During a recent pre-appointment check-in, after being weighed and having my blood pressure measured, I was startled to be asked: Do you know why you’re here?
It took me a beat to realize that this wasn’t an existential question, nor was I being asked to expound on my life philosophy. Rather, this was a cognitive pop quiz, part of the protocol used on folks of a certain age. Of course, it’s important to determine if a patient is showing signs of dementia. Alzheimer’s is a global epidemic, with women accounting for two-thirds of the cases. (My three siblings and I have an extra reason to be concerned — our beautiful and brilliant mother was stricken with early onset Alzheimer’s. While there can be a genetic predisposition for the dreaded illness, environmental factors also may play a role. I’ve always wondered if the chemicals our mother was exposed to while growing up in a coal mining town doomed her.)
I don’t blame the kind nurse who asked the question — she was just reciting the script given to her. I do blame the person who wrote that script. A more courteous but equally effective inquiry could be: What issues do you want to discuss with the doctor today? A patient’s response would quickly establish if any cognitive issues needed to be addressed.
Are you still sexually active?
After a 30-something doctor posed this question I very much wanted to reply: “Are you asking if I have date nights with my husband, or if I’m hooking up with randos I meet at early bird specials?”
It was the word “still” that irked, because it suggested there is an expiration date on physical intimacy. As reported in AARP Magazine: “If you think sex is the province of the young, you’re wrong.”
A survey conducted by the University of Michigan and AARP found that nearly three-quarters of seniors between the ages of 65 and 80 have a romantic partner and 54% of those couples are sexually active.
A better question could be: Are there any concerns about intimacy or sexuality that you’d like to discuss today?
What kind of work did you used to do?
The specialist looked to be the age of my son, which meant I probably was his mother’s age. This may have prompted him to ask the question, after giving my chart a cursory glance.
I politely informed him that I still work. He looked surprised and asked what I do. I told him about my current writing project, and he responded, “Cool.” I’ll confess to being jazzed to go from washed up to cool in under two minutes. But it was annoying that he seemed surprised that people with a lot of candles on their birthday cakes can be productive. Shouldn’t that lesson have been imparted in medical school?
A more thoughtful query could be: What activities are you involved with these days?
The most flippant question was said to my late mother-in-law, a caring and loving wife, mother and grandmother, as well as a talented artist. When she was in her early 80s, she began to experience severe gastrointestinal issues. She went to a string of doctors, who mostly suggested dietary changes. I accompanied her to one appointment. After she described her worsening symptoms, the gastroenterologist rolled his eyes and said, “What do you expect?” His message was clear — she was old and that’s why she felt so sick. Aghast, I blurted out: “Couldn’t these symptoms be signs of ovarian cancer?” Further lab work and scans, followed by exploratory surgery, confirmed widespread cancer.
While my mother-in-law experienced a cruel combination of sexism and ageism, women of all ages with ovarian cancer frequently are dismissed. When I interviewed her for a book on bias in medical care, Dr. Barbara Goff, a professor in the division of oncology and gynecology and chair of obstetrics and gynecology at the University of Washington, refuted the long-standing view that ovarian cancer is a silent killer. She explained that certain patterns of symptoms (such as difficulty eating, bloating and pelvic pain) are very common in women with ovarian cancer: “Physicians often blow these symptoms off … We surveyed 1,700 women and found that a third of those women were given a prescription medication for another condition before being diagnosed with ovarian cancer.”
A disrespectful question like “What do you expect?,” and other ageist questions, have no place in compassionate health care, no matter the age of the patient.
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