers are attempting to make the best out of a system that feels like a stew of mixed messages, mismanagement, and missed opportunities. Not black and white at all, but a massive gray area that doesn’t seem to be getting any clearer, even as our population is getting grayer as well.
This places me in an odd situation. On the one hand, I am the researcher/counselor trying to give advice and to be the voice of reason. On the other hand, I am aging and I feel this need to make sure that I am given what patients say we deserve — our fair share of the medical pie.
When they talk about how they have worked hard all their lives and paid into the system and are therefore supposed to receive everything that the medical establishment has to offer, a voice inside me goes “Yeah, me too. I have been working hard for a very long time.”
But then that other side of me speaks up. The side that hears what the doctors are saying about their patients and the kinds of demands these patients make. While this is a strange predicament for me, I tell myself, “Well, these doctors are going to be aging patients themselves at some point.”
Will they remember what they have been hearing in their consulting rooms? Will they realize that there are many other ways in which our needs go beyond what the healthcare system can provide? And I am not only discussing feeling physically well, but healthy in a much larger context — in terms of the emotional, psychological, and spiritual sides of our beings.
How do we get the medical care we deserve? Is that the real question? Or do we need to ask a better question?
Doctor, Make Me Feel Better.
I travel around the country talking with patients and healthcare providers about medications and treatments, about the communication between physicians and patients, and about the financing of healthcare. These discussions have given me invaluable insight into our current healthcare system, as well as some glimpses into what the future of the healthcare system will be. I am truly worried about what that future may be.
But I am even more concerned about what I am seeing right now. Older people are visiting their doctors for reasons that go beyond the services that physicians are trained to provide. They are using their doctor visits as a social event when they have nothing better to do with themselves. They are visiting their doctors to be listened to because they are bored, frightened, and lonely. They are using their doctor visits to fill the gaps in their lives that they have not been able to fill in any other way.
Before you navigate to another Website, allow me to provide you with some examples.
A relatively recent article in The New York Times (“Patients in Florida Lining Up for All That Medicare Covers,” September 13, 2003) discussed how the doctor’s visit in large retirement communities like Boca Raton is the weekly social event, with lunch and shopping planned around the highlight of the day, which is a visit with the friendly internist or other specialist.
When visiting communities with a large retirement population, I have found myself wondering how many office visits are for medical care and how many are about filling up the time and being reassured that all the aches and pains that have been medical-ized aren’t medical.
I listen to these patients talk about their medications as if they were new toys. They describe them with energy and enthusiasm lacking in the rest of their conversation, which makes me wonder why they have nothing else to look forward to in life.
For example, I was talking to a woman in her late sixties who spoke vaguely about the activities she was involved in, which did not extend much beyond occasional lunches with friends, and her own shopping and other errands. Yet when I asked her about her health, she recited each one of her medications and why she was taking it, as well as other medications she had tried along the way. She proudly displayed a plastic pillbox, sectioned something like a small egg carton that she filled every morning before leaving the house. There were white pills in various shapes and sizes, with a few pinks and blues.
This desire for the latest and greatest pill also leads patients to misinterpret pharmaceutical advertising so they can justify and demand the drug they just saw advertised. To me, this is yet another sign of our fast food society, in which we seek the next quick and easy solution rather than looking inward and doing the hard work required to develop our own resources. Why bother if a pill promises the same result?
Physicians have told me that they see older patients (as well as some younger ones) who really won’t have anything wrong with them physically, but who are clearly lonely or depressed, though they won’t talk about that part of their lives, even if doctors had the time and desire to address the emotional aspects of their patient’s lives. (I can’t help but notice all of the gifts on their desks and on their shelves from companies whose anti-depressants they prescribe, the full extent of the treatment most physicians offer for emotional problems).
Who’s Really in Pain?
I have heard both physicians and patients complain about the expectation that patients should have a hotline to their medical providers, with the doctor and nursing staff ready and waiting to pick up the phone and answer all the questions that patients have that day. Of course, each complains for two different reasons.
Again, I ask myself where am I in all of this? I want to be an advocate for patients who are fighting for their lives. I want to be an objective observer of the healthcare system, to assess how it is meeting the demands of patients in a managed care environment. And I want to have a competent physician handy at all times as I get older. Who blinks first?