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by Mark Lachs, November 18, 2010
In every environment I have ever practiced in — hospitals, offices, clinics, and nursing homes — patients and families who advocated for themselves got better care, so long as that advocacy was not obnoxious. The key is finding the sweet spot between wallflower and irritant.
I marvel, therefore, at how some of the most successful and assertive people clam up when they enter the hospital. ... I've had older patients who were about to undergo surgery sign a consent form after a discussion with the surgeon, only to call me afterward with a litany of questions they were too timid to ask the doctor — important questions, like "How many of these have you done before?" or "Will you actually do the surgery, or will it be a resident?" You've got to be kidding! I've seen people get more engaged in a discussion with their dry cleaner over why a stain didn't come out than with their doctor about a life-altering procedure they were about to have.
But no other hospital environment seems to produce temerity in patients and their families like the ER. This is understandable in one respect. If a physician or nurse is in the process of caring for patients with life-threatening trauma, it's natural to feel a bit hesitant about disturbing her. On the other hand, because of the general climate of chaos in most American emergency rooms these days, if you can't or won't speak up for yourself, it is very easy to get lost in the shuffle. Let me say it even more bluntly: While the ER is a very confusing place for someone of any age, it can be downright perilous for boomers and their families. It is essentially a four-alarm fire. And if you're not in flames, you will take a back seat to someone who is.
As a result of this, older people in the ER can languish needlessly as more pressing cases displace them. Compounding this problem is the tendency of many people as they age to develop communicative difficulties or mild confusion when they get sick. They may not be able to articulate a problem as precisely as a much younger adult. Providing details about history and medications can be harder. Physicians may subtly withdraw and move on to the next customer when this happens, perhaps ordering some nonspecific tests or x-rays, while they try to figure out what to do.
The solution: I always urge patients to bring a friend or family member with them to the ER. I'm well aware that many emergency departments do not permit this (except for children), but that is also changing. A patient who is confused or agitated is at high risk for falling or other injury, and there is simply not enough staff to baby-sit patients; what ER wants you to end up with a broken hip on top of whatever else you've got?
Treat Me, Not My Age, copyright © by Mark Lachs, is published by Viking, a division of Penguin Group (USA) Inc. Reprinted with permission. Read an interview with Mark Lachs.
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