A Bitter Pill one size fits health care for elders | Daily News

A Bitter Pill one size fits health care for elders

A Bitter Pill is an investigation into why the health care system does not work for old people who are in fragile health and what we can do about it. “Medical treatment of elderly people is not working. Worse, it is often harmful”, says author Dr. John Sloan, a family physician who has worked primarily with the elderly for more than twenty years.

Dr. Sloan argues that we must understand what people in poor health at the end of their lives really need: comfort, dignity, and quality of life. He also argues that, “caregivers, sons, daughters, nurses, doctors, and social workers—all of us—must assume responsibility for what happens to the elderly and give these loved ones the kind of care we hope, one day, someone will give us.”

The case of a 75 year former farmer from a remote village off the NCP came to my attention. Having been treated for renal failure currently at level 3 he also had a growth lower down in his intestines making it increasingly difficult to pass stools. One of his daughters took matters into hand and sought private medical advice. They found a huge growth literally blocking any passing of stools and is currently at Cancer Hospital Maharagama scheduled for two operations.

For the 75 year rural villager all he knows is intense pain. He is at the mercy of hopefully modern medical care. This man has little understanding of what’s happening or is in store for him. He quite simple does not understand language of modern medicine. Does medical care services truly understand needs and sentiments of our senior citizens?

Epidemiology in medicine

Epidemiology in medicine is about people and is based on the assumption that people are similar. For example, we all have a liver, blood that circulates, a brain, weight never greater than thirteen hundred pounds. But trouble arises when we assume we all have similar characteristics that not everybody actually has—intact memory, ability to move around the environment effortlessly, liver and kidney function close to some norm, and willingness to behave according to certain rules, for example.

An assumption of similarity is necessary for most science and works perfectly when you are dealing with electrons, molecules of potassium, or volumes of a pure gas such as helium. The more complicated the things being studied, the less similar they tend to be. Epidemiology is fine as long as it is talking about something that is the same for all individuals, whether they are infant, disabled, demented, angry, vegetarian, or sick in the hospital. Epidemiology is the science, the only science, used to justify most medical treatment. Is that okay?

Students trained recently are very likely to recommend identical treatment—identical to what their classmates would recommend and identical for every patient. This trend isn’t confined to medical students. Nutritionists, pharmacists, and other health care professionals coming out of their training programmes also tend to be consistent in their proposed treatment.

As we are teaching young doctors, pharmacists and nurses to practice according to reliable evidence, we might be discouraging them from thinking creatively about unusual one-off situations. As clinical guidelines for common diseases become better defined, there is less and less chance that experts will disagree with one another about the most effective treatment.

Heart attack is now diagnosed by a blood test. Heart failure, which is a different thing, to do with the heart’s function, is also now defined by a measurement tool outside the hands of the examining doctor: an echocardiogram. Osteoporosis is defined by a bone-density reading from a machine. Elevated cholesterol is defined by a blood test, and so on. It’s almost as if you didn’t need the doctor to make the diagnosis.

Science for elders

The price we pay for greater consistency is a less flexible attitude toward treating outliers. And the fragile elderly are nearly all outliers. The medical system is wonderful as long as you can benefit from what it has to offer. Many of its assumptions are conditional: you’re going to be fine as long as you resemble everybody else.

It’s probable the time to diagnose ailments of an elder citizen is at times greater than what is required for a younger person. Our seniors are served by the same system already stretched significantly. An OPD at most hospitals provide graphic evidence. When more tests are required from different places, when medication requires services from different locations, when mobility of the senior is restricted, when immediate care givers are scarce, what is the practical predicament of the senior citizen?

Midwives for elder care

Some months back I picked up the concept of Montessori’s for Elders which teach seniors to deal with day to day functional needs. There were protests on the validity of the approach. Likewise when I suggest carers akin to midwives who deal with senior citizens by visiting them at homes, arranging for regular clinic visits, helping them understand their routine in using medicine and medical care there maybe protests which say this is nonsensical and a suggestion which stretches resources further.

The reality is we have an aging population requiring care and care givers. Counter staff, doctors, specialists, lab technicians, pharmacists, physiotherapists have all got to understand the specific needs of senior citizen patients.

The grim reality in some instances for example in cancer is pain is managed not eradicated until you die of Cancer. Similarly we are hard pressed to learn about preventive geriatric care services. It may not even be 100% curative when dealing with old engines! The one size fits health care for elders is indeed a bitter pill.


 

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