New York gerontologist Mark Lachs is disturbed by medical stereotyping, explaining that "treating patients based on their age means you can miss very significant, treatable conditions."
Researchers point to another form of ageism operating at a doctor's subconscious level, which some have dubbed left-digit bias. They say this ageism leads to decisions that can have life or death consequences for patients. Here’s the important story...
Dr. Lachs of the Weill Cornell Medical College is author of the book, Treat Me, Not My Age. He believes medical ageism starts early and in a very subtle way.
For instance, if you sustain an injury while playing baseball, the doctor might recommend you take up golf instead, sending a subliminal message to slow down rather than dealing with the patient's particular problem.
Or a doctor might steer a woman over 40 towards a hysterectomy without asking whether she wants more children.
This attitude is displayed more strongly further down the line, when your doctor suggests that your health problem is to be expected “at your age,” without performing a complete evaluation that could reveal a treatable underlying cause.
Every Patient is Different, Why Treat Them the Same?
Dr. Lachs says it's wrong to base medical treatment on a person's age, "and it becomes more absurd as patients get to be 70, 80 and 90, with great variations in their functional ability."A new study brought the problem of medical ageism and left-digit bias into clear view. For at least one medical condition, it showed a big difference between those whose left digit is an eight and those for whom it’s a seven.
The study, published in the New England Journal of Medicine in February, shows that doctors are widely subject to left-digit bias. Before turning to the research performed at Harvard, let’s better understand left-digit bias by considering this example from daily life.
Imagine yourself in the grocery store and comparing product prices. The price of many products ends in 99 cents, because we tend to round down to the left digit rather than round up. What’s more, $4.99 is perceived as four something and that seems cheaper than paying five dollars even though the actual difference in price is only one penny.
Every marketer knows people perceive things this way, and sets prices accordingly.
In the study, Harvard researchers compared the treatment of heart attack patients just before and after their 80th birthday.
They found seven percent of those aged 79 received bypass surgery compared to only 5.3 percent of patients who had just turned 80. Being just a few weeks younger led to a 25% greater likelihood of being offered this form of surgery.
Medical Left-Digit Bias Appears to Cost Lives
Not being offered a bypass in the study had an impact on death rates. The 79-year-olds who underwent surgery had a 30-day mortality rate of 17.7 percent. For 80-year-olds not offered a bypass, mortality rose to 19.8 percent. That’s pretty surprising when you consider the surgery itself is a big risk.The researchers looked at bypass surgery performed just before and after ages 77, 78, 79, 81, 82 and 83 but found nothing similar. Crossing the 80-years-old threshold made the difference.
Dr. Anupam Jena, who led the research, said "doctors view these 79-year-old patients as being 'in their 70s' and 80 year old patients as being 'in their 80s'...they get categorized into being 'young' or 'old' by the treating doctor."
Dr. John Spertus, director of health outcomes research at Saint Luke’s Mid America Heart Institute in Kansas City, said "these types of cognitive biases are rampant in medical decision-making and this is a very clear demonstration of the phenomenon."
Three years ago another study found that if you arrived at the emergency department just after reaching 40, you were ten percent more likely to be tested for heart disease and 20 percent more likely to be diagnosed with heart disease than if you were a few weeks shy of 40.
My Take on All This
Now, I don’t want to say that the decisions these doctors are taking are unreasonable per se. For example, a person over 40 IS more likely to have signs of heart disease than someone younger. Many middle-aged people SHOULD stop running or playing basketball and switch to a lower-impact sport like golf.Our bodies do age. 70 is not the same as 40. BUT…some 70-year-olds are in great shape, and some 45-year-olds already have a foot in the grave, usually because of bad lifestyle choices.
The point is that people age at different rates, and doctors should evaluate each patient individually, not according to a number on the calendar.
And that, I can tell you, is something conventional doctors seldom do. We exist in an era of cookie-cutter, assembly line medicine, when doctors are paid on how many patients they process, how fast.
They try to figure out what your “indication” (i.e. symptom or condition) is, then give you “the” drug or other procedure for your “indication.” Ten minutes tops and then they’re out the door.
Most doctors don’t want to fool around with a medical condition that is difficult, maybe hard to diagnose, maybe has multiple causes, maybe is hard to treat. Usually the prescription is meant to relieve a symptom, not to get at the root cause.
How to Protect Yourself From Medical Bias
Dr. Jena said patients and their families need to be aware that age bias exists and influences doctors’ decision making. However, he didn't make any recommendations for how patients should approach a doctor they've never met before with any concerns about ageism.On the other hand, Dr. Lachs believes "too many patients simply submit. You need to articulate your concerns," he says.
He believes that with your regular doctor the relationship should be a partnership. He advises people to really engage and not be reverential, because "we physicians are human beings. We're God's children, and we make mistakes."
He also suggests having a game plan. Outline your goals before your visit and then communicate them to the doctor so that expectations are created at the beginning of the consultation.
I’ve got a game plan of my own. I inform myself about health issues, and my first line of defense is alternative doctors (or integrative M.D.’s) instead of conventional M.D.’s. Another buzzword meaning much the same thing as integrative is “functional M.D.”
This is not to say I never resort to conventional treatments. I often do. To be blunt, alternative medicine is not miracle medicine, much as some of its advocates would like to think it is.
But if I look at or try alternatives first, I often find a solution. And if I don’t find a solution, then I’ve got my integrative M.D. to serve as a check on the cookie-cutter guys and keep them from going wild with my health.
- https://www.nejm.org/doi/full/10.1056/NEJMc1911289?url_ver=Z39.88-
2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed - https://uk.reuters.com/article/us-health-decisionmaking-cabg-age/turning-80-lowers-
odds-heart-attack-patients-will-get-bypass-surgery-idUKKBN20D2TY - https://www.aarp.org/entertainment/books/info-11-2010/author_speaks_ageism_in_
medicine.html
