Excerpt: 'Treat Me, Not My Age'

Sept. 20, 2010 — -- In 'Treat Me, Not My Age: A Doctor's Guide to Getting the Best Care as You or a Loved One Gets Older,' author Dr. Mark Lachs explains how people who are 40 and over can navigate their way through the health care system and ensure they -- or loved ones -- get the best care.

Lachs is a geriatrician. His subspeciality is treating the issues affecting the elderly.

Read an excerpt from the book below and head to the "GMA" Library to find more good reads.

My mother-in-law remains crestfallen.

Although I graduated from medical school nearly twenty-five years ago, she still believes that her daughter endured my 110-hour workweek and meager intern compensation only to end up married to a social worker (a badge I wear proudly, by the way). To her way of thinking, the family should have gotten a surgeon or at least a cardiologist. She hasn't actually said it, but deep down I've always had this sinking suspicion that she believes I could have been a contender.

The questions usually surface at the end of Thanksgiving dinner:

"You have an office, right?"

"Do you use a stethoscope?"

"Can you prescribe medicine, or is that only the doctors who operate?"

"You're a real doctor, right? Not like a PhD. I'm only asking because one of the ladies I play canasta with wanted to know."

Since I'm well versed in reassuring her, permit me to do it again here; it lays the groundwork nicely for the crash course I'm about to give you, in the next chapter, about what we know about human longevity, the biology of aging, and how you can use that knowledge to your advantage.

I am a geriatrician -- a physician who provides care to older people and support to their families in the same way that a pediatrician serves children and their families. But I'm also an internist -- a physician who completed three years of internal-medicine training after medical school -- studying the complex inner workings of the body and the nonsurgical treatment of diseases many adults acquire over the course of a lifetime (for example, high blood pressure, diabetes, arthritis). After completing training in internal medicine (our specialty), most practitioners of geriatrics (our subspecialty) spend an additional year or two learning our craft, as other internal-medicine graduates might select additional training in one of the other subspecialties of internal medicine that you're probably more familiar with, such as cardiology, gastroenterology, endocrinology, or oncology. The training content of geriatric medicine is vastly different from that of any of those subspecialties (and altogether different from training in any other area of medicine, really).

A gerontologist is generally someone who does research in the area of aging. But because aging can be defined broadly, there are researchers from a wide range of fi elds -- economics, biology, housing, transportation, psychology -- who call themselves gerontologists. Some gerontologists aren't physicians but provide direct clinical service exclusively to older people (such as a psychologist who might choose to work with older people exclusively).

Invariably, after I give my geriatrician-versus-gerontologist spiel and folks understand that I'm a "real" doctor, they ask a series of predictable questions. "How old do I have to be to see you?" or "How old is geriatric?" usually comes first. This is, in fact, the central metaphysical question in geriatrics, and since metaphysics contends that the universe is relative, I'll provide a relative answer: It depends.

Let me explain. Needing a geriatrician is partially about age but mostly about function. In my practice I have ninety-year-olds who are going to work on a daily basis, and providing care for them is very much like doctoring a fifty-year-old. But visit just about any nursing home in America and you'll find fifty- and sixty-year-olds who have been rendered impaired by diseases like multiple sclerosis or stroke, and caring for them is very similar to caring for frail ninety-year-olds. So there's really no age at which you become geriatric. If you're young or old and have many chronic diseases and functional problems, geriatricians are probably for you, but we're also delighted to see older patients who are doing well and are trying to avoid frailty. As one of my patients in her early sixties likes to say, "How old is geriatric? The older I get, the older it gets!"

Another question I'm frequently asked is whether I'm a primary care physician (like the doctor you see for your annual physical or when you have a cold) or a consultant (like the doc you see for a one- or two-shot deal when you have a specific problem, like an orthopedist for a broken bone or a bad shoulder). Answer: both. Most geriatricians provide primary care to older adults and see them annually or more frequently as the need arises, but we're also called on by patients, families, and other doctors to help with specific problems and questions like the following:

Is my memory loss normal for my age?

Am I taking too many medicines?

Why is my mom falling?

Is my hospitalized patient confused from medications, or is it another problem?

Can Dad really live alone safely without help, or am I just being overprotective?

And finally, while we're dispensing with questions I'm most frequently asked, let me also deal with the ever-present, morbid end-of-life question: "Doc, it must be tough dealing with only dying patients. How do you do it?"

Well, first of all, the only people I know who are not dying, at whatever speed, are already dead.

Do I deal with end-of-life issues in my practice? Sure. But I prefer to frame it another way: While I certainly have expertise in hospice and palliative care, I am much more interested in how people live during the last years of their life on this planet, however long or short those years are. I have absolutely no interest in extending life expectancy to the extent that people are living and breathing but unable to do the things that mean the most to them. Those nursing homes with a smattering of prematurely disabled fifty-year-olds that I just told you about? Far more common are tenants aged eighty, ninety, and beyond, who have very limited quality of life. I would argue that the "life extension" these people have experienced -- a good deal of it a result of technology -- is as big a failure of medicine as any forty-year-old dying of breast cancer or fifty-year-old perishing from a heart attack.

As the Talmudic scholar Ben Azai said, "every man has his time." So for me, the question is not if or even when but, really, "how." My goal for patients is that when they leave the planet (believe it or not, not optional, a truth that has been lost on many Americans -- see chapter 19), they do so enjoying the things they love most -- family, golf, painting, theater, sex -- ideally up until the very last minute possible.

Reprinted by arrangement with Viking, a member of Penguin Group (USA) Inc., from TREAT ME, NOT MY AGE Copyright © Mark Lachs, M.D. , 2010.