Bias towards elderly who will not go quietly

[Anonymous]

Anonymous wrote:This is the OP and I agree with you. I do everything I can to ensure my parents wishes are met.

I think what I’m talking about is very subtle. I think all doctors would *say* they are respecting their older patients’ wishes. But are they really taking the same stance they would take if the same things were happening to a 50-year-old? I seriously doubt it. In my experience there just isn’t a lot of frank discussion between patients and doctors about what they really want.

My mom will say to me, “they seem to be just giving up on your father!” So I’ll talk to the doctor who will say to me, “Your father says he doesn’t want X.” And I will say, “Did you explain to him that without X he is likely to die very soon? Did you really explain to him what X is, the pros and cons?” And when this happens, surprise surprise my dad chooses X! But I think the truth is the doctors think X is just delaying the inevitable so they mention it in a way that is designed to discourage it. Or they talk about it and death in a way that is so oblique, my parents don’t even fully understand it.

It's not realistic to expect that they should. The 80+ yr old body is not the 50 yr old body, there is a lot of wear and tear that's happened in between, and it does affect the outcomes. My grandma died at 90 from something that was a 2 days hospital stay for my mom at 60.

[Anonymous]

I heartily agree, OP. Social media is filled with propaganda for DNR. I remember one propaganda image comparing a pleasant death with clergy to the full code.

Sadly, the burnt out HCWs and insurance companies agree on the pro-death side.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Eating ice cream and watching the birds would be fine.

How about being limited to a feeding tube and having your daily activities consisting of being moved to prevent bedsores?

I have known people in that shape and worse who had no interest in dying and were still glad to wake up in the morning.

Exactly. Sorry, nurse, you're going to have to run a full code instead of hanging out with your bestie at the nurses' station.

[Anonymous]

Anonymous wrote:Absolutely terrible thread title, BTW.

Agreed, it is a disgusting title.

I am an attorney who changed careers and have been working in mostly hospice care for the last near decade. The majority of my patients have been elderly, but some were DNR based on chronic degenerative conditions at younger ages.

I’ve noticed that the majority of doctors are just as uncomfortable as the average person with having conversations about death. They may be more matter of fact about it in their own thinking, but they don’t really want to talk about it with patients. There is a lot of avoidance of spelling things out plainly to people who are avoiding accepting it themselves. Even some doctors and nurses who work in HOSPICE, whose jobs are all about helping dying patients die, sometimes push too far to keep people on the alive side of things even if it means prolonging discomfort.

I can’t agree with your OP at all, not the ugly thread title. The truth is that the situation in American medicine is overwhelmingly the flip side of the coin - we spend astronomically to keep people alive in the final years or months, and often causing much anguish in the process for patients and families alike. All because we can’t talk about death in this country and most folks are terrified of it.

As to your parents OP - this is a well tread area of medical ethics and not some ageism bias of the doctors. When patients are in their 80s and beyond, they are statistically much less likely to fully recover from many procedures and treatments - exponentially less likely than a patient in their 50s, 60s, or even 70s. Same with their statistical likelihood of experiencing complications which hasten greater disability and/or death.

This factors into the physician’s determination of what is in the best interests of the patient, and no doctor is required to perform a surgery or treatment on a patient if they feel it is going against their best interests. Some doctors are skilled at explaining this and others just hem and haw and avoid flat out saying how things are. It has nothing to do with a lack of caring about your loved one. I would argue that there is more caring on offer from someone who nudges you in the direction of recognizing your impending mortality than in steering you toward further denial.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Absolutely terrible thread title, BTW.

Agreed, it is a disgusting title.

I am an attorney who changed careers and have been working in mostly hospice care for the last near decade. The majority of my patients have been elderly, but some were DNR based on chronic degenerative conditions at younger ages.

I’ve noticed that the majority of doctors are just as uncomfortable as the average person with having conversations about death. They may be more matter of fact about it in their own thinking, but they don’t really want to talk about it with patients. There is a lot of avoidance of spelling things out plainly to people who are avoiding accepting it themselves. Even some doctors and nurses who work in HOSPICE, whose jobs are all about helping dying patients die, sometimes push too far to keep people on the alive side of things even if it means prolonging discomfort.

I can’t agree with your OP at all, not the ugly thread title. The truth is that the situation in American medicine is overwhelmingly the flip side of the coin - we spend astronomically to keep people alive in the final years or months, and often causing much anguish in the process for patients and families alike. All because we can’t talk about death in this country and most folks are terrified of it.

As to your parents OP - this is a well tread area of medical ethics and not some ageism bias of the doctors. When patients are in their 80s and beyond, they are statistically much less likely to fully recover from many procedures and treatments - exponentially less likely than a patient in their 50s, 60s, or even 70s. Same with their statistical likelihood of experiencing complications which hasten greater disability and/or death.

