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How Elderly Patients Are Treated by the Medical Establishment

What follows is the ever-evolving cautionary tale of two women, a mother-daughter best-friend team, who share with readers the good, bad and oftentimes
ugly details of our modern-day medical establishment’s treatment of our beloved elders in a manner that is both humorous and poignant.

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The Elephant in the (Waiting) Room:
A Perspective on How the Medical Establishment Treats Senior Patients

By Dr. Reema Sayegh

My mother and I wish we were wild animals. Let me explain. We love watching Animal Planet and National Geographic because these channels feature great shows about the day-to-day lives of myriad creatures. Whether they are teeny rodents or sizable apex predators, it’s fascinating to learn about the specie's societal dynamics. As we watch more and more shows, I begin to notice a common thread in all species, the mature animals of their societies are the teachers and disciplinarians. They are the providers, protectors and nurturers. They are respected and revered. Or else!

That’s why we wish we were lions or wolves. Although I am an official Gen-Xer and grew up in the good old U S of A, I was raised in a family that honored its mature members. As a result, my mother is my best friend – the first of many rarities in our American culture. My mother is also nearly 40 years older than I am and became a widow at 54 (that’s number two rarity). I am an only child (now we’re at number three). This trio of rarities, while precious to us, explains our present challenge: my mother is now 89 and I have become her personal assistant.

Which I don’t mind. Really, I don’t. As I said, she is my BFF, so I am happy to have the opportunity to help her hang on to her treasured independence. Mostly, just not so much when it involves one particular errand: The Doctor’s Visit. Now don’t get me wrong, neither my mother nor I harbor any hard feelings towards her doctors, despite having watched my father and grandmother become ill and die despite the best allopathic care. Honestly I think it’s really the other way around.

Apparently, medical school doesn’t teach medical students the fine arts of diplomacy and tact when dealing with mature senior patients. And that’s a true shame because senior patients are generally the ones in greatest need of diplomacy and tact. After all, these folks experience various forms of “elder discrimination” on a regular basis.

Don’t believe me, just go to a shopping mall or grocery store and observe. I have lost count of how many times impolite, impatient shoppers sigh, roll their eyes, or worse yet muscle past my mother as she timidly and unsteadily tries to navigate herself, and her shopping basket through the crowds. Better yet, go out to a restaurant and watch other diners stare or pretend not to stare as I endeavor to get mother semi-comfortably situated in the bottomless cushy leather booths or heavy-as-lead high-backed chairs.

Now, visualize a typical doctor’s waiting room. Let’s face it. It isn’t a pretty sight. Last I checked, no well-feeling patient “served time” in a doctor’s waiting room. Every patient is either ill or in pain or both, some severely and others less so, but every patient is in the waiting room to seek help. In seven minutes or fewer. Yep, that’s right. According to recent statistics, most contracted providers are allowed this length of time to address the needs of each subscriber (the patient).

If that isn’t bad enough, the transition from charts to electronic medical records requires everyone from the receptionist to the medical assistant/nurse to the doctor to master the tricky art of multitasking as they simultaneously evaluate the patient, type in the data, update the records, and “task” each other with specific duties, all the while rushing through the entire process as if they were contestants on “Beat the Clock.”

No leeway is granted for senior patients who have trouble hearing the hurriedly mumbled doctor’s words, and if they dare ask the doctor to repeat what had been said, well, there goes another precious 30-60 seconds of the allotted visit time. When my mother does this, every single one of her doctors looks at me, and proceeds to reply to me. As if my mother isn’t even in the room. The first time this happened, my mother was insulted. The second and third times, she was frustrated. Now, it has become almost a game, as before we even enter the exam room, my mother wants us to place bets (with the winner getting a candy bar from the pharmacy on the way out) on how many times this will happen during each visit. She bets high! Ever the optimist, I bet low. She always wins, but that’s okay since I am always trying to avoid high-fructose corn syrup. When I try to redirect the doctor, depending on the individual, the type of day it’s been, and maybe even the moon cycle, I receive either a tight smile, really gritted teeth passing for a smile. I catch a furtive rolling of eyes, or I even hear a barely audible sigh before my mother is treated with a modicum of respect, and that good old diplomacy and tact about which we were reading.

Heaven forbid the senior patient, after sitting in the waiting room for never fewer than 20 minutes and often over an hour, needs a minute for his body to get going again after transitioning to standing. The last time we were at her rheumatologist’s office, an impatient medical assistant caught a corner of my mother’s walker skis with her foot as she tried to wedge past her en route to clock out for lunch. Really! This happened. And when she whirled around to address us with what I thought would be an apology, she merely glanced at my shaken mother, looked at me and said, “she’s okay” as she continued on. Wow, thanks for such largesse. It’s overwhelming, really.

As I reflect on this behavior, I can’t help but wonder what would have happened if that medical assistant had been an adolescent lion who body slammed the pride’s alpha female while she was walking beside her adult daughter. Oh, it makes me smile when I imagine the outcome. Sorry, call me catty – pun intended! I hope I don’t see this woman next week, when we go back for a follow-up, as I may not be able to contain my silly grin.

