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Mark Lachs, M.D.

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Is Your Health Care Ageist? (Even If You're Not That Old?)

Posted: 09/21/10 07:16 PM ET

You've probably heard about age discrimination in the workplace. And maybe you've even seen it in the doctor's office with a parent or spouse--that moment when the doc dismisses your 70- or 80-year-old loved one's complaint of an ache or pain as "just part of getting old," and then sends her out the door without a thoughtful or thorough evaluation so he can move on to the next "customer."

But have you ever stopped to think that the medical care you get as someone boomer-aged or younger--care that you may have dismissed simply as generically underwhelming--might also have its roots in ageism? I'm an internist who cares for younger adults as well as a gerontologist who cares for older ones, and I'm telling you it's out there. After all, you don't get old overnight. So why would you think that the age discrimination we know goes on in health care starts suddenly when patients turn 65 or 75?

In truth, its younger victims are surprisingly varied. They include the 50-something weekend-warrior athlete who gets injured but is told only to slow down, rest for a few months or switch to golf, instead of being offered (or even informed about) an aggressive procedure or physical therapy that could have them back on the field. If the doc doesn't think you'd need it, want it or tolerate it, you won't even get the option--even though weekend sports may be the most important thing in your life.

Then there's the 40-something woman with a large family who is guided towards a hysterectomy to treat uterine polyps because the doc just assumes "you're done and don't need a uterus anymore." Or how about the single 60-year-old in for an annual physical (the adolescent unit in my business) who gets every last screening test known to man--cholesterol, mammograms, colonoscopy--but doesn't get a single question about safe sexual practices, because we all know that no one over the age of 60 has sex?

Do you see I mean? You may have suffered this type of care and dismissed it as generically "bad," when in fact, it has its roots in subtle age discrimination.

So why does this happen? I don't think it's because the medical profession is discriminatory on purpose, but rather because we medical men and women are members, and mirrors, of a society that worships and is drawn toward youth. All things being equal, who do you think gets a more attentive evaluation of possible appendicitis in an emergency room, a 22-year-old fashion model or a 52-year-old homemaker?

There are other factors at work, too. As medicine gets more pressured and hurried, many doctors tend to take more of a "cookbook" or "age-focused" approach rather than look at the individual -- the living, breathing patient sitting across from us on the exam table with all his or her uniqueness. But there's a problem with that: we may have all been created equal, but we just don't age that way -- not mentally, and not physically. That's why appropriate care requires a patient-centered approach, not an age-centered one!

Whatever the reason for age discrimination in health care, it's important to recognize when it's happening to you. When you see medical ageism in action, you can gently steer the conversation (and your care, or the care of a parent or loved one) to the patient-centered approach, because age is only one of a host of factors; it shouldn't dictate your care. We geriatricians have a saying: "If you've seen one 80-year-old, then you've seen one 80-year-old." That's also true of us at 50, 60 and 70. I have 60-year-old patients who are home-bound and others who can whip me in a set of tennis. Why would I assume they would all want or need the same type of care?

In my next installment, I'll tell you how to recognize when you're experiencing ageism in the medical encounter -- at any age -- and what to do about it. And if you're interested in more detail about how to get the best health care for you or a loved one, visit my site www.treatmennotmyage.com.

 
 
 

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