This factors into the physician’s determination of what is in the best interests of the patient, and no doctor is required to perform a surgery or treatment on a patient if they feel it is going against their best interests. Some doctors are skilled at explaining this and others just hem and haw and avoid flat out saying how things are. It has nothing to do with a lack of caring about your loved one. I would argue that there is more caring on offer from someone who nudges you in the direction of recognizing your impending mortality than in steering you toward further denial.

The patient alone determines what is best for them. Physicians may be learned intermediaries but they have no right to decide whether a patient gets treatment or not. They have a duty to explain all options and the likely results of each. If they can’t do that, they should switch to pathology.

Not everyone who resists being “nudged” toward the beyond is in denial. Some just have more hope than the people doing the nudging.

[Anonymous]

I used to work in healthcare and sometimes this can feel like you're torturing someone. There are many situations where it would be more compassionate to let someone go rather than pull out all the stops.

[Anonymous]

Adding: by way of example, I know a man diagnosed with throat cancer who deteriorated rapidly and shifted his care to what seems to have been a good hospice program that was interested in his welfare and comfort, not in how “peacefully” they could send him to his reward. His chemo and radiation kicked in rather late, but he went into remission and is back to his regular life, including significant charitable service activity. Giving up too early would’ve foreclosed that. It is not denial for a person with a terminal illness to say “I’m going to die, but not today.”

[Anonymous]

Anonymous wrote:

Anonymous wrote:I think in an ideal world doctors could give their all to everyone. The reality is they are understaffed, very overworked and many are burned out. Since they are not superhuman, would you rather a doctor give more attention to a mother or father with children at home, one of whom may have special needs or medical issues or emotional struggles or put all their energy into giving your elderly parent a few more months?

DP, but obviously my parents are more important to me than some random stranger’s kids. Let’s not start moving eugenics-ward, shall we?

Sure, but you’re kind of shitty if you’d rather your elderly parents have 3 more years of life than a 20 year old have another 50-60.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Absolutely terrible thread title, BTW.

Agreed, it is a disgusting title.

I am an attorney who changed careers and have been working in mostly hospice care for the last near decade. The majority of my patients have been elderly, but some were DNR based on chronic degenerative conditions at younger ages.

I’ve noticed that the majority of doctors are just as uncomfortable as the average person with having conversations about death. They may be more matter of fact about it in their own thinking, but they don’t really want to talk about it with patients. There is a lot of avoidance of spelling things out plainly to people who are avoiding accepting it themselves. Even some doctors and nurses who work in HOSPICE, whose jobs are all about helping dying patients die, sometimes push too far to keep people on the alive side of things even if it means prolonging discomfort.

I can’t agree with your OP at all, not the ugly thread title. The truth is that the situation in American medicine is overwhelmingly the flip side of the coin - we spend astronomically to keep people alive in the final years or months, and often causing much anguish in the process for patients and families alike. All because we can’t talk about death in this country and most folks are terrified of it.

As to your parents OP - this is a well tread area of medical ethics and not some ageism bias of the doctors. When patients are in their 80s and beyond, they are statistically much less likely to fully recover from many procedures and treatments - exponentially less likely than a patient in their 50s, 60s, or even 70s. Same with their statistical likelihood of experiencing complications which hasten greater disability and/or death.

This factors into the physician’s determination of what is in the best interests of the patient, and no doctor is required to perform a surgery or treatment on a patient if they feel it is going against their best interests. Some doctors are skilled at explaining this and others just hem and haw and avoid flat out saying how things are. It has nothing to do with a lack of caring about your loved one. I would argue that there is more caring on offer from someone who nudges you in the direction of recognizing your impending mortality than in steering you toward further denial.

The patient alone determines what is best for them. Physicians may be learned intermediaries but they have no right to decide whether a patient gets treatment or not. They have a duty to explain all options and the likely results of each. If they can’t do that, they should switch to pathology.

Not everyone who resists being “nudged” toward the beyond is in denial. Some just have more hope than the people doing the nudging.

No, patients don’t dictate their care. You can’t just order a doctor to do this or that, if it’s not medically indicated. No wonder so many people are leaving the medical field. You think you can boss them around like they’re your nanny.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Absolutely terrible thread title, BTW.

Agreed, it is a disgusting title.

I am an attorney who changed careers and have been working in mostly hospice care for the last near decade. The majority of my patients have been elderly, but some were DNR based on chronic degenerative conditions at younger ages.

I’ve noticed that the majority of doctors are just as uncomfortable as the average person with having conversations about death. They may be more matter of fact about it in their own thinking, but they don’t really want to talk about it with patients. There is a lot of avoidance of spelling things out plainly to people who are avoiding accepting it themselves. Even some doctors and nurses who work in HOSPICE, whose jobs are all about helping dying patients die, sometimes push too far to keep people on the alive side of things even if it means prolonging discomfort.

