While addressing better care through mandated box-ticking may have some merit, tying this to higher compensation leads to unintended work-arounds, such as copying and pasting or carrying forward notes from previous encounters rather than taking the time to connect with and talk to the patient.
The current system compensates computer and box-ticking efficiency (efficiency is necessary because of the need to see more patients in an allotted time and to tick enough boxes) rather than compensating the physician and hospital for taking adequate time to listen, talk, examine, and, most important, have an empathetic conversation about the synthesis, diagnostic considerations, and plan of treatment.
Dr. Karl Kuban
The writer is a professor of pediatrics and neurology at Boston University Medical Center.
Clinicians are just as frustrated to have to type away during visits
In response to Rachelle G. Cohen’s opinion piece (“Ageism in health care? Yep, it’s a thing.”), I must cry foul. While I appreciate what she is saying, which describes any experience in any ER in the Boston area, I have to inform Cohen that every “computer-generated list of insufferable questions” is the last thing any nurse (or doctor or social worker) wants to be asking. These are all derived from requirements generated by the Joint Commission in conjunction with the federal Centers for Medicare and Medicaid Services and the Department of Health and Human Services.
Very few of those questions are ones that your nurse, be it in the emergency department, a medical surgical unit, or an ICU, wants to be asking or feels is particularly helpful to do his or her job. We would love to stick with “a little common sense and a healthy dose of respect.” However, we are prevented from doing so by computer programs intended to cover all the bases that are required by some government agency and, in some cases, by computer programs that are built in billing systems.
As we “type feverously” into our computers, we are just trying to fill in all those little boxes in as little time as possible, in order to actually provide the care each patient needs and deserves.
I am glad Cohen didn’t suffer lasting damage from her fall. I, too, wear Big Girl shoes and certainly empathize with the predicament in which she found herself.
Linda C. Barton
The writer is a nurse.
Age is a key determinant, but a poor proxy, for one’s health
As emergency physicians with specialization in geriatric emergency medicine, we are sorry that Rachelle G. Cohen felt reduced to her age when she came to the hospital after suffering a fall. An excessive focus on her age, as opposed to her overall good health, may have led to unnecessary evaluations. But it is important to note that in older people, falls are a leading cause of injury-related deaths, and they often signal the presence of serious medical conditions. Falls also double the risk of future falls, which is why the staff tried to address issues beyond Cohen’s injury.
We recognize, however, that age is a poor proxy for the state of a person’s health. We need better means of predicting which patients need interventions to prevent recurrent, potentially devastating falls. Researchers nationwide are working on new screening tools. In the meantime, care for older adults should consider each person individually, and should never be ageist or paternalistic.
Dr. Maura Kennedy
Dr. Shan Liu
Dr. Kalpana Shankar
The writers practice in Mass General Brigham emergency departments.
By asking patients questions, they often found serious concerns
I am a 70-year-old recently retired nurse. My husband is a 75-year-old internist and nephrologist who retired 10 months ago. Older Americans are not all the the same. Many are infirm, unable to ambulate well, have painful chronic diseases, and live on limited incomes and in unsafe environments. Many patients we saw over the more than 40 years of our internal medicine practice were hesitant to discuss psychological and social issues and even some medical issues. It would often take us time and prodding to get a complete and pertinent history.
Rachelle G. Cohen may live in a different world and be an independent, self-sufficient, active older adult with little or no medical issues. But it is the responsibility of the medical and health care community to make sure we cover the bases when we see people in need of care.
When taking a good history and asking questions, we often find serious, even life-threatening illnesses or problems incidentally. Yes, medical care and training needs to become more targeted, efficient, and without bias and unnecessary intrusion. There is a lot to fix. But keep in mind that the last two and a half years have been mighty difficult for so many of us in health care. And there are so many mandated questions we must ask and so many boxes we have to check, whenever we have an encounter with a patient — you have no idea. All this while trying to keep everyone safe during a pandemic.
We cannot have a different standard of care for every person over 65. We need to ask the important questions that affect so many even if they don’t affect everyone.
I’m sure the overworked caregivers who treated Cohen that day were just trying to do their best.
Jennifer Leinsdorf Belok
May is Older Americans Month. Take note.
Rachelle G. Cohen’s opinion piece on ageism in health care had its critics, judging from the comments posted online, but there is no denying that in our culture, negative attitudes and stereotypes exist. We focus on the deficits and burdens of age and overlook the gift that the elderly are in the wisdom born of their life experience.
Perhaps during Older Americans Month in May, we can focus on our elders as people, respect their dignity, and let them enrich our lives in healthy intergenerational dialogue.
Sister Mark Louis Randall
Carmelite Sisters for the Aged and Infirm