It’s a well-known reality of health care economics that Americans spend a lot of money in the last year of life. I suppose that almost goes without saying, since serious illnesses and injuries that result in death are costly, at whatever age they occur. Being hit by a car and dying means you were hit by a car … in your last year of life. And that two weeks in ...

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In his post, "The geriatrician shortage: The problem isn’t what you think," I completely agree that the current gap in health care professionals’ skills to care well for our aging population is exceedingly complex, reaching well beyond lack of medical school training or funding.  Funding for graduate medical education needs to be transformed to match the workforce needs of the nation, with special attention to filling workforce ...

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I’ve read several articles recently reporting on a shortage of geriatricians. The writers have some clear misunderstandings of who actually cares for our elderly and where they come from. Susan Jaffe writing for Kaiser Health News stated that the American Geriatrics Society (AGS) estimates that the nation will require 30,000 geriatricians by 2030 to serve our aging population. This is probably true, what the AGS believes. She goes on ...

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It was a little game we played. My shoes squeaked quietly down the hallway of the nursing home as I approached her room.  I knocked gently trying to avoid any particular rhythm or dissonance. Go away! Her voice was at once stern, and then followed by peels of laughter.  She only saved such greetings for me.  And I tried to trip her up.  I varied my visits by time and pattern.  Sometimes I ...

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Dear patients, This is a hard letter to write, but it is important that you know about a major change that is coming for both of us in 2017, just a short year away. As you recall, last year I left a large hospital group practice and opened my own office, and I want to thank you for your faithfulness in following me to my new location.  With the newfound freedom of ...

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shutterstock_90932108 asco-logo I have written about the support that a partner/spouse provides to someone living with cancer -- with prostate cancer and for young adults with cancer -- and I always include the partner in discussions about treatment choice or sexual difficulties. But a number of my older patients are single, and their experiences ...

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I have previously written about a patient on this site: “How elderly patients can be stubborn to their own detriment.” In that post, I discussed how the patient repeatedly turned down appropriate therapy for her hypertension, saying she didn’t need the help.  Now I’m writing an update. Due to the patient’s refusal to accept treatment for her hypertension, despite counseling on the part of her cardiologist and primary care physician that ...

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Medication non-adherence is a hot button topic in health care. Physicians lament patient “non-compliance” with their medical advice, and policy wonks tell us that more than half of patients do not take their medications as directed. Missed opportunities to control chronic illnesses such as diabetes, heart disease, and cancer surely do cost us untold billions of dollars and millions of quality life years lost annually in the U.S. ...

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For years, and especially as he entered his nineties, my father kept begging me not to "dump" him into a nursing home. He had seen too many of his cronies abandoned in this way by family members; his visits with these friends left him feeling depressed and hopeless for days. I assured Dad that I'd never put him in a facility. It was an easy promise to make. I didn't want ...

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shutterstock_69679648 "There's no crying in baseball!" Over the years, my fellow surgery residents and I heard these words shouted countless times by Dr. Norris, a cantankerous elderly surgeon with whom we had the dubious pleasure of working. Dr. Norris was a former Navy ship surgeon. He didn't operate much anymore, but he fondly remembered the "good old days" when trainees spent days on end in ...

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