Ageism in health care is more common than you might think, and it can harm people

Ashley Milne-Tyte

npr.org

Originally posted 7 March 24

A recent study found that older people spend an average of 21 days a year on medical appointments. Kathleen Hayes can believe it.

Hayes lives in Chicago and has spent a lot of time lately taking her parents, who are both in their 80s, to doctor's appointments. Her dad has Parkinson's, and her mom has had a difficult recovery from a bad bout of Covid-19. As she's sat in, Hayes has noticed some health care workers talk to her parents at top volume, to the point, she says, "that my father said to one, 'I'm not deaf, you don't have to yell.'"

In addition, while some doctors and nurses address her parents directly, others keep looking at Hayes herself.

"Their gaze is on me so long that it starts to feel like we're talking around my parents," says Hayes, who lives a few hours north of her parents. "I've had to emphasize, 'I don't want to speak for my mother. Please ask my mother that question.'"

Researchers and geriatricians say that instances like these constitute ageism – discrimination based on a person's age – and it is surprisingly common in health care settings. It can lead to both overtreatment and undertreatment of older adults, says Dr. Louise Aronson, a geriatrician and professor of geriatrics at the University of California, San Francisco.

"We all see older people differently. Ageism is a cross-cultural reality," Aronson says.

The info is here.

Here is my summary:

This article and other research point to a concerning prevalence of ageism in healthcare settings. This bias can take the form of either overtreatment or undertreatment of older adults.

Negative stereotypes: Doctors may hold assumptions about older adults being less willing or able to handle aggressive treatments, leading to missed opportunities for care.

Communication issues: Sometimes healthcare providers speak to adult children instead of the older person themselves, disregarding their autonomy.

These biases are linked to poorer health outcomes and can even shorten lifespans.  The article cites a study suggesting that ageism costs the healthcare system billions of dollars annually.  There are positive steps that can be taken, such as anti-bias training for healthcare workers.

Many Americans receive too much health care. That may finally be changing

Elsa Pearson Sites

StatNews.com

Originally published 8 Nov 23

The opioid crisis rocked America, bringing addiction and overdose into the spotlight. But it also highlighted the overtreatment of pain: Medical and dental providers alike overprescribed opioids after procedures and for chronic conditions. Out of that overtreatment came an epidemic.

In American health care, overtreatment is common. Recently though, there has been a subtle shift in the opposite direction. It’s possible that “less is more” is catching on.

For many Americans, it can be challenging to even access care: Treatment is expensive, insurance is confusing, and there aren’t enough providers. But ironically, we often use too much care, too.

Now, some providers are asking what the line between necessary and unnecessary really is. The results are encouraging, suggesting that, in some cases, it may be possible to achieve the same health outcomes with less treatment — and fewer side effects, too.

This shift is particularly noticeable in cancer care.

The info is here.

Here is my take:

The article delves into the pervasive issue of overtreatment and overdiagnosis in the healthcare system. It highlights the unintended consequences of modern medical practices, where patients are often subjected to unnecessary tests, procedures, and treatments that may not necessarily improve their health outcomes. The article emphasizes how overtreatment can lead to adverse effects, both physically and financially, for patients, while overdiagnosis can result in the unnecessary burden of managing conditions that may never cause harm. The piece discusses the challenges in striking a balance between providing thorough medical care and avoiding unnecessary interventions, urging a shift toward a more patient-centered and evidence-based approach to reduce harm and improve the overall quality of healthcare.

The author suggests that addressing the issue of overtreatment and overdiagnosis requires a comprehensive reevaluation of medical practices, incorporating shared decision-making between healthcare providers and patients. The article underscores the importance of fostering a healthcare culture that prioritizes the avoidance of unnecessary interventions and aligns treatments with patients' preferences and values. By acknowledging and addressing the challenges associated with overmedicalization, the article advocates for a more thoughtful and personalized approach to healthcare delivery that considers the potential harm of unnecessary treatments and strives to enhance the overall well-being of patients.

Panel Urges Overhauling Health Care at End of Life

By Pam Belluck
The New York Times
Originally posted on September 17, 2014

The country’s system for handling end-of-life care is largely broken and should be overhauled at almost every level, a national panel concluded in a report released on Wednesday.

The 21-member nonpartisan committee, appointed by the Institute of Medicine, the independent research arm of the National Academy of Sciences, called for sweeping change.

“The bottom line is the health care system is poorly designed to meet the needs of patients near the end of life,” said David M. Walker, a Republican and a former United States comptroller general, who was a chairman of the panel. “The current system is geared towards doing more, more, more, and that system by definition is not necessarily consistent with what patients want, and is also more costly.”

The entire article is here.

Overtreatment as Myth

New York Times Letter to the Editor
Originally published September 3, 2012

To the Editor:

Re “Overtreatment Is Taking a Harmful Toll” (Well, Aug. 28): Undertreatment could be a much bigger problem than overtreatment. Studies by the RAND Institute, published in The New England Journal of Medicine, have found significant underuse of preventive testing and treatment for cervical, breast and colorectal cancer, as well as for H.I.V., heart disease and diabetes. RAND concluded that, on average, Americans receive only 55 percent of recommended preventive care and that underuse of such care was a bigger problem than overuse.

Alan Mertz

Washington

The writer is president, American Clinical Laboratory Association.

♦

To the Editor:

The overwhelming medical care in this country is actually appropriate. By emphasizing the bad experiences of a few, this article may end up suggesting to people that they should not trust their doctors.

Defensive medicine is sometimes practiced for fear of malpractice suits, but this should not be confused with the honest effort of the overwhelming majority of physicians to give their patients the best care possible.

Barry E. Rosenbloom, M.D.

Beverly Hills, Calif.

Overtreatment Is Taking a Harmful Toll

By Tara Parker-Pope
The New York Times - The Well Column
Originally published August 27, 2012

When it comes to medical care, many patients and doctors believe more is better.

But an epidemic of overtreatment — too many scans, too many blood tests, too many procedures — is costing the nation’s health care system at least $210 billion a year, according to the Institute of Medicine, and taking a human toll in pain, emotional suffering, severe complications and even death.

“What people are not realizing is that sometimes the test poses harm,” said Shannon Brownlee, acting director of the health policy program at the New America Foundation and the author of “Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer.”

“Sometimes the test leads you down a path, a therapeutic cascade, where you start to tumble downstream to more and more testing, and more and more invasive testing, and possibly even treatment for things that should be left well enough alone.”

The entire article is here.