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The Author Speaks

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

Interview with gerontologist Mark Lachs

None of us wants to be stereotyped by age.

Yet all too often in the world of medicine, we are defined and labeled by our years on the planet — and treated according to preconceived notions about that age. Because of this, we can potentially miss out on the unique and individualized care we need for maximum health and well-being, says physician and gerontologist Mark Lachs, author of the new book, Treat Me, Not My Age.

Lachs asserts that none of us ages in exactly the same way. This is especially critical, he says, "because when we're looking at a tremendous increase in longevity among the population, we're also looking at more chronic illness among older people." We need to know what is at stake.

Ageism can start early and subtly — in our 40s, 50s, 60s, Lachs says. "If you're a young person who plays pick-up basketball, like our president, for example, and you injure your knee, your doctor might say, 'Well, take up golf.' That's a subliminal message to slow down that may have nothing to do with your particular situation. For people who are much older, it's actually a common form of ageism. You might go to the doctor for pain, and without a complete evaluation or an exam, the doctor may say, 'You should expect that. You're getting older.' And that's just crazy."

'Patients should feel that their doctor is leaving no stone unturned.'

Lachs is based at New York's Weill Cornell Medical College, and his research has appeared in the New England Journal of Medicine; his honors include an academic leadership award from the National Institute on Aging. He spoke to the AARP Bulletin about navigating the health care system. (Read an excerpt from Treat Me, Not My Age.)

Q. We're seeing more ageism among doctors and hospitals, you say. Why is this?

A. Medicine has become more and more hurried. We now have what I call "the incredible shrinking office visit." As a gerontologist as well as an internist, I see a lot of patients who have gotten a sort of drive-by treatment, and it's not right. Patients should feel that their doctor is leaving no stone unturned, that complaints are being fairly adjudicated, and that someone is really thinking about their issues. No ailment should ever be written off as an "old age" ailment. Treating patients based on their age means you can miss very significant, treatable situations.

Q. How so?

A. If you've seen one 70-year-old, you've seen one 70-year-old. We're all created equal, but as we get much, much older, we don't age that way. In my practice I have 90-year-olds who go to work every single day, and I also have 50-year-olds with multiple sclerosis who are bedridden. When you treat patients like a number, you run risks.

Q. What are those risks?

A. Let me give you some examples. What if you're a woman in your 40s who has fibroids and your doctor steers you toward a hysterectomy without asking whether you want to have more children? That's a form of age discrimination. Here's another example: An 88-year-old female patient of mine asked me recently if she still needed regular pap smears and mammography. She had been getting them routinely for many, many years, and she always had negative pap smears and negative mammograms. I looked very carefully at her history and assessed all of the risks of not doing the tests at that point. And I told her, "No. No. There is no reason for you to have these tests right now." Every patient is different, and I hate the way the health care system pigeonholes people based on a number, and it becomes more absurd as patients get to be 70, 80 and 90, with great variations in their functional ability.

treat me, not my age

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Q. What can patients do about it?

A. Among other things, outline your goals for any doctor's visit before you arrive. Then, try saying, "Doctor, today I'd like to cover three things — my knee pain, the results of my cholesterol test, and whether or not I need a mammogram." So the expectations are created at the beginning. That's reasonable, and doctors will appreciate it. Too many patients simply submit. You need to articulate your concerns. Ask questions. Ask why a test is necessary or not. Ask about the background.

Q. You're talking about much more than medical tests. You're talking about a game plan to get the best treatment. What else should patients be aware of?

A. We all know about the dangers of hospitalization, including the increased risk of infection. But lots of bad things happen when people move between physicians and institutions, or even within institutions. The world's become so specialized that information gets lost. In my book I tell a story from my days as a resident, when a primary care patient came in with a bypass scar on his chest. The bypass had been done at my own institution — yet nobody had told me about it. A patient can be handed off from a primary care doctor to an orthopedist and back again, and one guy doesn't know what the other is doing.

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