Have you been diagnosed as "old"
The more conversations I have, the more aging individuals tell me that they are diagnosed as “old”. Now, doctors don’t say it like that. Rather, when the individual talks to their doctor about symptoms that concern them, the doctor may say something like:
“Well, this is common in older people.”
The problem is when that statement is the end of the conversation, because, understandably, the patient feels dismissed as being too old to treat.
Before I explain what patients can do to move beyond a diagnosis that “you’re old,” I have to explain some of the facts that I think doctors are weighing in that statement.
1. We have a higher risk of illness as we age. The longer we live, the more we suffer damage to our tissues and cells, and that can lead to disease. For this reason, illness and chronic conditions are more common in those who have achieved greater age.
2. There are higher treatment risks as we age. If a person has to go through surgery, anesthesia is more dangerous in older individuals; also recovery is often longer and more difficult than in middle-aged adults, for example. If instead a person is prescribed medication, there will be medication side-effects; importantly, since many older patients take multiple medications, there is increased risk of drug interactions. Sometimes there isn’t much point in treating, because there probably won’t be much benefit compared to the added risks and side-effects.
As much as the doctor speaks the truth when they say a condition is “common in older people”, and as much as the doctor is carefully evaluating the options, I think it is inappropriate for the doctor to end the conversation with that statement. If I were the patient that didn’t have the satisfaction of understanding the relative danger of my symptoms, and if I didn’t have the chance to discuss treatment options, I would start making my own assumptions: I would think that because of my age, my doctor thinks my concerns aren’t worth their time, and perhaps that I am not worth their time.
If you are diagnosed as “old”, it’s time to try opening the dialogue again. Here are the questions that I think will help the patient to get to the heart of the issue and to feel respected:
1. “I understand that these symptoms are more common with older age. What are the possible root causes? What is the most common cause, and what is the most dangerous cause?” Part of what’s unknown is how worried you should be about your condition. Often the most common causes pose no danger to the individual, which can offer some measure of peace; dangerous causes of symptoms are usually less common, but the doctor shouldn’t rule-out these dangerous causes because their probability is not zero. If the doctor seems ready to dismiss the cause of the symptoms based on limited risk, ask…
2. “What is the standard protocol for testing the cause of these symptoms?” This reminds the doctor to recall the textbook standard of care – to make sure you receive that care – to set aside judgements and assumptions. Before you agree to any testing, though, make sure you ask about the risks and benefits of any tests, and follow-up with…
3. “I know that there are often risks to treatment, especially in older patients. What are the risks and benefits of the treatment options for each possible diagnosis?” Asking this question will help you to determine if you are likely to accept treatment once you have a diagnosis. If you wouldn’t accept treatment, then it’s worth asking yourself if there is value in going through testing to get a diagnosis.
In the end, as a patient, I would want to have the chance at least to understand the doctor’s recommendations, and even better, to come to my own conclusions – even if I conclude the same as the doctor – because it would give me the dignity of understanding that my opinion matters, and that my wellbeing is being carefully considered. Were I simply told my illness is due to age, I would be denied that dignity.
If your doctor has explained that your illness is because you are old, and if you are looking for support to re-open the dialogue with your doctor, I would be honoured to be that support person. Please call – I am ready to give you the dignity of being heard, and will walk with you on your next steps forward.