Geriatricians

The Jules Verne carousel in Lyon, France

One of the things about being in your seventies is that you have lived in your body for a long time.  You've dealt with its strengths and weaknesses, and you've likely gone through some illnesses or injuries.  You've also dealt with doctors to varying degrees, depending on your health and your inclination.  When we were living in State College, we had warm, collaborative relationships with our providers, in part because of Judy's professional exchanges with them, but also because they knew us and our expertise and respected us for it.  We've been fortunate to have been quite healthy, and our doctors were supportive of our "less is more" approach to medications and procedures, especially because we could back it up with research.

When we moved to Pittsburgh we ran into a long-running feud between Highmark and UPMC.  UPMC is definitely the big dog in town, but our insurance through Penn State is Highmark.  So we took the doctor-dating questionnaire and were matched with a Highmark provider that was supposed to want to work to minimize medications and work collaboratively with us.  We waited four months to see her, and then in the initial 20 minute visit, we felt rushed, not listened to, and squished into a checklist-inspired box of 70-plus year olds who should take a fistful of medications to meet the insurance criteria.  Let's just say we weren't happy campers.  We were looking for more of a guide than a policeman.

After some reflection and not a little bit of frustration, we are starting over.  In discussing our treatment with our friend who is a geriatrician, it dawned on us that a geriatrician is exactly what we want.  After all, we are now geriatric.  Or as our 6 year old grandson Sam introduces us, “These are my grandparents. They are really old.”  He actually says this proudly, adding that Steve is very strong, because he goes to the gym every day.

We weren’t looking for a credential necessarily but a perspective on aging and health that characterizes geriatric medicine.  Here are the things that we believe represent the core of geriatrics:

·        -A collaborative relationship with a physician.  Geriatricians take the time to get to know their     patients and their patients’ goals.  There will be times when treatment for a health problem conflicts with goals.  A patient may make a choice to refuse treatment based on quality of life.  A geriatric physician will explain the options for treatment so that patients can make their choice.  We don’t want a physician who just ticks off boxes of things to do prescribed by our Medicare plan, but one who supports our choices.

·        -All medications have the potential for adverse side effects.  The more medications someone takes and the longer they take them, the greater the potential for side effects.  Judy certainly saw that year after year in her practice.  In fact, depression and anxiety as side effects of medications was one of the most frequent problems she saw.  One of the hallmarks of geriatric practice is “start low and go slow,” when introducing a new medication.  Another hallmark is recognizing that too many medications can be adversely affecting cognition, mood and energy levels.  Less can be more.  And sometimes lifestyle modification is the most potent medication there is.

·        -Aging involves chronic illnesses, which by definition cannot be cured.  But often it is possible to improve functioning and adaptation to an illness through rehabilitation, life style changes and home modifications.  And we would be remiss if we did not add, psychological support.

In effect, geriatric medicine does not strive to make us young again.  Any intervention has its trade-offs.  Taking an antibiotic has clear, immediate benefits that most of the time will outweigh adverse effects.  By contrast, taking medications that might prevent a stroke or heart attack for someone who has no risk factors may not be worth the possibility of adverse effects.  Some things can’t be treated or should not be treated.  For example, a little bit of hypertension may be helpful in maintaining cognitive functioning in old age.  

Having mulled on these issues, we have decided to go to a geriatrician as our primary care physician. We have an appointment in a couple of months.  The get-acquainted appointment is not 20 minutes, as was the case in our last primary care physician, but they've asked us to allow 3 hours, so we can meet with the whole team.  We’ll let you know how it goes.

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