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The Author Speaks

Ageism in Medicine: How It Appears, Why It Can Hurt You

Interview with gerontologist Mark Lachs

Q. But there are dangers to this as well.

A. Yes, because the physician can begin addressing the conversation to the child, without making eye contact or even speaking to the patient, which is another subtle form of ageism. If that's happening in the encounter, you need to gently redirect the physician to your mom or dad. You might say, "Dad, how does that sound to you?" You don't want to be rude, but you want to constantly make sure that your parent does not become the inanimate object in the room.

Q. You say that a doctor's bedside manner can actually lead to better medical care in some cases. How so?

A. It's an issue of doctor-patient fit. It's really important for patients and doctors to be able to talk to each other, really engage — not just cover the facts. There is also some data now that's starting to suggest that if you're engaged with your physician, you're more likely to adhere to medications, to follow up with recommendations. This is not about having your blood pressure taken correctly; it's about feeling doctored, feeling cared for and communicated with. That's always the fun of medicine for me, to get to know my patients and their stories and to grow along with them. People really see me as their physician but also as someone who can help them think things through. Think about how you respond to advice from someone whom you know and trust — versus someone you don't have much of a relationship with. You're much more likely to say, "Wow, this guy's truly concerned about me, I'm interested in what he has to say." And you probably adhere more to their advice and recommendations.

Q. You also talk about the profound benefits of aging in your book — that retirement can be better than people sometimes expect. Let's not neglect this important point.

A. Here's a quick history of retirement. Some people become rudderless in retirement, notwithstanding the current economic environment in which people have to work. But the overwhelming body of literature on retirement is that it's fabulous. There's independence, for one thing. And there's time. Most people tell me, "I don't know how I had time to work." That's a great thing to hear. If you have the resources, retirement can be an overwhelmingly positive experience.

Q. That's the goal!

A. And there's also the freedom to speak your mind, to not be tethered, which cannot be underestimated. I had a patient who was fired. He didn't like the boss, and he used a four-letter word with him. I told my patient, "That must have been terrible." He said, "No, it was fabulous! Do you know how many times when I was a younger man with four mouths to feed that I wanted to tell the boss to go take a hike? Now, I finally could." This was therapeutic for him.

Q. Clearly there are bright sides to getting older.

A. Marriages that survive are the most satisfying relationships. And sexuality can also persist until late life, which is fabulous. George Burns had a great joke: The key to late life is living to 100, because you rarely read about people who die after 100.

The science bears that out. Once you make it past a certain age without a disability, you keep going with less and less disability. And for boomers in their 50s and 60s, the foundation for that kind of existence is placed early on. Even with modest interventions like daily walking, or low-intensity weight training, or making sure to see friends socially — all of those affect longevity and quality of life.

Q. You see aging as such a hopeful time.

A. Rather than say, "I'm never going to get old," which is what Americans are being sold in so many places, say instead, "I'm going to get older."

Maureen Mackey is a writer and editor from New York.

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