Q: The next step you talk about in your book is the hospital.
A: One of the big perils in the hospital is technology, which is also its great virtue. Technology can improve quality of life and be life-extending. But, sometimes, it creates endless complications.
An example are imaging tests such as CT scans. Physicians hardly think of this as an invasive test. But often one has to administer a dye to see what's going on. That dye can cause kidney failure in someone with impaired kidney function -- something that's common in older adults.
Sometimes there's no real need for scans. An example would be an older person who becomes acutely confused in the hospital, which happens a lot. The appropriate response is to look at what's causing the confusion and take away the offending agent. Often, that's a medication that was started in the hospital. Or, it's an infection. But the routine knee-jerk reaction is to do a CT scan to rule out the possibility of a stroke or bleeding in the brain.
For the most part, doctors want to do whatever it takes to diagnose a problem. For younger patients, this may make sense. But for frail older patients with multiple medical conditions, a cascade of complications can result.
Q: What do you advise older patients and their families do?
A: When a test is proposed, ask the doctor "how important is it to pursue this diagnosis" and "how will the results change what you do?"
It's also reasonable to say something along the lines of "every time I've had a test, it seems like I get into some kind of trouble. So, I really want to know, with this test or this treatment, what kind of trouble could I get into?"
Q: In your book, you talk about how a doctor-patient relationship can be sidelined when someone goes to the hospital. Instead, hospitalists provide care. How should people respond?
A: It's really important to give that doctor a sense of the patient and who they are. Say, your 88-year-old mother is in the hospital, and she's become profoundly confused. The doctor doesn't know what she was like a week or a month ago. He may assume she has dementia unless he hears otherwise. He won't understand it might be delirium.