Have you noticed that while everyone
has an elderly relative with multiple medical problems, on multiple
medications, and struggling — aka a geriatric patient — many of them have no
idea what a geriatrician is, or how complex is the work we do?
has an elderly relative with multiple medical problems, on multiple
medications, and struggling — aka a geriatric patient — many of them have no
idea what a geriatrician is, or how complex is the work we do?
The truth is that we are power users
of doctoring skills, but many seem to be unaware of this.
of doctoring skills, but many seem to be unaware of this.
This past weekend I met an engineer
who works in Silicon Valley with tech start-ups. He is a Yale grad. His father
died last year, after spending nine years in and out of nursing homes.
who works in Silicon Valley with tech start-ups. He is a Yale grad. His father
died last year, after spending nine years in and out of nursing homes.
He had never heard of a geriatrician
before meeting me. On the other hand, when I described how we help older
complex patients, his face lit up, but then he looked perplexed.
before meeting me. On the other hand, when I described how we help older
complex patients, his face lit up, but then he looked perplexed.
“But why don’t other doctors do
what you do?” he asked me. “And why does health care for older people
suck?”
what you do?” he asked me. “And why does health care for older people
suck?”
Well, those are million dollar
questions for sure. (Technically, probably even billion dollar questions given
what health care for older people costs in this country.) Let’s think about a
concise answer to the first question, as I find people ask me this quite a lot.
questions for sure. (Technically, probably even billion dollar questions given
what health care for older people costs in this country.) Let’s think about a
concise answer to the first question, as I find people ask me this quite a lot.
Right now I usually propose two key
reasons that doctors don’t do what geriatricians do:
reasons that doctors don’t do what geriatricians do:
1. Lack of geriatric expertise.
This means both lacking the
knowledge, as well as lacking experience and comfort implementing whatever
geriatric material was taught in med school, residency, or CME course. (I
remember my reluctance to do a mini-mental in residency. Obviously geriatrics fellowship
was a terrific cure for this, as practice makes comfortable, if not always
perfect.)
This means both lacking the
knowledge, as well as lacking experience and comfort implementing whatever
geriatric material was taught in med school, residency, or CME course. (I
remember my reluctance to do a mini-mental in residency. Obviously geriatrics fellowship
was a terrific cure for this, as practice makes comfortable, if not always
perfect.)
2. Lack of health technology
tools designed for power use.
Technology tools which help us do
our doctoring faster are great, but how many of them actually work well when
applied to patients as complex as our geriatric patients?
- Whereas the average primary care
visit may require reconciling and formulary checking 3-6 medications, we often
reconcile 8-15 meds.
- Whereas the average patient may have
2-3 other doctors providing medical care, our patients often have 5 or more
involved.
- Whereas the average patient may have
2-4 chronic diseases requiring ongoing management, our patients often have 6 or
more.
In my experience, most technologies and tools available to help doctors do their work are not very effective when you are trying to do a lot of whatever it is you need to do.
Imagine if you used an email program
that allowed you delete mail only one item at a time. This would be ok back in
1995 when you perhaps only received 5 emails per day. Deleting or otherwising
managing them one at a time would be fine.
that allowed you delete mail only one item at a time. This would be ok back in
1995 when you perhaps only received 5 emails per day. Deleting or otherwising
managing them one at a time would be fine.
But nowadays, almost all
professionals must be power email users, able to manage lots of daily email
quickly, or in batches.
professionals must be power email users, able to manage lots of daily email
quickly, or in batches.
I think health IT for on-the-ground doctors is still in a bit
of a 1995 mode. Very few of the products work well in a power mode. But
providing good care to geriatric patients without spending way too much time
requires power doctoring.
of a 1995 mode. Very few of the products work well in a power mode. But
providing good care to geriatric patients without spending way too much time
requires power doctoring.
Technologies that support power
doctoring are sorely needed. Those designing healthcare technology tools should
build in the capacity for power use, rather than design just for use on less
complex patients.
doctoring are sorely needed. Those designing healthcare technology tools should
build in the capacity for power use, rather than design just for use on less
complex patients.
This would help geriatricians become
more efficient, and make caring for geriatric patients more manageable for
every doctor.
more efficient, and make caring for geriatric patients more manageable for
every doctor.
