Doctors and the old – why we look away

Taureef Mohammed

WHAT does it mean to get old?

As a doctor who sees old people in the hospital and outpatient clinics, I have a skewed view: getting old means more medical problems – more doctor visits, more medications, more aches and pains, decreasing kidney function, stiffened blood vessels, increased risk of dementia, cancer, and the list goes on. Getting old, from a doctor’s perspective, is more a curse than a blessing.

And doctors have no way to reverse the curse. Which is why doctors ignore the old person. Instead of treating the person, doctors treat the disease. By treating the disease – signing the prescriptions, ordering the battery of tests, and then pouncing on the results – we feel useful. And feeling useful is a basic need.

When we try to address the old person, the old person with the disease, we feel insufficient. That we are doctors makes the insufficiency feel worse: we did not study for five years, then specialised for another five years to feel insufficient at the end of it. Alas, it is better – and easier – not to look at the old man.

And then there is the not-so-small issue of money. In Canada and the private sector in TT, where doctors bill for every patient they see, treating the disease – alone – is more lucrative. Treating the disease is faster than treating the person; the more patients one sees, the more money one makes.

Older people talk slower, move slower, do everything slower – they are going to take more time. More time means less money. It is more economical, therefore, to ignore the old man and treat his diabetic foot, and only his diabetic foot.

The consequence of this constant looking away is a lack of understanding of old people, the most frequent users of healthcare. We, doctors, have little to no idea about what getting old is, other than it being the wearing down of the component parts of a machine. We did not study old age in medical school, as much as we studied, say, kidney disease. We do not, and perhaps cannot, empathise with old people.

When confronted by the old man – an 89-year-old with dementia – we are therefore weary and cautious, wishing that he was 40 years old. Asking a simple question like “How can I help you today?” is to open a can of worms. In the end, we look away – perhaps to the lab results on our computer screens – and end up missing the diagnosis: the heart attack, the metastatic cancer, the sepsis, all of which can present atypically in an older person. It is an embarrassing reality.

Was it inevitable, though, that this would become the reality? Is it really fair to expect a young doctor to understand all the complexities of getting old? Is it not understandable that they look away? Most people do.

In 1905, Dr William Osler – the father of modern medicine, known for revolutionising the way medical students were taught, his method of teaching on the wards still the standard today – 55 years old at the time, made some controversial remarks about ageing.

The speech was a farewell address at Johns Hopkins – he was one of its founding doctors – and in it he contemplated issues of ageing, retirement, and letting go, as he looked forward to semi-retirement life in the UK as Regius Professor at Oxford. To a packed hall, he spoke about “the comparative uselessness of men above 40 years of age,” and suggested professors should retire at 60 years old, making reference to a fictional story in which men were euthanised at 67.

The American press and public were not pleased, and he was not given a warm farewell. Years later, he seemed to regret the euthanasia reference, warning some boys at Oxford that Anthony Trollope, author of The Fixed Period, the story he had referenced in his speech, was “dangerous.”

That the father of modern medicine had such outrageous views on ageing is significant. Perhaps we doctors can find some solace in knowing that even Dr Osler had difficulty understanding ageing, and what it meant to get old.

In 1905, though, life expectancy was in the 40s, so negative perceptions about ageing were probably inconsequential. Since then, life expectancy has doubled. Negative perceptions about ageing will no doubt catch up with us – if they haven’t already.

Over the last couple years, it has caught up with me – and so has Bob Dylan’s lyrics: “How many times can a man turn his head/Pretending he just doesn’t see?”

Taureef Mohammed is a physician from TT working in Canada

E-mail: taureef_im@hotmail.com