This silly grin stays on my face as I recall last month’s visit to Urgent Care when, much like Elvis, diplomacy and tact left the building. After he briefly greeted my mother, AKA the patient, true to form, the physician on duty began to ask me all the particulars behind the reason for our visit. This time, my mother redirected the young man, and told him to speak up. Go mom! Things actually went well after that, for a while. Until he asked about what she was doing for her sudden-onset blistering skin eruptions. I held my breath, since I knew my mother would never be anything but completely forthright. “My daughter put me on a homeopathic remedy and applied a calendula/Epsom salt poultice.” I inwardly braced for impact, as my naturopathic assistance typically earned me the conventional medical establishment’s reactions of tight smiles, glaring eyes, and the label of heretic. After hearing my mother’s reply, the doctor again looked at me and immediately asked where I had gotten the idea to do those things. Fighting back an urge to swipe at him with my formidable (yet imaginary) retractable claws or growl at him with my whiskery (yet imaginary) lips curled back in a snarl revealing my huge canines, I calmly explained my background, including credentials, and informed him that in fact his father, a local gastroenterologist, had been my patient 13 years ago when I worked at the Longevity Clinic.

Magic! Crisis averted! “Well, good thing you have your daughter as your Pit Bull” came the response. Refusing to let this one pass, I cringed inwardly, but calmly replied, “Thank you, the Bull Terrier is one of my favorite, and surely most understood, breeds of dogs. If you are referring to my being her loyal advocate and companion, well, she’s my mother and that’s what one should do for one’s mother. “She’s worth it.” After what felt like forever, the doctor managed a smile, told my mother to follow up with the rheumatologist as soon as possible, since he did not think the skin condition was an infection (he was right, by the way, it wasn’t), and could be due to one of her medications (right again, it was). As we prepared to leave, I asked if she should continue the holistic protocol until we saw the rheumatologist. “Totally your call,” he replied, as he shrugged his shoulders. “That’s clearly not my area of expertise.” Clearly. So much for the benefits of full disclosure. Sigh. But hey, at least he was fairly open minded, and maintained civility throughout.

Senior oral hygiene That’s more than I can say for mother’s long-time dentist. In addition to her rheumatoid arthritis, my mother also has osteoporosis, and this has affected her teeth and jaws. Years ago, this dentist designed a cantilever bridge for her bottom teeth, which lasted longer than most automobiles, but, like most automobiles, needed routine maintenance. As my mother’s gums receded, her mandible also began to slowly disintegrate, which required frequent trips to the dentist for bridge modifications. The once cheery dentist became less and less so did the time between visits grew shorter and shorter. During what my mother refers to as “the final visit” the dentist made three attempts to successfully and comfortably “re-fit” the apparatus, to no avail. After much gagging, moaning and “time outs” for rests, the harried dentist abruptly stood up, threw out his arms like that famous statue above Rio de Janeiro, and said, “Well, you’ve outlived your teeth.” While I quickly looked away as I struggled to lower my upper eyelids in an effort to not look as shocked and outraged as I felt, my mother visibly stiffened, and after blinking back tears of hurt and rage, reclaimed her composure, thanked the dentist, and said she guessed she’d just have to get along without it.

Once we were in the car, we sounded like two ladies with severe cases of Tourette syndrome. I hadn’t used so many of “those words” together at one time since my days as a writer and assistant editor in the (rock) music industry. And my mother surprised me with the words she used. Even though Sons of Anarchy was her all-time favorite TV show, and I still can’t explain that one, I didn’t realize she even knew some of the words she was using.

After we returned home, we sat together for a while and plotted the dentist’s fate. Again, we imagined what would have befallen him, had we been lions or wolves. We concluded that in either case this adult male challenger would have beaten a hasty retreat after sustaining numerous, nasty injuries, and would have been forever on banned from the pride or pack, destined to live in obscurity in the shadows.

Since we are human, my mother has decided that casting him out as a service provider will have to do. (Heaven help his replacement, but that’s another story!) As I read this to my husband, I discovered my mother keeps secrets. Apparently, she made him promise that, upon her death, he would deliver a scathing letter to the dentist, admonishing him for his poorly chosen words, and telling him off from beyond the grave. I am sure that somewhere right now, mid-life psychotherapist readers are discussing passive-aggressive personality traits over hot wings and beer. That’s okay. For now, just get back to me 20 or 30 years down the line when this happens to you. Until then, remember that the Golden Rule applies to people of all ages, even those in their Golden Years. Now go call your mothers!

Dr. ReemaAbout the author: Dr. Reema Sayegh has a Ph.D. in Holistic Nutrition and Doctor of Naturopathy degree, and has enjoyed an extensive career in the integrative wellness field. In 2004, Dr. Reema rescued a nine-year-old Great Dane mix named Zeus, who inspired her to “shift gears.” She has since become a Reiki master teacher, published author, public speaker, animal welfare advocate, and currently works as a certified holistic pet consultant, working in tandem with veterinarians and their clients to provide companion animals with adjunct natural wellness modalities, and specialty geriatric and hospice care. Dr. Reema lives in southern California with her husband and the love of their lives, a spirited canine teacher, healer, and fun-loving goofball named Dakota. To reach Dr. Reema, you may email her at drreema4pets@yahoo.com.