I can’t agree with your OP at all, not the ugly thread title. The truth is that the situation in American medicine is overwhelmingly the flip side of the coin - we spend astronomically to keep people alive in the final years or months, and often causing much anguish in the process for patients and families alike. All because we can’t talk about death in this country and most folks are terrified of it.

As to your parents OP - this is a well tread area of medical ethics and not some ageism bias of the doctors. When patients are in their 80s and beyond, they are statistically much less likely to fully recover from many procedures and treatments - exponentially less likely than a patient in their 50s, 60s, or even 70s. Same with their statistical likelihood of experiencing complications which hasten greater disability and/or death.

This factors into the physician’s determination of what is in the best interests of the patient, and no doctor is required to perform a surgery or treatment on a patient if they feel it is going against their best interests. Some doctors are skilled at explaining this and others just hem and haw and avoid flat out saying how things are. It has nothing to do with a lack of caring about your loved one. I would argue that there is more caring on offer from someone who nudges you in the direction of recognizing your impending mortality than in steering you toward further denial.

The patient alone determines what is best for them. Physicians may be learned intermediaries but they have no right to decide whether a patient gets treatment or not. They have a duty to explain all options and the likely results of each. If they can’t do that, they should switch to pathology.

Not everyone who resists being “nudged” toward the beyond is in denial. Some just have more hope than the people doing the nudging.

No, patients don’t dictate their care. You can’t just order a doctor to do this or that, if it’s not medically indicated. No wonder so many people are leaving the medical field. You think you can boss them around like they’re your nanny.

While medical arrogance may know no boundaries, it is the physician’s duty to explain options and associated prognoses. Failure to do so is prima facie negligence. What is “medically indicated” is a matter of opinion, and patients have a right to have that opinion and the grounds for it made clear. Hiring a physician to provide services does not create a custodial relationship where the physician holds the power of life and death to be exercised at his or her caprice. Oh, and I don’t “think” I can boss the Great Exalted around, I know I can, and I do.

[Anonymous]

Your title should be “Bias against elderly …..”

[Anonymous]

I’ve actually heard from a few people that even those who don’t want to be saved end up being saved against their wishes. I thought the bias was the opposite actually

[Anonymous]

Anonymous wrote:

Anonymous wrote:Absolutely terrible thread title, BTW.

Agreed, it is a disgusting title.

I am an attorney who changed careers and have been working in mostly hospice care for the last near decade. The majority of my patients have been elderly, but some were DNR based on chronic degenerative conditions at younger ages.

I’ve noticed that the majority of doctors are just as uncomfortable as the average person with having conversations about death. They may be more matter of fact about it in their own thinking, but they don’t really want to talk about it with patients. There is a lot of avoidance of spelling things out plainly to people who are avoiding accepting it themselves. Even some doctors and nurses who work in HOSPICE, whose jobs are all about helping dying patients die, sometimes push too far to keep people on the alive side of things even if it means prolonging discomfort.

I can’t agree with your OP at all, not the ugly thread title. The truth is that the situation in American medicine is overwhelmingly the flip side of the coin - we spend astronomically to keep people alive in the final years or months, and often causing much anguish in the process for patients and families alike. All because we can’t talk about death in this country and most folks are terrified of it.

As to your parents OP - this is a well tread area of medical ethics and not some ageism bias of the doctors. When patients are in their 80s and beyond, they are statistically much less likely to fully recover from many procedures and treatments - exponentially less likely than a patient in their 50s, 60s, or even 70s. Same with their statistical likelihood of experiencing complications which hasten greater disability and/or death.

This factors into the physician’s determination of what is in the best interests of the patient, and no doctor is required to perform a surgery or treatment on a patient if they feel it is going against their best interests. Some doctors are skilled at explaining this and others just hem and haw and avoid flat out saying how things are. It has nothing to do with a lack of caring about your loved one. I would argue that there is more caring on offer from someone who nudges you in the direction of recognizing your impending mortality than in steering you toward further denial.

Thanks for this comment from the front lines.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Absolutely terrible thread title, BTW.

Agreed, it is a disgusting title.

I am an attorney who changed careers and have been working in mostly hospice care for the last near decade. The majority of my patients have been elderly, but some were DNR based on chronic degenerative conditions at younger ages.

I’ve noticed that the majority of doctors are just as uncomfortable as the average person with having conversations about death. They may be more matter of fact about it in their own thinking, but they don’t really want to talk about it with patients. There is a lot of avoidance of spelling things out plainly to people who are avoiding accepting it themselves. Even some doctors and nurses who work in HOSPICE, whose jobs are all about helping dying patients die, sometimes push too far to keep people on the alive side of things even if it means prolonging discomfort.

