Tag Archives: health care

Link: Geriatricians In Short Supply

Physicians specializing in geriatric care are an endangered species, according this article in the New York Times. They are scarce in the area where I’m living, though we do have a couple of internal medicine practitioners who list geriatric medicine as a second specialty.

A geriatrician discussed in the article treated one patient on the day of the interview for pressure ulcers, a poorly dressed wound, dehydration, and depression. These were all problems that afflicted Sally down in Florida. The poorly dressed wound was a particular problem. I wish she could have seen a geriatrician.

Seniors are increasing in numbers all around the country. We should find ways of increasing the numbers of physicians trained to treat them.

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Dr. Sacks Opts for Treatment

Oliver Sacks, eminent physician and best-selling author, has opted for an advanced treatment, known as “hepatic artery embolization,” to deal with the liver cancer that has stricken him at age 81.

Oliver Sacks.   © Luigi Novi / Wikimedia Commons

Oliver Sacks. © Luigi Novi / Wikimedia Commons

Writing in the New York Review of Books, Sacks describes the side effects that ensued from this treatment with eye-opening clarity. “I felt awful,” he reports, “If I had to feel like this from now on, I kept thinking, I would sooner be dead.”

Yet, after ten days Sacks suddenly began to feel well again. Indeed, at time of writing, he was experiencing feelings of exuberance and gratitude, even though he knew the time for this would be brief. His hope was only that “I may feel really well for three or four months …”

Seniors trying to develop a practical and realistic approach to the end of life face an almost insoluble conundrum. Like Dr. Gawande, we are concerned about the excessive, expensive, painful and uncertain treatments modern medicine can push us toward — treatments that can deprive us of a death with dignity. On the other hand, which of us would not opt for a treatment that could make us feel really well again, and give us a few more months of life? And how can we possibly know whether a particular treatment is worth trying?

There is no certain answer to this last question, but we can try to keep ourselves informed and learn from the experiences of others. Long before we become ill, we can try to find a primary care physician we trust for honest answers. We can talk with family and closest friends about our end of life wishes, and look to them for counsel and support when the time comes. Then we can only hope that like Dr. Sacks, we will make the right decision for ourselves.

 

 

Gawande Criticizes Over-treatment and Over-testing

Dr. Atul Gawande, author of the widely-praised book, Being Mortal, has an article in the May 11 New Yorker, entitled Overkill,” that’s well worth reading.

Using data and anecdotes, as he does so well, Gawande argues that pointless medical care is widespread in the United States. We are over-tested and over-treated. Countless CT scans, MRIs, and EEGs, among other tests — not to mention arthroscopic surgeries, thyroidectomies, and spinal fusings — are done inappropriately and unnecessarily, he maintains.

Gawande worries that high cost, high profit testing and procedures tend to drive out necessary and often less-expensive forms of care,  The solution, in his view, is to strengthen the primary care system, so that dedicated primary care physicians will have the time and the resources to deal with the real needs of their patients.  He feels that progress is being made along these lines under the Affordable Care Act, but worries that the gains could be undone.

One take-way for seniors is that we need to try to find primary care physicians who are willing to work with us in devising realistic, common sense approaches to our ailments.