I can’t agree with your OP at all, not the ugly thread title. The truth is that the situation in American medicine is overwhelmingly the flip side of the coin - we spend astronomically to keep people alive in the final years or months, and often causing much anguish in the process for patients and families alike. All because we can’t talk about death in this country and most folks are terrified of it.

As to your parents OP - this is a well tread area of medical ethics and not some ageism bias of the doctors. When patients are in their 80s and beyond, they are statistically much less likely to fully recover from many procedures and treatments - exponentially less likely than a patient in their 50s, 60s, or even 70s. Same with their statistical likelihood of experiencing complications which hasten greater disability and/or death.

This factors into the physician’s determination of what is in the best interests of the patient, and no doctor is required to perform a surgery or treatment on a patient if they feel it is going against their best interests. Some doctors are skilled at explaining this and others just hem and haw and avoid flat out saying how things are. It has nothing to do with a lack of caring about your loved one. I would argue that there is more caring on offer from someone who nudges you in the direction of recognizing your impending mortality than in steering you toward further denial.

The patient alone determines what is best for them. Physicians may be learned intermediaries but they have no right to decide whether a patient gets treatment or not. They have a duty to explain all options and the likely results of each. If they can’t do that, they should switch to pathology.

Not everyone who resists being “nudged” toward the beyond is in denial. Some just have more hope than the people doing the nudging.

A doctor can certainly decide not to give me HRT if I have underlying risk factors or refuse to give me antibiotics which are useless for a cold. They can refuse to give me painkillers if I am an addict. They can refuse to give me a heart transplant if I have advanced brain cancer.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Absolutely terrible thread title, BTW.

Agreed, it is a disgusting title.

I am an attorney who changed careers and have been working in mostly hospice care for the last near decade. The majority of my patients have been elderly, but some were DNR based on chronic degenerative conditions at younger ages.

I’ve noticed that the majority of doctors are just as uncomfortable as the average person with having conversations about death. They may be more matter of fact about it in their own thinking, but they don’t really want to talk about it with patients. There is a lot of avoidance of spelling things out plainly to people who are avoiding accepting it themselves. Even some doctors and nurses who work in HOSPICE, whose jobs are all about helping dying patients die, sometimes push too far to keep people on the alive side of things even if it means prolonging discomfort.

I can’t agree with your OP at all, not the ugly thread title. The truth is that the situation in American medicine is overwhelmingly the flip side of the coin - we spend astronomically to keep people alive in the final years or months, and often causing much anguish in the process for patients and families alike. All because we can’t talk about death in this country and most folks are terrified of it.

As to your parents OP - this is a well tread area of medical ethics and not some ageism bias of the doctors. When patients are in their 80s and beyond, they are statistically much less likely to fully recover from many procedures and treatments - exponentially less likely than a patient in their 50s, 60s, or even 70s. Same with their statistical likelihood of experiencing complications which hasten greater disability and/or death.

This factors into the physician’s determination of what is in the best interests of the patient, and no doctor is required to perform a surgery or treatment on a patient if they feel it is going against their best interests. Some doctors are skilled at explaining this and others just hem and haw and avoid flat out saying how things are. It has nothing to do with a lack of caring about your loved one. I would argue that there is more caring on offer from someone who nudges you in the direction of recognizing your impending mortality than in steering you toward further denial.

The patient alone determines what is best for them. Physicians may be learned intermediaries but they have no right to decide whether a patient gets treatment or not. They have a duty to explain all options and the likely results of each. If they can’t do that, they should switch to pathology.

Not everyone who resists being “nudged” toward the beyond is in denial. Some just have more hope than the people doing the nudging.

No, patients don’t dictate their care. You can’t just order a doctor to do this or that, if it’s not medically indicated. No wonder so many people are leaving the medical field. You think you can boss them around like they’re your nanny.

While medical arrogance may know no boundaries, it is the physician’s duty to explain options and associated prognoses. Failure to do so is prima facie negligence. What is “medically indicated” is a matter of opinion, and patients have a right to have that opinion and the grounds for it made clear. Hiring a physician to provide services does not create a custodial relationship where the physician holds the power of life and death to be exercised at his or her caprice. Oh, and I don’t “think” I can boss the Great Exalted around, I know I can, and I do.

Your post is laughable, because nobody is asserting that the physician controls the patient’s choice. The patient can always get a second opinion and if they look long enough, they will doubtless eventually find a physician more motivated by medical fees to be collected than by the Hippocratic oath.

If your parent has reached the twilight years and still hasn’t learned this fundamental truth of medicine, please do explain it to them. It is not the doctor’s obligation to urge them to seek a second opinion.